There are many potemtial causes
for cervical somatic dysfunction
One consideration is posture imbalance.
Sometimes when we have imbalance between the
anterior, posterior, right and left neck muscles,
that could potentially cause increased
tightness and lead to an imbalance
causing cervical somatic
dysfunction of assymetry.
Traumatic cranial somatic dysfunctions could
also lead to cervical somatic dysfunction,
If we have a significant assymetry of the
cranium leading to assymetry at the occiput,
that could lead to somatic
dysfunctions of the neck
Some cervical traumas could cause
cranial somatic dysfunctions
Whiplash is example, if you have an
impending accident and you're driving,
you tighten up and so you take these muscles that are
shortened already and then you suddenly stretch them
And so this whiplash occurs and could
cause imbalance of the neck muscles,
could cause increased spasm and tightness
leading to cervical somatic dysfunctions
Certain chronic inflammatory conditions could
lead to cervical somatic dysfunctions.
Repetitive injuries such as taking a phone
and holding it against your shoulder,
or doing something repetitively with
your shoulders or your head and neck
could lead to somatic
dysfunctions of the neck.
Certain pathologies of your eyes, ears, nose and throat
could potentially cause cervical somatic dysfunctions
Your viscera, your vagus
nerve or cranial nerve X
can have visceral somatic reflexes up
to the C2-C3 upper cervical region
Your diaphragm C3-4 and 5
which is your phrenic nerve
could potentially have also reflexes
up to the mid cervical region
so irritations of the diaphragm, whether of the
pulmonary issue or direct issue with the diaphragm
that could potentially cause
problems with your mid-neck.
Your thoracic outlet at your
C7-T1 junction in the first rib,
if you have neck muscles there -
if you have muscle imbalance here,
if you have issues with your brachial plexus as it
comes out through that thoracic outlet to your fingers
could lead to cranial
and then problems with your sacrum and pelvis could also
contribute to cervical somatic dysfunctions because of the
connection between the sacrum, the dura up all
the way to C2 and 3 and then attaching to
the foramen magnum of your occiput.
Making the somatic dysfunction diagnosis at the OA
junction involves understanding how the anatomy,
the condyle sitting on the atlas causes the OA
junction and joint to move in this particular way.
So specifically, sidebending rotation at the OA
joint will always occur in opposite direction
A mnemonic you could remmeber, is
OA stands for "opposite always"
This occurs because of the
position of the condyles
and also because of the lateral
so whenever you sidebend the joint, it also pulls
it and rotates it in the opposite direction.
Here you have a patient and you find on palpation at
the OA junction that your fingers on the right side
does not advance as deep as
your fingers on the left side,
when you flex the neck , the sulci
become more symmetric.
What is your somatic
So here, our patient has a
shallow sulcus on the right,
meaning when I was putting my fingers in
that suboccipital space and pushing up,
the right side does
not advance as much.
So the shallow side is
usually your sidebent side.
If you imagine your skull is like a helmet and I bend my
helmet a little bit to the right and sidebend to the right,
you can see how I wouldn't be able
to get my fingers in that sulcus.
so you know that the sulcus is shallow on
the right so they'll always sidebend right
and since you know that the sidebending and rotation
are opposite, rotation's gonna be to the left.
Since the dysfnction became more even with
flexion, that is a freedom of motion,
so we're gonna name it as the "OA is
flexed, sidebent right and rotated left"
At the AA articulation, diagnosis
of this joint is purely rotation,
so when we diagnose this segment, what we
need to do is to really lock the segment out
and then rotate the head to
the right or to the left,
and the freedom of motion is the side
where the head rotates more towards
so it's gonna be either AA rotated
right, or AA rotated left.
So here's a practice question - in your patient
you find on passive range of motion testing,
that there's increased rotation to the right
compared to the left, so what is your diagnosis?
The AA is rotated right since there is freedom of motion
rotating the head more to the right compared to the left.
Cc3-C7, diagnosing this region
is similar to diagnosing
for any of the type II somatic dysfunction
of the thoracic and lumbar spine.
There's always gonna be a
and thus rotation and sidebending
are gonna be in the same direction.
There is no type I or neutral somatic
dysfunctions in the cervical spine.
So let's practice.
You find that at the level of C2 you
cannot translate from right to left
in a flexed position but in extension, it
becomes easier to translate the segment,
what is your diagnosis and what
is you rotational barrier?
So here we're utilizing
translation to motion test.
Typically, you could use rotation when you're
motion testing, or you could translation.
Translation occurs in the coronal plane and
so when we translate from right to left,
so if I'm pushing one segment from right to left,
that's gonna cause sidebending to that side,
so if I cannot translate from right to left, that
means that the barrier is right sidebending,
so that means the freedom
is left sidebending
and in this case, the segment
became easier in extension.
So the diagnosis is "C2, extended,
rotated sidebent at left"
cause I know sidebending was left, I
assumed that rotation is also left
because of the rotation and sidebending
is coupled to the same side.
So the rotational barrier is right rotation
so we name it for a left rotation freedom