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Neck Pain - Back - Landmarks - Vertebral Levels

Feel the back of the head. This area is called the occiput. In the center of the back of the head is the bump called the inion. If you move your fingers away from the bump, the ridge that you feel is called the superior nuchal line. The trapezius muscle attaches to the superior nuchal line and you may feel tenderness as you feel this muscle.

There is a big prominence in the skull bone at the back of the ear, near the angle of the jaw and this prominence is the mastoid process. This is the bone from which the sternocleidomastoid muscle that rotates the head arises from. Also, the longissimus muscle coming all the way from the lower back region attaches there (you can thus appreciate the myofascial connection between head, neck, lower back and vice versa). If there is pain and spasm in these muscles, you may feel tenderness in the region of the mastoid process.

If you bend the neck down, you can feel the spinous processes of the vertebral bodies. Since the spinous processes are not covered by muscles, you should be able to easily feel them.

Beside the spinous processes in the neck region are the paraspinal muscles and the trapezius muscles. The first spinous process that you can feel is that of the C2 vertebra and this is felt at the base of the head in the midline.

If you have a tight trapezius, you may feel a tight cord that stretches from this skull to the lower part of the midback. The largest and most easily felt spinous process is that of the C7 vertebral body and the one immediately below it which is also easily felt is the spinous process of the T1 vertebral body.

Transverse skin creases across the spinous processes may be noted corresponding to the level at which disc space narrowing maybe present.

The normal cervical spine has a C-shaped curve with the hollow of the C at the back of the neck. This is called cervical lordosis. If you put your hand at the back of the neck between the base of the skull and the C7 spinous process you should be able to cup your palm and fingers into the hollow of the C-shaped curve of the cervical spine.

Presence of spasm in the muscles at the back of the neck will flatten the cervical lordosis and cause straightening of the neck spine.

Pain in the neck may also come from the facet joints. You may be able to feel the facet joints if you move your fingers outward about 1" away from the spinous processes. The facet joints lie under the edge of the trapezius muscle. They may be tender especially at the level of the C5 and C6 since arthritis is more common at this level.


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