05 Nov Whiplash – How the deep neck muscles change with neck pain.
The deep cervical extensors (at the back of the spine) and flexors (at the front of the spine) control segmental movements in the cervical spine. When the neck is injured, particularly in whiplash, the balance of these muscles is disturbed.
Structural changes such as fatty tissue infiltration are found in the extensor muscles in whip-lash patients, however not in patients with neck pain of no known cause. A transformation of muscle fibre type has been observed, however, independent of neck pathology. These factors are attributed to:
- chronic nerve irritation or compression
- muscle weakness/tension and altered coordination (from pain or fear of movement),
- facet joint (spinal joints) trauma and
- involvement of the sympathetic nervous system (flight, fright , fight nervous system).
Superficial cervical extensors show increased activation and delayed relaxation after activity, however deep extensor muscles have displayed reduced activation and less activity in multidirectional isometric (where there is no movement of the body) contractions. Magnitude of pain and muscle activation seems to be related. Higher pain levels are associated with altered strength of the deep extensor muscles.
Other factors that may influence this type of neck pain include psychological distress, fear-avoidance behaviour, and general disuse.
Activation of the deep cervical extensors should be emphasized at selected spinal levels for the management of pain from whiplash.
From: Schomacher & Falla, Manual Therapy 18 (2013) pg 360-366.
We can teach you how to retrain the deep neck extensor muscles here at The Physio & Yoga Clinic.