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Analyzing Cervical Fascia & Its Role in Performance

The head and neck are vital for performance, yet for some reason, are often overlooked in considerations for programming and performance preparation. In most cases, the greatest extent of “neck specific” focus we see in training is multi-directional neck isometrics in some football and combat sport settings. Beyond that? Pretty sparse.


It would be a cliché understatement for me to say there’s more for us to be cognizant of, but the fact is the neck really is one of the more sophisticated- and in a sense- sacred areas of our anatomy. Beyond a complex network of unique bones, muscles and connective tissue, the neck encompasses significant vascular structures, an expansive network of nerves (cervical and brachial plexus) and is a fundamental region for lymphatic channels and fluids. The neck also has a sophisticated fascial network that is intricately interwoven throughout the aforementioned structures.

(Image via: Teach Me Anatomy)


Quick aside- This will be a relatively lengthy piece and will cover some complex topics. So for ALL basic understanding of fascia, please reference here- The Fascia Chronicles | Fascia Archive


Structure and Functional Neck Anatomy

As I alluded to above, the neck is a very sophisticated anatomical region, and although we’ll cover some training considerations, we can’t discuss training the neck without first recognizing the vital anatomy found. To start, we have 7 cervical vertebrae, which are commonly divided into two components- the upper cervical (C1-C2) and the lower cervical spine (C3-C7). The cervical vertebrae collectively have two predominant functions- stabilize the base of the skull and permit a wide range of motion to the head & neck.

(Image via: OrthoBullets)


There are approximately 20 muscles in the neck region, and the majority of these muscles are somewhat unique when compared to the rest of the body, given their shapes, orientation and function. Broadly speaking, the muscles of the neck can be categorized by proximity to the cervical spine- anterior (cervical flexors), lateral, and posterior (cervical extensors) vertebral muscles (5).


We can also categorize these muscle as being either superficial or deep, and function as either local stabilizers or global movers. For example, the traps, levator scapulae, sternoclemastoids (SCM’s), and scalenes are classified as superficial muscles that act predominantly as global movers. Whereas the deeper cervical muscles- longus colli, longus capitus (deep flexors), and semispinalis cervicis, multifidi (deep extensors) act predominantly as local stabilizers. Importantly, these deep muscles also play additional vital roles in proprioception, oculomotor function, and kinesthetic functions such as balance (5).



Neurovascular & Lymphatic Anatomy

Beyond the intricate musculoskeletal anatomy, we also have a complex neural and vascular network that spans the neck region. While it’s beyond the scope of this article to get deep on this part of the anatomy, it’s important to at least be aware of the major neural and vascular structures. For the neural component, we have the cervical and brachial plexus, which are the predominant nerve bundles that feed the upper extremities, thoracic region, and upper abdomen. The vascular structures, which predominantly include the jugular veins/arteries, carotid veins/arteries, and superior/inferior thyroid veins/arteries. As you'd assume, these vessels are primarily responsible for feeding blood supply to and from the brain.

(Image via: Netter Anatomy)


The neck is fundamental to the lymphatic system, which is our primary system for fluid balance and processing metabolic wastes. The collarbone region, axillary (armpit), and sternum are all hotbed areas for lymphatic channels and ducts. The thyroid, which acts as our “biological thermostat”, is intricately linked to these nearby lymphatic channels, and helps to properly regulate fundamental balance within the body. The lymph nodes, which are found in abundance in the neck, can be seen simply as “filtering stations” that collect waste products to be filtrated out of the system.

(Image via: Earth's Lab)


Fascial Anatomy

Now we’re getting to the more exciting part…


Similar to the muscular anatomy, the fascia found in the cervical region can be categorized based on anatomical region or compartment. There are three primary fascial compartments to be aware of- the investing fascia (external), prevertebral fascia (middle), and the pretracheal fascia (deep) (1). The prevertebral fascia can then be further divided into the muscular and visceral components, which are classified based on proximity and functionality of the localized tissue.

As we know about fascial tissue, it envelopes and interconnects virtually every aspect of our anatomy from head to toe. So the neck is no different in this regard, wherever we have muscle, tendon, bone, or other anatomical structures, we have associating fascia. What is unique about the fascia in the cervical region, relative to the rest of the body, is the heightened role in fluid dynamics, particularly speaking to the lymph.


Although the lymphatic and cardiovascular (CV) systems are very closely associated, there are a few pronounced differences between them. Where the vessels of the CV system are aided by a contraction-relaxation (pumping) action of the heart, the lymphatic network does not have the same mechanism of moving fluid. In lieu of this, lymph is moved throughout the lymphatic network primarily by way of muscles squeezing, and the gliding of fascial layers (2). Moreover, where the CV system has vessels that transport blood both to and away from the heart, the lymphatic system only has one direction of flow, that ultimately “terminates” at the neck. Once lymph is migrated to the neck, it is filtered through a series of ducts, glands, and nodes where the toxins and waste are then processed out of the stream to be excreted by the body. Important stuff to say the least, and the localized fascia is a critical factor.


Fascial Lines and Anchor Points

There are between 6-12 (*depending on where you look) predominant myofascial lines that span the entire body. Broadly speaking, these fascial lines are continuous bands of thick, dense fascia that essentially connect the body both front to back and left to right. An important function of our fascial lines is helping to provide spring (elasticity) and continuity during movement throughout the axial skeleton. As speed or complexity of movement are increased, there is a greater contribution from these myofascial lines.

(Image via: Anatomy Trains)


An easy example to help illustrate this is the mechanics of throwing- during the cocking phase the right side of the thorax is compressed posteriorly and lengthened anteriorly as the arm goes into external rotation. The opposite occurs as the athlete goes into the throwing and release action as the anterior side becomes compressed and the posterior side becomes lengthened. This compression/lengthening relationship is also present from the left and right sides of the body, and again above and below the pelvis.

When we discuss fascial mechanics during movement or sport performance, everything can be simplified down to the tradeoff or distribution of tension and compression throughout the fascial network. Considering this, and the physical properties of fascia being elastically driven, the continuity of the attachment site(s) will be imperative for optimal function. And it just so happens that the neck is a keystone for anchoring many of these fascial lines.

Cervical Fascia & Sport Considerations

So all of the dense anatomy is cool, but what does it really mean for us as strength coaches and practitioners? Well, in the most fundamental sense the first priority is being aware that we need to look beyond just the mechanical involvement of the neck, speaking particularly to the fluid dynamics and lymphatic function. As I’ve been quite expressive about over the last several years, the objectives of optimizing performance must extend beyond muscular strength, speed, and aerobic capacity, even if you are “just” a strength and conditioning coach.


But let’s explore the collective roles of the cervical fascia here, and we’ll start back with the mechanical aspects. The first mechanical responsibility that we need to address is head stabilization, particularly during sprinting or change of direction. As we know, unwarranted head movement during sprinting can be a decrement to overall form and outcome. While the muscles of the neck will be the primary means for stabilizing the head, the fascia plays an integral role in this as well. If we go back to our anatomy and isolate the deeper compartments of the neck, there is an interesting role of the suboccipital group, which is to aid and assist in proprioceptive function and have input to visual and vestibular function (5). Remember, where the eyes go, the body tends to follow.


Now, connecting this to our conventional fascial anatomy, we know that fascia is fundamental to sensorimotor function and embedded with countless proprioceptive bodies (7). So putting two and two together here, if we have compromised function in the deep neck compartments (albeit muscular or fascial specific), we can ultimately have decrements to vision, global proprioception, vestibular function, and oculomotor control (6). Collectively, these can all become culprits for disrupting processing speed, depth perception, and peripheral vision.


Beyond head stabilization, we then have the opposing demand- head-trunk disassociation. There are a number of examples for this- hitting a baseball, pitching/throwing, club sports, throwing a punch and so forth. Along with the mechanical aspects of cervical disassociation, there is also a neurological point to consider as well. Think about when you have a “kink” in your neck and you’re trying to drive on the highway. Rather than simply turning your head before merging- without thinking, you have to lean forward and rotate your entire body to the direction you’re looking- and think consciously. In the context of sport, when fascia is not hydrated or properly mobilized it can create “sticking” points, which in a sense causes a reduction in movement precision and dexterity. This is where the neurology again becomes a prominent factor, as this will have ramifications on agonist-antagonist coupling, a disruption to synergistic function (i.e., cervical stabilization during various arm actions) and also prompt individuals to rely on non-functional compensatory patterns.


So, What Does This All Mean for Training


There are a number of ways we can apply this to training, but for the sake of your time let’s wrap this up with a few simple points to focus on.


1.) Stabilize and Strengthen

Neck exercises can be tricky, and often goofy or uncomfortable to conduct. Novel tools like the Iron Neck can help simplify this, and beyond its simplicity, the Iron Neck is great for the multi-directional aspect. If specialized tools aren’t an option, some neck movements can be simulated with a band, although frankly isn’t a great option overall in my opinion. My best recommendation is using simple manual resistance and bridge patterns performed as isometrics. Neck bridging is something that superficially appears simple, but there’s a good bit of nuance and difficulty involved. My guy Tim Kelly has a phenomenal progression for neck bridges and was kind enough to share with me for this article. Last, be sure to include a good bit of trap and upper back work however you choose to go about it. But a robust posterior neck and upper back will be critical for head injury and concussion reduction.


2.) Separate and Lengthen

While strength and stability are imperative, we also need to consider the opposing functions. Stretching the neck is similar to the isometrics, in that it can be tricky, uncomfortable, and there really isn’t anything profound or eye catching that needs to be done… we just need to do it. A basic 4-way neck stretch can be incorporated simply in a post training or at home routine. As for the separation, this really highlights the importance of positioning and cueing during training, because again, there isn’t much for specific drills that applies here, it’s just a matter of cueing and coaching the athlete while they perform rotational or global based actions.


3.) Soft Tissue & Vibration

Soft tissue work on the neck is imperative for all athletes, as this is typically an area that gets beaten up and overlooked. An array of soft tissue modalities can be conducive, but the empirical point being to perturb the onset of hypertonicity, fluid backup, and/or structural degradation. Modalities like deep tissue massage are not just frivolous or simply “relaxing”. One of the main benefits of deep tissue massage is that it will directly influence the lymphatic flow and circulation by improving tissue glide. Recall from above how the lymphatic system does not have an organic “pump” mechanism, so in order to promote lymphatic flow we must have movement. General movement- training, running, yoga, etc. are all applicable here, but not a complete solution. To promote better localized and direct stimulation, soft tissue work and manual manipulation can be a game changer. This is also where vibrational tools demonstrate tremendous value, as there is an abundance of research showing the unique response of lymph and fluids to specific vibrational frequencies (4).


4.) Breathwork & Mechanics

I didn't touch on this component as much as I wanted to in this, but don't mistake that for a lack of significance. The demand for concerted breath work and understanding the mechanics is growing throughout performance facilities, and for good reason. The differences between chest and diaphragmatic breathing are profound, and as they relate to the neck, chronic chest-driven breath mechanics will expedite the tissues in the neck becoming more tonic (or stiff). Moreover, referencing back to our lymphatic points, in addition to muscle pump and fascial glide, respiration is fundamental for lymphatic flow and regulation. Collectively, a lot of neck dysfunction can be traced back to improper or incomplete breath patterns. For all things breath related, please check out Rob Wilson and his work.


Depending on the athlete, their history, and their present sport or life demands, some combination of these things should be present in the training program. We need to remember that “just getting strong” isn’t enough. In a nutshell- Develop fundamental strength for head stabilization and concussion/head injury reduction. Have good flexibility and mobility so that the head can separate from the trunk when demanded to, and also be able to traverse large ranges and paths of motion without incurring damage. Treat the neck with soft tissue modalities and vibrational tools so that the fluid and neural components are proficient to help keep athletes healthy and functioning at their best physiologically.


References

1.) Natale, G. Condino, S. Stecco, A. Soldani, Pl. Belmonte, MM. Gesi, M., 2015. Is the cervical fascial an anatomical proteus? Surg Radiol Anat. 37(9):1119-27.

2.) Schleip, R. Wilke, J. Fascia in Sport and Movement. United Kingdom, Handspring Publishing, 2021.

3.) Stecco, C. Functional atlas of the human fascial system. Toronto, Churchill Livingstone Elsevier, 2015.

4.) Stecco, A. Stern, R. Fantoni, I. De Caro, R. Stecco, C., 2015. Fascial disorders: Implications for treatment. J of Phys Med Rehab, 1-8.

5.) Sutcliffe, P. Lasrado, S., 2022. Anatomy, head and neck, deep cervical neck fascia. Stat Pearls.

6.) Wilke, J. Krause, F. Vogt, L. Banzer, W., 2016. What is evidence-based about myofascial chains: a systematic review. Arch Phys Med & Rehab, 97:454-461.

Wilke, J. Schleip, R. Yucesoy, C. Banzer, W., 2018. Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol, 124:234-244.

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