The Lower Cervical Region

By Donald Capoferri

Palpation Hints

I.  Study and learn "normal-textbook" Spinal Anatomy.
(a)  Know the muscle origins and insertions.
(b)  Picture in thought the muscles of the spine as you palpate, as they run from origin to insertion.
II.  Palpate with the tips of the fingers and not with the finger pads.
III.  Always palpate across the muscle fibers.
IV.  Where it is possible and practical, trace a muscle to its origin and insertion.

The lower cervical region is given special consideration here because of difficulty in its analysis; unlike the upper cervical region, the difficulty here is not only due to the subtlety of contraction of the working muscles that are analyzed, but in addition involves muscles that are difficult to detect because of obscurity.

Third and Fourth Cervical Vertebrae

(Third cervical is the smallest vertebra of the spine and when palpating it you must be careful not to confuse the muscles of axis and fourth cervical with its musculature.)

Palpation Procedure: Palpate for the spinous of axis, slip the fingers inferior just a bit until you feel the spinous of third cervical (or fourth cervical accordingly) it is small so you may have to apply just a little more pressure.  Once you have found the spinous process, follow the lamina around to the transverse process.  Immediately posterior to the transverse process (on the posterior tubercle) is the origin of the levator scapula muscle.  The muscle band runs longitudinally, from inferior to superior, so that when you palpate, do so across the fibers, from anterior to posterior.

"Chiropractic" Action: The levator tells us laterality of the body of the third and fourth cervical; working the side opposite of body laterality (Use the Kinetic Check to find the muscle if it is difficult.)
 

Palpation Procedure: Scalenus medius is also used to analyze the third and fourth cervical vertebrae.  As the scalenus medius is traced longitudinally, it also "inserts" onto the posterior tubercle of the cervical transverse processes.  Locate the transverse process of the vertebra and then drop just anterior and inferior (about a fingers width), below the transverse process of the vertebra.  Again, palpate across the fibers of the muscle.

"Chiropractic" Action: The scalenus medius will be working for correction on the side of vertebral body laterality.  (There are occasions when anatomical angle and structure permit the scalenus medius to work on the opposing side as well).

Both the levator scapula and scalenus medius will be like a tight rubber band in the soft tissue.

Palpation Procedure: Intertransversarii muscles can also be used in this area.  These are small slips of muscle connecting adjacent transverse processes.  Palpate the transverse processes of the vertebra above and below; in between, palpate across the longitudinal fibers of the intertransversarii.  The muscle is double in the cervical region, so it can be fairly easy to palpate.

"Chiropractic" Action: It will be active in the wedged misalignment, pulling the transverse processes up or down according to the listing.  This muscle also works on the side of vertebral body misalignment because the most significant rotation will occur on the side of the posterior transverse proocess.

When working for the correction of the misalignment, the intertransversarii are comparable to a slip of fibrous bone.

Fourth to Seventh Cervical Vertebrae

Palpation Procedure: The multifidus muscle may also "present" itself for palpation as far superior as the fourth and even the third cervical vertebra.  The multifidus runs from the articular process of one cervical vertebra to the spinous of the vertebra above.  Palpate the spinous process of a vertebra inferior to it, and move anterior and lateral (about two finger widths), on to the articular process of this vertebra.  Then palpate bilaterally in a springing fashion into the belly of this muscle only to the depth of the soft tissues (without mobilizing the joints themselves).

"Chiropractic" Action: This muscle will "tell" you spinous laterality of the fourth cervical vertebra and all vertebrae where it is present and palpable; working opposite of spinous laterality.