The forgotten prevertebral muscles: Longus Colli & Capitus

When it comes to rehabilitation post injury, most manual practitioners would agree that exercising a muscle which has developed restrictive scarring/fibrosis would be counterproductive as training these muscles would only result in emphasizing compensation patterns established by the nervous system.  A common example would be the multifidii musculature in cases of chronic or acute low back pain.  It is well documented that following injury the multifidii of the lower back become both fibrotic, and neurologically inhibited.  This inhibition leads to compensation by the ‘outer core’ muscles in an attempt to maintain segmental stability.  In said situation, it is common-place for many manual therapists to first remove the restrictive scarring with the use of treatment techniques such as Active Release, Myofascial Release, soft tissue massage, etc.  Treatments are then followed up by attempts to neurologically stimulate the muscle group and train it using specific exercises.

In the cervical spine however this concept is commonly overlooked.  This is especially apparent when considering two of the most ignored muscles in the body, the Longus Capitus and Colli.  These two muscles located in the prevertebral region of the cervical spine, are the second most commonly injured muscles in rear-end auto accidents resulting in Whiplash (the first being the Sternocleidomastoid).  In addition to their susceptibility to injury, the importance of these muscles for maintaining segmental stability of the cervical spine make them extremely important to assess and treat in almost all cases of neck pain.

Some practitioners who have a concept of this importance prescribe exercises in an attempt to retrain these groups following injuries.  An example can be found by following this link:

http://www.youtube.com/watch?v=ra5DuTOAD7s

However, treatment of these muscles is rare.  Therefore as mentioned above, training them will only serve to worsen compensation patterns and ultimately lead to chronic dysfunction.

The most likely cause for manual therapists not treating these structures is the fact that most probably feel that the muscles are not accessible by palpation…..which is FAR from the truth.  Palpation of these muscles must be approach with care due to their proximity to the large neurovascular bundle which includes the carotid artery, however with proper instruction, they are accessed rather easily.  This procedure cannot be safely described on paper….hands on instruction is needed and can be attained at the Functional Anatomic Palpation Systems SPINE Seminar.

Anatomy Review:

Longus Capitus:

            From:  basilar part of the occipital bone (anterior to the foramen magnum)

            To:  anterior tubercles of C3-C5 TVPs

            Innervation:  anterior rami of C1-C3 (cervical plexus)

            Action:  flexes head

Longus Coli:

            From:  anterior tubercle of C1 (atlas); bodies of C2-3 and transverse processes of C2-C6

            To:  bodies of C5-T3, transverse processes of C3-C5 vertebrae

            Innervation:  anterior rami of C2-C6 (cervical plexus)

            Action:  flexes neck with rotation to the opposite side if acting unilaterally

Travell and Simons Trigger Point Pain Referral: The active TrPs refer to the laryngeal region, anterior neck and sometimes into the mouth.

Trigger Point Signs and Symptoms: Can cause difficulty in swallowing (Dysphagia), choking, pain with talking, sore throat, hoarseness.