Effect of sit-stand workstation position and computer task on head and trunk postural sway and discomfort.

Adjustable-height desks may provide musculoskeletal health benefits to offset the effects of prolonged sitting. One mechanism may be increased postural variability, here characterized by head and trunk postural sway. Linear acceleration of the head and trunk were measured while participants used computer workstations in seated and standing positions during keyboard and mouse tasks; secondary measures were discomfort and proprioception (head and neck repositioning error). Median accelerations of the head and trunk were 20-26% lower in mouse tasks compared to keyboard tasks (p < 0.01). There were no significant differences in sway parameters between seated and standing positions. Discomfort and proprioception were correlated; subjects who experienced increased neck discomfort after 1.5 h of computer work had almost twice the head and neck repositioning error. The results suggest that postural sway is more affected by different tasks (keyboard vs. mouse) than by different workstation configurations and that low proprioception acuity may relate to the development of discomfort.

The role of neck muscle co-contraction and postural changes in head kinematics after safe head impacts: Investigation of head/neck injury reduction.

Concerns surrounding concussions from impacts to the head necessitate research to generate new knowledge about ways to prevent them and reduce risk. In this paper, we report the relative temporal characteristics of the head resulting from neck muscle co-contraction and postural changes following a sudden force applied to the head in four different directions. In the two "prepared" conditions (i.e., co-contraction and postural), participants experienced impulsive forces to the head after hearing a warning. The warning given for the postural condition informed both the direction and timing of the impulsive force. Participants responded to the postural warning by altering their head posture, whereas in the co-contraction warning, the force direction was unknown to them, and they were asked to isometrically co-contract their neck muscles after the warning. Peak angular velocity reduced by 29% in sagittal extension, 18% in sagittal flexion, and 23% in coronal lateral flexion in prepared vs. unwarned conditions. Peak linear acceleration was attenuated by 15% in sagittal extension, 8% in sagittal flexion, and 18% in coronal lateral flexion in prepared vs. unwarned conditions. Changes in peak angular acceleration were not uniform. We also measured a significant delay in the peak angular velocity (22 vs. 44.8 ms) and peak angular acceleration (7 vs. 20 ms) after peak linear acceleration in prepared compared to unwarned conditions. An increase in muscle activation significantly reduced the peak angular velocity and linear acceleration. Gross head movement was significantly decreased with preparation. These findings suggest that a warning prior to impact can reduce head kinematics associated with injury.

Cervical Muscle Activation Due to an Applied Force in Response to Different Types of Acoustic Warnings.

Mild traumatic brain injury (mTBI) and whiplash-associated disorder are the most common head and neck injuries and result from a sudden head or body acceleration. The head and neck injury potential is correlated with the awareness, level of muscle activation, and posture changes at the time of the perturbation. Environmental acoustic stimuli or a warning system can influence muscle activation and posture during a head perturbation. In this study, different acoustic stimuli, including Non-Directional, Directional, and Startle, were provided 1000 ms before a head impact, and the amplitude and timing of cervical muscle electromyographic (EMG) data were characterized based on the type of warning. The startle warning resulted in 49% faster and 80% greater EMG amplitude compared to the Directional and Non-Directional warnings after warning and before the impact. The post-impact peak EMG amplitudes in Unwarned trials were lower by 18 and 21% in the retraction and rebound muscle groups, respectively, compared to any of the warned conditions. When there was no warning before the impact, the retraction and rebound muscle groups also reached their maximum activation 38 and 54 ms sooner, respectively, compared to the warned trials. Based on these results, the intensity and complexity of information that a warning sound carries change the muscle response before and after a head impact and has implications for injury potential.

Cervical Spine Musculotendon Lengths When Reading a Tablet in Three Seated Positions.

A popular posture for using wireless technology is reclined sitting, with the trunk rotated posteriorly to the hips. This position decreases the head's gravitational moment; however, the head angle relative to the trunk is similar to that of upright sitting when using a tablet in the lap. This study compared cervical extensor musculotendon length changes from neutral among 3 common sitting postures and maximum neck flexion while using a tablet. Twenty-one participants had radiographs taken in neutral, full-flexion, and upright, semireclined, and reclined postures with a tablet in their lap. A biomechanical model was used to calculate subject-specific normalized musculotendon lengths for 27 cervical musculotendon segments. The lower cervical spine was more flexed during reclined sitting, but the skull was more flexed during upright sitting. Normalized musculotendon length increased in the reclined compared with an upright sitting position for the C4-C6/7 (deep) and C2-C6/7 (superficial) multifidi, semispinalis cervicis (C2-C7), and splenius capitis (Skull-C7). The suboccipital (R2 = .19-.71) and semispinalis capitis segment length changes were significantly correlated with the Skull-C1 angle (0.24-0.51). A semireclined reading position may be an ideal sitting posture to reduce the head's gravitational moment arm without overstretching the assessed muscles.

Sensitivity analysis of muscle properties and impact parameters on head injury risk in American football.

Head injuries frequently occur in American football and other contact sports. Uncertainty on the effects of cervical muscle properties on head injury risk may be due to the limitations of previous observational studies. This simulation study employs a musculoskeletal model of the head and neck to investigate the effect of several factors related to head injury metrics in American Football. These factors include isometric muscle strength, the eccentric multiplier (which is related to the athlete's ability to apply greater muscle force during eccentric contractions), posture, muscle activation patterns, and impact properties. Impact properties were based on the literature and tuned to reproduce peak linear and rotational accelerations of the skull. We hypothesized that active neck muscles significantly reduce head injury metrics. We systematically altered each model parameter to test our hypothesis. We then determined which model parameters affect head injury metrics the most. The results of this study indicate that active neck muscles have a statistically significant effect on head injury metrics. Increasing muscle strength and eccentric multiplier also resulted in a statistically significant reduction of head injury metrics. However, posture prior to impact had a much stronger effect than any other factor on head injury metrics. A comprehensive approach to athlete training protocols is recommended, including exercises aimed at increasing eccentric muscle strength and preparation for impacts. Future studies should investigate how targeted muscle strengthening and impact training (i.e. activation patterns and posture) modifies risk.

Effect of Subject-Specific Vertebral Position and Head and Neck Size on Calculation of Spine Musculoskeletal Moments.

Spine musculoskeletal models used to estimate loads and displacements require many simplifying assumptions. We examined how assumptions about subject size and vertebral positions can affect the model outcomes. Head and neck models were developed to represent 30 subjects (15 males and 15 females) in neutral posture and in forward head postures adopted while using tablet computers. We examined the effects of (1) subject size-specific parameters for head mass and muscle strength; and (2) vertebral positions obtained either directly from X-ray or estimated from photographs. The outcome metrics were maximum neck extensor muscle moment, gravitational moment of the head, and gravitational demand, the ratio between gravitational moment and maximum muscle moment. The estimates of maximum muscle moment, gravitational moment and gravitational demand were significantly different when models included subject-specific vertebral positions. Outcome metrics of models that included subject-specific head and neck size were not significantly different from generic models on average, but they had significant sex differences. This work suggests that developing models from X-rays rather than photographs has a large effect on model predictions. Moreover, size-specific model parameters may be important to evaluate sex differences in neck musculoskeletal disorders.

The inclusion of hyoid muscles improve moment generating capacity and dynamic simulations in musculoskeletal models of the head and neck.

OpenSim musculoskeletal models of the head and neck can provide information about muscle activity and the response of the head and neck to a variety of situations. Previous models report weak flexion strength, which is partially due to lacking moment generating capacity in the upper cervical spine. Previous models have also lacked realistic hyoid muscles, which have the capability to improve flexion strength and control in the upper cervical spine. Suprahyoid and infrahyoid muscles were incorporated in an OpenSim musculoskeletal model of the head and neck. This model was based on previous OpenSim models, and now includes hyoid muscles and passive elements. The moment generating capacity of the model was tested by simulating physical experiments in the OpenSim environment. The flexor and extensor muscle strengths were scaled to match static experimental results. Models with and without hyoid muscles were used to simulate experimentally captured motions, and the need for reserve actuators was evaluated. The addition of hyoid muscles greatly increased flexion strength, and the model is the first of its kind to have realistic strength values in all directions. Less reserve actuator moment was required to simulate real motions with the addition of hyoid muscles. Several additional ways of improving flexion strength were investigated. Hyoid muscles add control and strength to OpenSim musculoskeletal models of the head and neck and improve simulations of head and neck movements.

Neck Muscle Moment Arms Obtained In-Vivo from MRI: Effect of Curved and Straight Modeled Paths.

Musculoskeletal models of the cervical spine commonly represent neck muscles with straight paths. However, straight lines do not best represent the natural curvature of muscle paths in the neck, because the paths are constrained by bone and soft tissue. The purpose of this study was to estimate moment arms of curved and straight neck muscle paths using different moment arm calculation methods: tendon excursion, geometric, and effective torque. Curved and straight muscle paths were defined for two subject-specific cervical spine models derived from in vivo magnetic resonance images (MRI). Modeling neck muscle paths with curvature provides significantly different moment arm estimates than straight paths for 10 of 15 neck muscles (p < 0.05, repeated measures two-way ANOVA). Moment arm estimates were also found to be significantly different among moment arm calculation methods for 11 of 15 neck muscles (p < 0.05, repeated measures two-way ANOVA). In particular, using straight lines to model muscle paths can lead to overestimating neck extension moment. However, moment arm methods for curved paths should be investigated further, as different methods of calculating moment arm can provide different estimates.

Mobility and Upright Posture Are Associated with Different Aspects of Cognition in Older Adults.

Objectives: Aging is associated with cognitive decline, including visuomotor and memory concerns, and with motor system changes, including gait slowing and stooped posture. We investigated the associations of visuomotor performance and episodic memory with motor system characteristics in healthy older adults. Methods: Neurologically healthy older adults (N = 160, aged 50-89) completed a battery of cognitive and motor tasks. Cognitive variables were grouped by principal components analysis (PCA) into two components: visuomotor performance and verbal episodic memory. Our primary predictor variables were two aspects of motor function: timed-up-and-go (TUG) speed and neck angle. Additional predictor variables included demographic factors (age, sex and education) and indicators of physical fitness (body mass index/BMI and grip strength). All seven predictor variables were entered stepwise into a multiple regression model for each cognitive component. Results: Poor visuomotor performance was best predicted by a combination of advanced age, high BMI and slow TUG, whereas poor verbal memory performance was best predicted by a combination of advanced age, male sex, low education and acute neck angle. Conclusions: Upright posture and mobility were associated with different cognitive processes, suggesting different underlying neural mechanisms. These results provide the first evidence for a link between postural alignment and cognitive functioning in healthy older adults. Possible causal relationships are discussed.

Gravitational demand on the neck musculature during tablet computer use.

Tablet computer use requires substantial head and neck flexion, which is a risk factor for neck pain. The goal of this study was to evaluate the biomechanics of the head-neck system during seated tablet computer use under a variety of conditions. A physiologically relevant variable, gravitational demand (the ratio of gravitational moment due to the weight of the head to maximal muscle moment capacity), was estimated using a musculoskeletal model incorporating subject-specific size and intervertebral postures from radiographs. Gravitational demand in postures adopted during tablet computer use was 3-5 times that of the neutral posture, with the lowest demand when the tablet was in a high propped position. Moreover, the estimated gravitational demand could be correlated to head and neck postural measures (0.48 < R(2) < 0.64, p < 0.001). These findings provide quantitative data about mechanical requirements on the neck musculature during tablet computer use and are important for developing ergonomics guidelines. Practitioner Summary: Flexed head and neck postures occur during tablet computer use and are implicated in neck pain. The mechanical demand on the neck muscles was estimated to increase 3-5 times during seated tablet computer use versus seated neutral posture, with the lowest demand in a high propped tablet position but few differences in other conditions.

Inter-individual variation in vertebral kinematics affects predictions of neck musculoskeletal models.

Experimental studies have found significant variation in cervical intervertebral kinematics (IVK) among healthy subjects, but the effect of this variation on biomechanical properties, such as neck strength, has not been explored. The goal of this study was to quantify variation in model predictions of extension strength, flexion strength and gravitational demand (the ratio of gravitational load from the weight of the head to neck muscle extension strength), due to inter-subject variation in IVK. IVK were measured from sagittal radiographs of 24 subjects (14F, 10M) in five postures: maximal extension, mid-extension, neutral, mid-flexion, and maximal flexion. IVK were defined by the position (anterior-posterior and superior-inferior) of each cervical vertebra with respect to T1 and its angle with respect to horizontal, and fit with a cubic polynomial over the range of motion. The IVK of each subject were scaled and incorporated into musculoskeletal models to create models that were identical in muscle force- and moment-generating properties but had subject-specific kinematics. The effect of inter-subject variation in IVK was quantified using the coefficient of variation (COV), the ratio of the standard deviation to the mean. COV of extension strength ranged from 8% to 15% over the range of motion, but COV of flexion strength was 20-80%. Moreover, the COV of gravitational demand was 80-90%, because the gravitational demand is affected by head position as well as neck strength. These results indicate that including inter-individual variation in models is important for evaluating neck musculoskeletal biomechanical properties.

Collegiate and high school athlete neck strength in neutral and rotated postures.

A knowledge of neck strength is important for developing conditioning protocols and for evaluating the relationship between neck strength and head and neck injury, but very few studies have examined neck strength in relationship to athletic participation. The purpose of this study was to quantify isometric neck strength in collegiate and high school athletes. We hypothesized that (a) male athletes would have significantly greater neck strength than females; (b) collegiate athletes would be significantly stronger than high school athletes; and (c) neck strength would vary significantly with head posture. A total of 149 subjects participated (77 men and 72 women; 90 college and 59 high school level). Flexion, extension, and lateral flexion neck strength were measured in neutral and rotated head and neck postures. Neck strength varied significantly according to participants' sex, age, and posture (p < 0.05). Male college students were stronger than those in all other groups (female college students, male high school students, and female high school students). The average female neck strength was 61, 54, and 56% of the average male neck strength for extension, flexion, and lateral flexion, respectively. High school athletes' neck strength was 75, 68, and 65% of collegiate athletes' neck strength for extension, flexion, and lateral flexion, respectively. On average, neck strength was the greatest for extension compared with other force directions. The subjects showed large variation in neck strength with posture, but in general, there were no consistent trends among the subjects. This finding suggests that those whose neck strength was considerably lower in nonneutral postures may consider training to increase strength in rotated postures. These data provide important baseline information for future studies evaluating injury risk or training protocols.

Neck muscle paths and moment arms are significantly affected by wrapping surface parameters.

In this paper, we studied the effects of wrapping surfaces on muscle paths and moment arms of the neck muscle, semispinalis capitis. Sensitivities to wrapping surface size and the kinematic linkage to vertebral segments were evaluated. Kinematic linkage, but not radius, significantly affected the accuracy of model muscle paths compared to centroid paths from images. Both radius and linkage affected the moment arm significantly. Wrapping surfaces that provided the best match to centroid paths over a range of postures had consistent moment arms. For some wrapping surfaces with poor matches to the centroid path, a kinematic method (tendon excursion) predicted flexion moment arms in certain postures, whereas geometric method (distance to instant centre) predicted extension. This occurred because the muscle lengthened as it wrapped around the surface. This study highlights the sensitivity of moment arms to wrapping surface parameters and the importance of including multiple postures when evaluating muscle paths and moment arm.

Moving muscle points provide accurate curved muscle paths in a model of the cervical spine.

Muscle paths in musculoskeletal models have been modeled using several different methods; however, deformation of soft tissue with changes in posture is rarely accounted for, and often only the neutral posture is used to define a muscle path. The objective of this study was to model curved muscle paths in the cervical spine that take into consideration soft tissue deformation with changes in neck posture. Two subject-specific models were created from magnetic resonance images (MRI) in 5 different sagittal plane neck postures. Curved paths of flexor and extensor muscles were modeled using piecewise linear lines-of-action in two ways; (1) using fixed via points determined from muscle paths in the neutral posture and (2) using moving muscle points that moved relative to the bones determined from muscle paths in all 5 postures. Accuracy of each curved modeled muscle path was evaluated by an error metric, the distance from the anatomic (centroid) muscle path determined from the MRI. Error metric was compared among three modeled muscle path types (straight, fixed via and moving muscle point) using a repeated measures one-way ANOVA (α=0.05). Moving muscle point paths had 21% lower error metric than fixed via point paths over all 15 pairs of neck muscles examined over 5 postures (3.86 mm vs. 4.88 mm). This study highlights the importance of defining muscle paths in multiple postures in order to properly define the changing curvature of a muscle path due to soft tissue deformation with posture.

Sagittal plane kinematics of the adult hyoid bone.

The hyoid bone is a unique bone in the skeleton not articulated to any other bone. The hyoid muscles, which attach to the hyoid bone, may play a role in neck mechanics, but analysis of their function requires quantifying hyoid bone mechanics. The goal of this study was to obtain the detailed kinematics of the hyoid bone over a large range of flexion-extension motion using radiographs at 5 postures. The position of the hyoid bone in the sagittal plane was characterized with respect to head, jaw, and vertebral movements. Sex differences in hyoid kinematics were also investigated. We hypothesized that (1) the position of the hyoid bone in the sagittal plane is linearly correlated with motion of the head, jaw, and vertebrae, and (2) the hyoid position, size, and kinematics are sex-specific. We found that the hyoid bone X, Y, and angular position generally had strong linear correlations with the positions of the head, jaw, and the cervical vertebrae C1-C4. Hyoid X and angular position was also correlated to C5. Sex differences were found in some regressions of the hyoid bone with respect to C1-C5. The angular and linear measurements of the hyoid bone showed sex differences in absolute values, which were not evident after normalization by posture or neck size. Incorporating these results to neck models would enable accurate modeling of the hyoid muscles. This may have implications for analyzing the mechanics of the cervical spine, including loads on neck structures and implants.

Calf muscle-tendon lengths before and after Tendo-Achilles lengthenings and gastrocnemius lengthenings for equinus in cerebral palsy and idiopathic toe walking.

The calf muscle-tendon lengths in children exhibiting equinus gait in two clinical populations, cerebral palsy (CP) and idiopathic toe walking (ITW), were examined to compare the effects of diagnosis and two different surgical procedures, Tendo-Achilles lengthening (TAL) versus Vulpius procedure (VP) gastrocnemius recession. Pre- and post-surgical gait data were obtained from 38 subjects (58 limbs) and 38 age-matched controls. Peak muscle-tendon lengths increased following surgery in 84% of limbs. For medial gastrocnemius (MGAS) and lateral gastrocnemius (LGAS) in stance, muscle-tendon lengths increased significantly following TAL surgeries but were not significantly different pre- and post-VP surgeries. For soleus (SOL) (swing and stance) and MGAS and LGAS (swing), muscle-tendon lengths increased significantly following both TAL and VP surgeries. Pre-operatively, muscle-tendon lengths were significantly shorter for the TAL group compared to the VP group; however, post-operatively the lengths were not significantly different between the surgeries. There were no significant differences between CP and ITW patients or indications that the surgery affected the groups differently. The change in length following surgery was well correlated to the subjects' initial muscle-tendon length.

Defining and evaluating wrapping surfaces for MRI-derived spinal muscle paths.

Muscle paths can be approximated in biomechanical models by wrapping the path around geometric objects; however, the process for selecting and evaluating wrapping surface parameters is not well defined, especially for spinal muscles. In this study, we defined objective methods to select the shape, orientation, size and location of wrapping surfaces and evaluated the wrapping surfaces using an error metric based on the distance between the modeled muscle path and the centroid path from magnetic resonance imaging (MRI). We applied these methods and the error metric to a model of the neck musculature, where our specific goals were (1) to optimize the vertebral level at which to place a single wrapping surface per muscle; and (2) to define wrapping surface parameters in the neutral posture and evaluate them in other postures. Detailed results are provided for the sternocleidomastoid and the semispinalis capitis muscles. For the sternocleidomastoid, the level where the wrapping surface was placed did not significantly affect the error between the modeled path and the centroid path; use of wrapping surfaces defined from the neutral posture improved the representation of the muscle path compared to a straight line in all postures except contralateral rotation. For the semispinalis capitis, wrapping surfaces placed at C3 or C4 resulted in lower error compared to other levels; and the use of wrapping surfaces significantly improved the muscle path representation in all postures. These methods will be used to improve the estimates of muscle length, moment arm and moment-generating capacity in biomechanical models.

Head and neck anthropometry, vertebral geometry and neck strength in height-matched men and women.

Women have an increased incidence of whiplash injury and neck pain compared to men. Physical and numerical models represent one avenue to explore and potentially explain these gender differences, but a valid model of the female neck does not yet exist. A fundamental question in the development of a female neck model is whether female necks are simply scaled versions of male necks, or whether there are significant inter-gender geometrical differences. The goal of this study was to quantify differences in head and neck geometry and neck strength in pairs of male and female subjects matched for standing height and neck length. Based on 14 matched pairs of men and women, we found that most head and neck anthropometric parameters were significantly smaller in females compared to males. Moreover, gender differences in a number of neck anthropometry parameters (an average of 9-16% smaller in females) were larger than differences in head anthropometry parameters (an average of 3-6% smaller in females). Female vertebrae between C3 and C7 were significantly smaller than male vertebrae in the anterior-posterior dimension (p < 0.012) but not in the medial-lateral dimension (p > 0.07). Female necks were also significantly weaker than male necks (32% weaker in flexion and 20% weaker in extension; p < 0.001), and these strength differences corresponded well to those predicted solely from the observed geometric differences. These results demonstrate that male and female necks are not geometrically similar and indicate that a female-specific model will be necessary to study gender differences in neck-related disorders.

Musculotendon and fascicle strains in anterior and posterior neck muscles during whiplash injury.

STUDY DESIGN: A biomechanical neck model combined with subject-specific kinematic and electromyographic data were used to calculate neck muscle strains during whiplash. OBJECTIVES: To calculate the musculotendon and fascicle strains during whiplash and to compare these strains to published muscle injury thresholds. SUMMARY OF BACKGROUND DATA: Previous work has shown potentially injurious musculotendon strains in sternocleidomastoid (SCM) during whiplash, but neither the musculotendon strains in posterior cervical muscles nor the fascicle strains in either muscle group have been examined. METHODS: Experimental human subject data from rear-end automobile impacts were integrated with a biomechanical model of the neck musculoskeletal system. Subject-specific head kinematic data were imposed on the model, and neck musculotendon and fascicle strains and strain rates were computed. Electromyographic data from the sternocleidomastoid and the posterior cervical muscles were compared with strain data to determine which muscles were being eccentrically contracted. RESULTS: SCM experienced lengthening during the retraction phase of head/neck kinematics, whereas the posterior muscles (splenius capitis [SPL], semispinalis capitis [SEMI], and trapezius [TRAP]) lengthened during the rebound phase. Peak SCM fascicle lengthening strains averaged (+/-SD) 4% (+/-3%) for the subvolumes attached to the mastoid process and 7% (+/-5%) for the subvolume attached to the occiput. Posteriorly, peak fascicle strains were 21% (+/-14%) for SPL, 18% (+/-16%) for SEMI, and 5% (+/-4%) for TRAP, with SPL strains significantly greater than calculated in SCM or TRAP. Fascicle strains were, on average, 1.2 to 2.3 times greater than musculotendon strains. SCM and posterior muscle activity occurred during intervals of muscle fascicle lengthening. CONCLUSIONS: The cervical muscle strains induced during a rear-end impact exceed the previously-reported injury threshold for a single stretch of active muscle. Further, the larger strains experienced by extensor muscles are consistent with clinical reports of pain primarily in the posterior cervical region following rear-end impacts.

Morphology, architecture, and biomechanics of human cervical multifidus.

STUDY DESIGN: Cadaveric dissections and biomechanical modeling were used to study the human cervical multifidus muscle. OBJECTIVES: To describe attachment patterns of the multifidus in the cervical region, to quantify the muscle's architecture, and to use a biomechanical model to calculate the moment-generating capacity of the cervical multifidus. SUMMARY OF BACKGROUND DATA: Deep neck muscles such as the multifidus may play an important role in cervical spine stability and neck pain. However, there are limited data regarding the fascicular attachments or architecture parameters necessary to calculate force and moment. METHODS: The multifidus spinae was studied by dissection of nine cadaveric specimens. Fascicles were grouped according to attachment, and architecture parameters (musculotendon length, fascicle length, and physiologic cross-sectional area) were quantified. The data were used in a biomechanical model to calculate moment arm, force-, and moment-generating capacity of the multifidus. RESULTS: The multifidus originates from the facet capsules of lower cervical vertebrae and the transverse processes of upper thoracic vertebrae. The fascicles span 2 to 5 vertebral segments from origin to insertion, and they insert on the spinous processes and laminae of superior cervical vertebrae. For each fascicular subgroup, musculotendon lengths ranged from 2.0 to 6.9 cm, fascicle lengths ranged from 1.2 to 3.7 cm, and physiologic cross-sectional area ranged from 0.1 to 1.0 cm2. The total moment-generating capacity of the cervical multifidus in the neutral posture was predicted to be approximately 0.7 Nm for extension and lateral bending and 0.3 Nm for axial rotation. CONCLUSIONS: The fascicular attachment pattern of the multifidus spinae in the cervical region appears to be unique to that region. The direct attachment to cervical facet capsules supports a possible role in neck pain and injury. Characterizing the biomechanical function of the multifidus is important for the analysis of normal and pathologic conditions.