Cervical spine movements are complex and result of individual vertebral motion. There are six movements possible in the normal range of motion of the cervical spine. These are
Flexion
A movement by which chin attempts to touch the chest.
Extension
A movement in the opposite direction of flexion
Lateral Flexion
This movement allows you to tilt your neck as if touch ear to your shoulder. The movement is equal on both sides.
Rotation
Rotation is the movement which we use to look over our shoulder or look back. The movement is equal on either side.
The normal cervical range of motion is
- Flexion – 80 to 90 degrees
- Extension – 70 degrees
- Lateral flexion – 20 to 45 degrees on both sides
- Rotation – 90° of rotation to both sides.
In normal daily use, the movements are hardly uniplanar as outlined above.
Normal Kinematics of the Upper Cervical Spine
Both flexion and extension movements are reported to be initiated is also initiated in the lower cervical spine.
The first cervical vertebra, the atlas, articulates with the occipital condyles, and its primary motions are flexion and extension.
Normal flexion to hyperextension at the atlanto-occipital joint range is 15 to 20 degrees. Rest is contributed by lower vertebrae.
Rotation and lateral flexion between the occiput and atlas are not possible due to the depth of the atlantal sockets. These movements occur on atlantoaxial joint [C1-C2].
The C1-C2 motion segment accounts for 50% of the rotation in the cervical spine.
The normal ranges of rotation of C1 on C2 are reported to be 50° to each side. Rotation of the atlas on the axis does not occur without a small degree of extension and lateral flexion and sometimes flexion.
Cervical spine flexion and extension often create motion in the direction opposite that being experienced in the atlas. Thus, when the cervical spine is flexing, the atlas extends, and when the cervical spine extends, the atlas flexes.
The orientation of the cervical vertebral bodies of the mid to lower cervical column allows for rotation and flexion movements but is resistant to lateral flexion. Lateral flexion is possible in the cervical column but only due to coupled rotational movement in each segment to that side.
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Habib A. Ellahi - Pakistan - Punjab says
July 20, 2015 at 7:04 pmHi Dr Arun
my name is Habib from Pakistan punjab my father diaganose Cervical bone Tb pain in neck, and start taking anti tb med from 18 june plus about 16 injection of steptomycine as well and stopped
had second bypass in 2014, diabatic paitent as well.
pain in neck and weakness as well after taking above medicin after 15 days he is not able to stand by him self
imbalance need support to walk dr gave serc 24 mg medicine twice a day for the same
is it due to above injections or anyother problem please advise your valuable openion.
as long as he is sitting or lying on bed he is talking like fit man.
Awaiting
Thanks
Arun Pal Singh says
July 22, 2015 at 9:31 amHabib,
In TB of cervical spine, the prime concern apart from the disease itself is neurological deficit which may be manifested as weakness of legs and arms. In your father’s case, your writing suggests he has neurological deficit. In such cases, the patient is advised bed rest along with medicine and observed for response.
Most of people get better this way. Some people do not improve and may require surgery. Spine is not subjected to loads when person is lying. That is why he gets better when in lying position.
You might want to consult with your treating doctor for advise on treatment.
Take care.
Ian Bonwick says
August 25, 2015 at 11:09 pmHi Dr Arun
Above you state the normal ranges of cervical motion. Could you possibly suggest a book or journal that contains this information. I am in need of a source for my dissertation.
Thank you
Ian
Arun Pal Singh says
September 7, 2015 at 6:56 amIan,
There are many books. You can have a look simply by doing search for the term in Google and instead of web, choose books from the interface.
Martin Ryan says
March 16, 2016 at 5:57 amFused from my c4 to T3 how much range of motion will I get back ??
Dr Arun Pal Singh says
March 27, 2016 at 10:15 pmBy all means this is is very gross estimate, because I wanted to answer your question. That is lot of fusion going on. What for?
If so much is fused, you can have
Flexion – 20 30 degrees
Extension – 20-30 degrees
Lateral flexion and rotation >50 degrees.
Basically you would have C1, C2, and C3 mobile vertebrae only in the neck. Loss of movements contributed by lower vertebrae would be substantial.
Take care.
Frey Faust says
October 8, 2016 at 11:42 amDear Dr Arun, above you write that the lower cervical spine allows for rotation. I was under the impression that rotation is limited to C1-2. I Have understood that lateral flexion is actually a process of extension and rotation in the lower C spine. Is this correct?
Dr Arun Pal Singh says
October 18, 2016 at 12:07 pmFrey Faust,
C1-C2 motion segment accounts for 50% of the rotation in the cervical spine. Rest is contributed by lower segements. You can check C1 C2 motion by carrying out rotation in extreme flexion of neck. The range of motion for rotation would reduce.
Phyllis Sochrin says
November 12, 2016 at 7:13 pmHi Dr Arun,
I recently broke the dens on C2 and the neurosurgeon fused C1 and C2. How much lateral range of motion can I expect to get. Actually, I would also like to know about the range of motion for flexion and extension if possible.
Thank you
Dr Arun Pal Singh says
November 27, 2016 at 8:25 pmThe C1-C2 motion segment accounts for 50% of the rotation in the cervical spine. So you are expected to lose half of rotatory range. Flexion and extension would be affected to lesser degree.
But this is just speculation. Reality may be bit different.
Phyllis Sochrin says
December 3, 2016 at 3:57 amThank you. I had the surgery 9/9/16, was in the neck brace/collar for 7 weeks and am doing well except for limited range of motion and discomfort – more aches rather than pain – toward the end of the day. I am adjusting to it and happy to be alive.
Mohammad Touhidul Islam says
July 13, 2017 at 9:25 pmHi Dr Arun,
I recently had the surgery on 6.6.2017 and Doctor fused occiput to C2 by following gallias fusion tactics with bone graft and wires and also Goel/Harms technique has been used. I can not move my neck right or left at all. I want to know is it possible in future to remove rod and get back some neck movement?
Dr Arun Pal Singh says
July 31, 2017 at 6:11 amgenerally speaking, hardware could be removed after fusion is over. For a particular query, you should ask your doctor about the expected loss of movements.
Take care.
Andy says
October 26, 2017 at 12:15 amHi .. I am supposed to have interior that Secta me spinal fusion on the C5 to 7 segments …I am concerned my doctor says that the 56 and seven is at the column area that I shouldn’t lose no range of motion is this true
Dr Arun Pal Singh says
October 26, 2017 at 1:15 pmAndy,
If c5, C6 and C7 are fused, you would lose motion between c5 and c6, and c6 & c7. That amounts to two motion segments.
I hope that helps. Take care
Chrissy Estremera says
October 26, 2017 at 3:37 pmHi I had c4 to t2 fused and a rod and screws implanted along with a spinal cord stimulator implanted in my cervical spinal for arm. I am 6 months post opt and just returned back to work. I sit at a desk for 8 hours and work on a computer and answer phones and constantly using my arms and hands and turning my head. I’m in a lot of pain since I have returned to work because of all the movement and continually for 8 hours with out breaks. No ergonomic set up. I have done pt for 8 weeks for muscle strengthening in my neck. My pain level has increased to the point that I’m barely sleeping and I can’t concentrate. Will this ever get better or do you have any suggestions? I’m desperate ?
Chrissy says
October 26, 2017 at 3:41 pmI forgot to mention above this is my 2 fusion because my first fusion failed and that was acdf c5c6c7 and that was in 2013. I was good for about 10 months and went back to the pain I started with. It took me 2 years to finally get another dr to realize that much wasn’t fused. My original surgeon just kept sending me to pain mgmt.
Dr Arun Pal Singh says
November 21, 2017 at 6:20 amChrissy,
If your work makes you worse, you need to change the intensity of the work or take a further break. Please discuss with your doctor and work on the cause reoval i.e. nature of the work.
Take care.
Mike Popitz says
October 23, 2018 at 4:52 pmWhat is the average comfortable range of motion for simultaneous upper cervical spine extension AND lower cervical spine flexion, aka Sniff Position? Please.
Dr Arun Pal Singh says
October 25, 2018 at 11:40 amI would not be able to answer that Mike. Maybe someone who studies kinematics in detail would be able to guide you on this. I apologize.