Clinical and radiological assessment of the cervical extensor muscles in people with neck pain. A narrative review

Background: Clinical and radiological investigations of the function and structure of the cervical extensor muscles are increasingly being used in physiotherapy practice.

Objectives: The aim of this review is to investigate the reliability and clinical utility of these tests, to report on normative data and to evaluate the association between the results of these investigations and neck pain.

Major Findings: A range of clinical and radiological tests have been described to assess the function and structure of the cervical extensor muscles. Clinical tests that evaluate cervical muscle strength and endurance can be performed reliably and there is some evidence that performance of these tests is impaired in people with neck pain. There is however, a need for better understanding of what constitutes normal strength and endurance in these muscles and whether abnormal function is a cause or effect of neck pain. Clinical tests of extensor motor control have not been extensively studied. Of the radiological investigations commonly used for evaluation of cervical extensor muscle structure, ultrasound cross-sectional measures have demonstrated acceptable reliability and correlate reasonably well with higher resolution MRI images.

Conclusions: The clinical and radiological tests commonly used to assess cervical extensor muscles generally have acceptable reliability and are mostly well suited within the physiotherapy clinic. Both clinical and radiological tests need further investigation through case-controlled longitudinal studies that explore the relationship between these tests and neck pain.