Columna Cervical

4
5 extremities, or the body as a whole. For example, the swayback
Sacrococcygeal kyphosis
Fig. 8.1 Normal curvatures of the vertebral column. These curvatures
represent the normal resting posture of each region. (From Neumann DA:
Kinesiology of the musculoskeletal system: foundations for physical reha-
bilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.39.)
pensatory strategies that alter normal motion of the trunk, the
posture illustrated in Fig. 8.4C, is often associated with signif-
icant tightness of the lumbar extensor muscles and excessive
stretch (and potentially weakness) of the abdominal muscles.
This posture can increase shear forces on the intervertebral
discs and joints that interconnect the lumbar spine. Clini-
cians who treat people with back and neck pain often attempt
to correct faulty postures as a primary component of the reha-
bilitation process.!

Cervical
lordosis

Thoracic
kyphosis

Lumbar
lordosis

Sacrococcygeal
kyphosis

A B C
Fig. 8.2 Side view of the normal sagittal plane curvatures of the vertebral column. (A) Neutral position of the vertebral column during standing. (B) Ex-
tension of the vertebral column increases cervical and lumbar lordosis but decreases (straightens) thoracic kyphosis. (C) Flexion of the vertebral column
decreases cervical and lumbar lordosis but increases thoracic kyphosis. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.8.)
 GENERALIDADES
• La columna cervical nos permite posicionar la
cabeza en el espacio
• Está sumamente dotada de propioceptores que
informarán pequeñas perturbaciones de la
postura de cabeza-cuello
• Colabora en la orientación de la mirada hacia la
horizontal
• Colabora en la estabilidad de cabeza, siendo
responsable del desarrollo ontogénico normal del
ser humano.
 Rango de
Movimiento
180 CHAPTER 8 Structure and Function of the Vertebral Column

1
2
Line of Gravity
3
30–35! 4 Cervical lordosis Although highly variable, t
5 son with ideal posture pa
6

7
of the temporal bone, anter
1
slightly posterior to the hip
and ankle (Fig. 8.3). As ind
2
3
4 ity courses just to the conc
5 curvature. Consequently, i
6
7
torque that helps maintain
40!
8
Thoracic kyphosis curvature, allowing one to s
9 lar activation and minimal
10 tissues. These ideal biom
11
energy of maintaining post
12 Many persons exhibit po
1 tightness or weakness, tra
2 bution, disease, or heredit
45!
3
Lumbar lordosis observed abnormal or “faul
4
tures may significantly des
pensatory strategies that al
5 extremities, or the body as a
posture illustrated in Fig. 8
icant tightness of the lumb
Sacrococcygeal kyphosis
stretch (and potentially we
This posture can increase
Fig. 8.1 Normal curvatures of the vertebral column. These curvatures discs and joints that inter
represent the normal resting posture of each region. (From Neumann DA: cians who treat people with
Kinesiology of the musculoskeletal system: foundations for physical reha- to correct faulty postures a
bilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.39.) bilitation process.!
 CHAPTER 8 Structure and Function of the Vertebral Column 185

CHAPTER 8 Structure and Function of the Vertebral Column 185

Lateral view

Superior view Lateral view

Atlas (C1)
Superior view Axis (C2)
Inferior articular
Apophyseal joint
Atlas (C1) process (axis)
Transverse Atlas (C1) Axis (C2) (C1-C2)
foramen Inferior articular
Apophyseal joint
Pedicle of axis process (axis)
Transverse Atlas (C1) (C1-C2)
foramen Spinous process
Apophyseal
Pedicle ofjoint
axis (axis)
(C2-C3) Spinous process
Apophyseal joint (axis)
(C2-C3)
Articular pillar
Pedicle Articular pillar
C3 C4 C5 C5
Pedicle
C3 C4 C5 C5
Spinous
Anterior tubercle process
Spinous
Vertebral Anterior tubercle process
(C7)
Anterior Vertebral (C7)
tubercleAnterior canal
canal Posterior tubercle Costal facet
tubercle Posterior tubercle Costal
C6
C6
C7
C7 (on facet
transverse
Costal facet (on transverse
Costal facet process)
(full) process)
(full)
Posterior
Posterior T1
T1
tubercletubercle Lamina Transverse Pair
Lamina Transverse Pairofofpartial
partial
process
process costal
costaldemifacets
demifacets
Spinous
Spinous
process
process T2
T2
A A BB
Fig.(A)
Fig. 8.11 8.11 (A) Superior
Superior view ofview
theofseven
the seven cervical
cervical vertebrae.
vertebrae. (B) (B) Lateral
Lateral viewofofthe
view thecervical
cervical vertebral
vertebral column.
column.(From
(FromNeumann
NeumannDA:DA:
Kinesiology of the
Kinesiology of the
musculoskeletal
musculoskeletal system:system: foundations
foundations for physical
for physical ed ed
rehabilitation,
rehabilitation, 2, 2,
St St Louis,2010,
Louis, 2010,Mosby,
Mosby, Figs.
Figs. 9.14
9.14 and
and9.18.)
9.18.)

Cervical Vertebrae Atlas (C1)

 al movements articular surfaces enables slide or shifting movements
joints between which then can be converted into flexion and extension.
etween biome- Thus, any disruption between these articular surfaces may
ese joints and
ed to measure
ment. It is diffi-
Occipital Posterior atlanto-
se such value Vertebral artery bone occipital membrane Articular
capsule
as the position of AOJ
ontal positions,
ctures such as
Experimental
tical measure-
center of rota- Mastoid
avada et al., process Transverse
process of C1
nematic values Articular capsule
actual data is of AAJ

Ligamentum flavum
es two motion
and the other FIGURE 15.4 Posterior atlanto-occipital membrane.
 MOVIMIENTOS CERVICALES:
OSTEOKINEMÁTICA

• Flexión/ extensión
• Rotaciones
• Inclinaciones
C2-C3 a la unión C6-C7. Posee discos intervertebrales y apófisis unciformes qu
modifican los movimientos del segmento.

Figura 1. Columna cervical: segmento cervical superior ( ) e inferior ( ).

Comportamiento
Neuromecánico
de la columna
cervical

C0-C1-C2
182 CHAPTER 8 Structure and Function of the Vertebral Column

Inferior view
External occipital protruberance
Trapezius
Superior nuchal line

Semispinalis capitis Inferior nuchal line

Splenius capitis
Lambdoidal suture
Sternocleidomastoid
Medial nuchal line
Longissimus capitis

Digastric (posterior belly) Mastoid process

Obliquus capitis superior Foramen
magnum Occipital condyle
Rectus capitis posterior major
External acoustic
Rectus capitis posterior minor meatus
Rectus capitis lateralis
Styloid process
Stylohyoid
Rectus capitis anterior Mandibular fossa
Longus capitis Basilar part Carotid canal
(occipital bone)

Fig. 8.6 Inferior view of the skull. Distal muscular attachments are indicated in gray, proximal attachments in red. (From Neumann DA: Kinesiology of the
musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.3.)

Lateral view
Superior articular facet Superior articular process
Transverse process Superior costal demifacet
Costal facet Superior view
Spinous process
Intervertebral foramen
T6 Laminae
Apophyseal joint Transverse process
Intervertebral
 Reduca (Enfermería, Fisioterapia y Podol
Serie Biomecánica clínica. 3 (4): 45-64,
ISSN: 1989

a 2. Atlas: carillas articulares para los cóndilos del occipital (a); carillas para las masas late
xis (b) y carilla para la apófisis odontoides del axis (c).
 Craniocervical flexion

FL
45!-50! FLEXIÓN C0-C1
XI
5 Grados
ON

Ligamentum C3

E
FL
45 !- 50!
C2 nuchae
E
D
Interspinous
•SLI Los cóndilos occipitales ligament
se delizan hacia
Ligamentum
nuchae
C3
SLID
E
atrás y ruedan hacia delante en
Interspinous ligament relación a las masas laterales C4
S
C4 E
S LID
Anterior
External • Concha occipital se aleja del arco
longitudinal
External
auditory
C5 ID
E ligament C5 IDE
SL
auditory
LEXION FLEXION FLEXION SL FLEXION
meatus
meatus posterior del atlas
R O LL Styloid Compressed
ccipital bone process Atlas
R O LL
annulus fibrosus

E
C6
Styloid

ID
E
SLID Atlas
SL
anto- Occipital
Ligamentum bone T IL
T process
Capsule of

E
brane flavum apophyseal joint
C6

ID
psule
E
SLID

SL
Atlas Axis
Posterior atlanto- Ligamentum
C7 T IL
A occipital membrane B C T
flavum
and joint
Atlanto-occipital joint capsuleAtlanto-axial joint complex Intracervical region (C2-C7)

Atlas Axis
matics of craniocervical flexion. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut tissues
hin black arrows; slackened tissues are indicated by a wavy black arrow. (From Neumann DA: Kinesiology of the musculoskeletal system: C7
hysical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.46.)
A B C
Atlanto-occipital joint Atlanto-axial joint complex Intracervical region (C2-C

Fig. 8.23
onal 150 to 160 degrees Kinematics of craniocervical
of total horizontal plane flexion.
these joints allows (A) Atlanto-occipital
about joint.
45 degrees of rotation (B) Atlanto-axial joint. (C) Intracervical region (C2-C
in either
eyes,
aretheindicated
visual field approaches
by thin black360 degrees
arrows;direction
slackened and is mechanically
tissues coupled with
are indicated by avery slight
wavy black arrow. (From Neumann DA: Kinesiology o
g the trunk. amounts of lateral flexion secondary to the orientation of
foundations
-axial for physical
joint is responsible rehabilitation,
for about half of the ed joints
the facet 2, St(Fig.
Louis, 2010,
8.24B). Mosby, Fig. 9.46.)
The arthrokinematic move-
occurs in the craniocervical region. The verti- ments involved with rotation to the right are illustrated in
 CHAP TER 8 Structure and Function of the Vertebral Column 193

Craniocervical extension

80!
Extensión C0-C1
80!

SLIDE
10 Grados

SLIDE
C2
C2

E
SLID

E
N

Ant
C3

SLID
SI

erio
EN

IDE

r long
EXT

SL

Ant
C4
C3

O
itudinal li
EXTENSION

SI
ID
External acoustic

erio
SL
meatus EXTENSION C5

EN

E
LL Anterior capsule

gament
O

ID
Occipital bone of apophyseal

r long
R

EXT
joint

• Los cóndilos occipitales se deslizan

Atlanto-occipital

E
C6

SL
ID
Mastoid process membrane and
SLIDE as

SL
Atl
C4
joint capsule
T
TIL

hacia anterior y ruedan a posterior

itudinal li
C7

EXTENSION
Atlas

E
A B Axis C

ID
External acoustic

SL
Atlanto-occipital joint meatus
Atlanto-axial joint complex EXTENSION
Intracervical region (C2-C7) C5
Fig. 8.22 LL Anterior capsule

gament
Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut
O of apophyseal
Occipital bone
tissues are indicated by thin black arrows. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2,
• Concha occipital se dirige hacia el
R

St Louis, 2010, Mosby, Fig. 9.45.)

Atlanto-occipital joint

E
C6
arco
lt as posterior del atlas

ID
Mastoid process membrane and
SLIDE

SL
joint capsule A
T
TIL
degrees is pictured in Fig. 8.23. About 25% of the total sagit- Flexion and extension of the intracervical region (C2- C7
tal plane motion occurs through the combined motions of
Atlas C7) result in an arc of motion determined by the oblique
plane of the cervical facet joints. As described earlier, A xis
A
the atlanto-occipital and atlanto-axial joints; the remaining
motion occurs across the intracervical (C2-C7) region. B these
joints are oriented in a plane about 45 degrees between the C
The atlanto-occipital joints are well designed to produce horizontal and frontal planes. During extension, the inferior
flexion and extension because the convex occipital condyles facets of the superior vertebra slide posteriorly and inferi-
and corresponding concave facet surfaces of the atlas fit like orly—relative to the vertebra below it (see Fig. 8.22C). The
Atlanto-occipital joint
rockers on a rocking chair: The occipital condyles roll back- Atlanto-axial joint complex
mechanics of flexion are the reverse of the mechanics of Intracervical region (C2-C7)
ward during extension (see Fig. 8.22A) and forward during extension (Fig. 8.23C).!
flexion (Fig. 8.23A). In accordance with the arthrokinematic
Fig. 8.22 Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated an
Axial Rotation
rules described in Chapter 1, the roll and the slide occur in
opposite directions. Rotation of the head and neck in the horizontal plane is an
tissues are indicated by thin black arrows. (Fromimportant
Neumann
The atlanto-axial joint, although primarily designed for DA:toKinesiology
motion, integral ofshown
vision and hearing. As the inmusculoskeletal system: foundations for physical rehabilitation,
horizontal plane motion, allows about 10 degrees of extension
Fig. 8.24, the craniocervical region rotates about 90 degrees
St Louis, 2010, Mosby, Fig. 9.45.)
and 5 degrees of flexion (see Figs. 8.22B and 8.23B).
to each side, allowing nearly 180 degrees of rotational motion.
 Inclinación C0-C1
5 grados
i. Los cóndilos occipitales se
deslizan contralateral y
ruedan en sentido
ipsilateral
 Rotación C0-C1

Se considera Despreciable
Figura 2. Atlas: carillas articulares para los cóndilos del occipital (a); carillas para las masas laterales
del axis (b) y carilla para la apófisis odontoides del axis (c).

La segunda vértebra cervical es el Axis. En su porción anterior y craneal se

encuentra la apófisis denominada odontoides, que se articula con el arco anterior del
atlas formando la articulación atlanto-odontoidea. Las masas laterales poseen carillas
articulares craneales para el atlas (unión atlanto-axoidea) y caudales para la 3ª
vértebra cervical (Fig. 3).

Figura 3. Axis: carilla articular para el arco anterior del atlas (1) y carillas articulares para las masas
laterales del atlas (2).

Este segmento superior de la columna cervical está constituido por tres

articulaciones: occipito-atlantoidea, atlanto-axoidea y atlanto-odontoidea. La primera
de ellas, la unión Occipito-atlantoidea, es una articulación de tipo condílea (Fig. 4) que
es la responsable del mayor rango de movimiento en el plano sagital del segmento
 FLEXIÓN/EXTENSIÓN C1-C2

Flexión 5 grados Extensión 10 grados

 C1-C2
EL comportamiento del movimiento flexo-
extensión de cervical de C1 en C2, visto
desde en el plano sagital, es optimizado por
la superficie articular del diente
ROTACIÓN C1-C2
35 a 40 grados CHAPTER 8 Structure and Function of the Vertebral Column 195

• El Faceta inferior atlas contralateral se

desliza hacia anterior

• El Faceta inferior atlas ipsilateral se

desliza hacia posterior
Craniocervical axial rotation

80°
rotation

C2
SLIDE

Capsule of
apophyseal joint C3
SLIDE

Alar ligament
(taut) C4
Inferior facet Transverse ligament SLIDE
of atlas of atlas
Superior facet
IDE

Capsule of of axis C5
SLIDE
SL

apophyseal joint Dens

ROTATION
E
LID
 INCLINACIÓN C1-C2

Se considera Despreciable

*Se realiza únicamente en las art. C0-C1 y C3-C7

Comportamiento
Neuromecánico
de la columna
cervical

C3-C7
 Craniocervical extension

Extensión: C3-C7
80!
CHAPTER 8 Structure and Function of the Vertebral Column 193

SLIDE
Craniocervical extension
C2

E
SLID
N

Ant
C3

O
SI

erio
EN

IDE

r long
EXT

SL
C4

itudinal li
EXTENSION

E
ID
External acoustic

SL
meatus EXTENSION C5
LL Anterior capsule

gament
Occipital bone O of apophyseal
R

Atlanto-occipital joint

E
80! C6

ID
Mastoid process membrane and
SLIDE as

SL
joint capsule Atl
T
TIL

SLIDE
C7
Atlas C2 s
A B Axi C

E
SLID
N

Ant
C3
O
SI
Atlanto-occipital joint Atlanto-axial joint complex Intracervical region (C2-C7)

erio
EN

IDE
Fig. 8.22

r long
EXT

Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut

SL
C4
tissues are indicated by thin black arrows. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2,

itudinal li
EXTENSION

E
St Louis, 2010, Mosby, Fig. 9.45.)

ID
External acoustic

SL
meatus EXTENSION C5
LL Anterior capsule

gament
Occipital bone O of apophyseal
R

55-60º grados
Atlanto-occipital joint E
C6
ID

Mastoid process membrane and

SLIDE as
SL

A t l
joint capsule
T
TIL
C7
Atlas i s
A degrees is pictured B in Fig. 8.23. About A 25% of the total sagit-
x
C Flexion and extension of the intracervical region (C2-
tal plane motion occurs through the combined motions of C7) result in an arc of motion determined by the oblique
the atlanto-occipital
Atlanto-occipital joint
and atlanto-axial joints;
Atlanto-axial joint complex
the remaining plane of the cervical facet joints. As described earlier, these
Intracervical region (C2-C7)
motion occurs across the intracervical (C2-C7) region. joints are oriented in a plane about 45 degrees between the
Fig. 8.22 Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut
Flexión: C3-C7

35-40º grados
Flexion and Extension and the Effect on the Diameter of the Intervertebral Foramina

Agujero Foraminal en Flexión

Intervertebral foramina allow protected passage of spinal nerves
to and from the spinal cord. As the name implies, an interver-
tebral foramen is created by the approximation of two adjacent
vertebrae. Consequently, the motion or position of either verte-
bra can alter the shape and therefore the size of the foramen.
as tingling, numbness, muscle weakness, reduced reflexes, and
radiating pain.
Individuals with a narrowed intervertebral foramen or osteo-
phyte formation may develop a chronically flexed neck or “for-
ward head” posture in an attempt to alleviate pressure on the

Cervical
Flexion increases the diameter of the intervertebral foramen;
extension, in contrast, decreases it (Fig. 8.26). This has clinical
relevance in cases of a stenosed (narrowed) intervertebral fora-
men. For example, osteophyte formation within the interverte-
bral foramen may cause compression of a spinal nerve as it
passes through this space. This can result in symptoms such
spinal nerve roots. The flexed position of the lower cervical ver-
tebrae increases the space of the intervertebral foramen, allow-
ing the nerves to exit with less chance of impingement.
Treatment of cervical nerve root compression often includes
cervical traction with the neck in partial flexion to decompress
the irritated nerve root and reduce painful symptoms.

Neutral position Fully flexed

Inferior articular facet

C3-C4 apophyseal
joint

C3
C3

C4
C4

A B
Fig. 8.26 Comparison of the intervertebral foramen in a neutral position (A) and in a fully flexed position (B). Flexion significantly increases the space
within the intervertebral foramen, allowing greater room for passage of a spinal nerve root. (From Neumann DA: Kinesiology of the musculoskeletal
system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.50.)
 CHAPTER 8 Structure and Function of the Vertebral Column 195

Rotación: C3-C7
Craniocervical axial rotation

C2
SLIDE
80°
rotation
Capsule of
apophyseal joint C3
SLIDE

Alar ligament
(taut) C4
Inferior facet Transverse ligament SLIDE
of atlas of atlas
Superior facet
IDE

Capsule of of axis C5
SLIDE
SL

apophyseal joint Dens

ROTATION
DE

C2
SLI

SLIDE

Capsule of C6 DE
apophyseal joint C3 SLI
SLIDE

Atla Alar ligament

30-35º grados
s (taut) C4
Inferior facet Transverse ligament SLIDE
of atlas of atlas

Axis Superior facet C7

IDE

of axis
Capsule of Vertebral artery C5
SLIDE
SL

apophyseal joint Dens

RO ROTATION
DE

T ATI
O
SLI

N
A B C6
SLI
DE

Superior
Atla
s
view
Atlanto-axial jointAxis
complex (C1-C2) Intracervical region (C2-C7)
C7
Vertebral artery
RO
T
nematics of craniocervical
A axial rotation.
ATI
ON (A) Atlanto-axial joint. (B) Intracervical region (C2-C7). (From Neumann DA: Kinesiology of the mus-
B
 Inclinación: C3-C7
Craniocervical lateral flexion

L
40° fle a
x

te o n
ra
i
l
Capsule of
apophyseal joint C2

C3
L
40° RO fle a
LL x

te o n
C4

ra
i
l
Capsule of
apophyseal joint C2
Cranium
C5
C3

RO
LL C4
C6
astoid process 30-35º grados
Cranium
Lateral
flexion C5

Atlas Rectus capitis

lateralis C7
C6
Lateral
A
Mastoid process Axis flexion
Rectus capitis
B
Atlas
lateralis C7
Atlanto-occipital joint Intracervical region (C2-C7)
A Axis
B
niocervical lateralAtlanto-occipital
flexion. (A) joint Atlanto-occipital joint.Intracervical
(B) Intracervical
region (C2-C7) region. (From Neumann DA: Kin
 CERVICAL BAJA: C3-C7

Las superficies superiores

e inferiores de los cuerpos
vertebrales serán los
responsables de la copla
directa rotacion-
inclinacion

ROTA E INCLINA AL
MISMO LADO
COPLA DIRECTA
 CERVICAL BAJA: C3-C7
Articulaciones Uncovertebrales

• Guían flexoextension

• Colaboracion acoplamiento rotación-

inclinacion
 CERVICAL BAJA: C3-C7
Articulaciones uncovertebrales
• Guían flexoextension
• Colaboracion acoplamiento rotación-inclinación

Vista de corte segmentario vertebral en plano facetario

 CERVICAL BAJA: C3-C7

Vértebra cervical tipo

• Facetas articulares
ü 45º desde plano transverso
otraction of the head is the result of flexion of the lower retraction of the head. This motion reverses the forw
vertebrae and extension—and typically hyperexten- posture by bringing the lower cervical vertebrae into

Protracción de Cabeza
the upper craniocervical region (Fig. 8.27A). Over time,
cles and ligaments of the upper cervical region shorten,
to the close proximity of the bony structures in this
and the upper craniocervical region into greater flexio
performed regularly, chin tucks often yield good resu
recting a forward head posture.

Protraction Retraction

Flexion

Extension

Extension
Flexion

A B
7 Protraction and retraction of the head. (A) During protraction, the lower cervical spine flexes as the upper craniocervical regio
retraction, in contrast, the lower cervical spine extends as the upper craniocervical region flexes. (From Neumann DA: Kinesio
puter screen for extended periods of time), the muscles of this
region can become excessively shortened or lengthened, result-
ing in muscular imbalance. Regardless of the factors that cause
an individual to adopt a forward head posture, the posture itself
stresses many of the muscles in the region. Extensor muscles
such as the levator scapula and the semispinalis capitis will likely
become over-stretched and fatigued (Fig. 8.49B). Suboccipital
muscles such as the rectus capitis posterior major may become
begins, it may continue, eventually resulting in headaches and
pain radiating to the scalp and temporomandibular joints.
Treatment for chronic forward head posture involves restor-
ing a more optimal craniocervical posture. This is accomplished
through improved postural awareness, ergonomic workplace
design, stretching and strengthening of the appropriate muscu-
lature, and specific manual therapy techniques.

Rectus capitis
posterior major
Semispinalis
capitis
Levator scapula Sternocleidomastoid
Scalenus anterior

A B
Fig. 8.49 (A) Four muscles of the craniocervical region acting as guy wires to help maintain ideal posture. (B) Forward head posture places stress
on the levator scapula and semispinalis capitis muscles. The rectus capitis posterior major (a suboccipital muscle) is shown actively extending the up-
per craniocervical region. The highly active and stressed muscles are depicted in brighter red. (From Neumann DA: Kinesiology of the musculoskeletal
system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 10.31.)
CONSULTAS?