Pain in the cervical spine - muscle imbalance

CLBolestKrcniPatereThe cervical spine is the mobile part of the spine. It is transferring into thoracic spine, which is on the other hand the least mobile segment of the spine, because a rib cage is being attached to it, and it is connected to the sternum bone. Therefore the transfer between the cervical and thoracic spine is physically very demanding area, where the mobility of the cervical spine meets with significantly restricted mobility of the thoracic spine.

It is important to note that even the upper cervical spine is exposed to a great burden because the first two vertebrae are holding the head which is fairly heavy (read more about: Headaches, migraines, ringing in the ears (tinnitus), lights in front of the eyes (scotoma). Cervical spine is the most burdened segment of the spine, and therefore many types of tension leading to pain in the area of the cervical spine or area between the shoulder blades may occur.

Important factor in problematics of the cervical spine is especially its stereotypical burdening. Our ancestors who had during the day more natural movement, kept their head and cervical spine in a straight position, which keep the cervical spine in a physiological extension, we are on the other hand in our jobs or at school usually in a flexing or static position (sitting, standing).


During the day we perform such movements, which make us bend the trunk, basically the thoracic and lumbar spine, so that we could communicate with people around us, looking around the street or just watching the teacher on a lecture. The cervical spine has to naturally correct the position of the head through the increased extension of the cervical spine, which leads to overloaded short muscles of the nape.

Unnatural position of the spine overloads one group of muscles (usually surface muscles), meanwhile other muscles are weakened (usually muscles of the deep layers). In case of cervical spine it is usually group of shoulder blade muscles. Among the major muscles affecting the shoulder blades are especially trapezius muscles and levator scapulae muscles, which are muscles that are usually in a higher tension due to incorrect position of the cervical spine and shoulders.

On the other hand, during pain in the neck the lower muscles of the shoulder blades are often weakened - serratus anterior muscle and latissimus dorsi muscle. This muscle imbalance causes also elevated position of the shoulders, which closely relates to the problematics of the cervical spine.
Our body, especially the musculoskeletal system is fairly tolerant. Coherent overloading of the muscles of the cervical spine might evoke some pain in the neck or shoulder area, and we tend to ignore these symptoms, we solve it by a quick stretching of the painful area or by massage. However without long lasting functional solution, the muscle imbalance only deepens.

Other soft tissues also react to the overloading (skin, subcutaneous tissues, fascia), which get contracted, as they get shorter they lose their flexibility, which subsequently deepens the painfulness. Pain and problems in the area of the cervical spine often results in some of these symptoms:

  • Headache, pain behind eyes
  • Ringing in the ears, nausea
  • Numerous blockages of the cervical and thoracic spine but also ribs
  • Pain between or below the shoulder blades
  • Acute pain in the area of the shoulder joints
  • Tingling or burning in arms, pain in the elbow area


It is very ideal to start with therapy focused on functional activity of single muscle groups then also parts of the muscles in the so called functional chains. This balance leads to optimization of the posture of the cervical spine. In therapy it is important to relieve the tension of the overloaded soft tissues (skin, subcutaneous tissues, muscle fascia), removing the possible blockages and relax or stretch the overloaded hyperactive muscles. Although for a successful therapy it is very important to strengthen the weakened muscle groups in the area of the cervical spine and nape. Cervical spine is thanks to coordination kept in a correct extended position, muscles are together in a harmonic tension, therefore there is no room for pain.

YTJemná trakce krční páteře (1)YTpnf pro hlavuMobilization of the cervical vertebraeAutomobilization upper ribsBending backYTRelaxace horních vláken trepézu (1)

Example of exercises during pain of the cervical spine:

Author: Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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