5 minutes: Attendance and Breath of Arrival 50 minutes: Problem Solving Neck
Punctuality- everybody's time is precious: Be ready to learn by the start of class, we'll have you out of here on time o Tardiness: arriving late, late return after breaks, leaving early o The following are not allowed: Bare feet o Side talking o Lying down o Inappropriate clothing o Food or drink except water o Phones in classrooms, clinic or bathrooms o You will receive one verbal warning, then you'll have to leave the room.
Neuromuscular neck pain Hypertonicity either throughout an entire neck muscle or in localized areas of a neck muscle.
o Keeping the head in an upright position places postural strain on cervical muscles and other soft tissues. o Once the head moves forward of the center of gravity, there is a significant increase in muscle activity to hold the head upright.
o This can lead to muscular dysfunction in the form of trigger points or hypertonicity in an entire muscle. o A pain-spasm-pain cycle can result from even slight muscular dysfunction.
o Sudden loading of hypertonic cervical muscles can produce symptoms in other areas such as the temporomandibular joint. o Because many cervical muscles maintain constant isometric contractions during the day just to keep the head erect, patterns of dysfunction are facilitated by the very act of attempting to hold the head upright. o These patterns of dysfunction can have a tendency to recur any time the individual is exposed to physical, psychological, or chemical stressors.
Immobilization using a cervical collar o Variable effectiveness: only used if the pain is severe and joint hypermobility is a serious concern. Rest o Variable effectiveness: continue normal daily functions, but avoid any painful activities. Instruction in body mechanics, stretching, and strength training o Effective: if done properly and regularly Anti-inflammatory medications o Variable effectiveness: reduces pain if there is inflammation
Neuromuscular pain is established by constant reinforcement. Early in your treatment, encourage the client to change these movement patterns to complement the myofascial manipulation. Stretching and flexibility enhancement are essential to treating neuromuscular pain. Stretching is most effective after soft tissue manipulation has enhanced tissue pliability.
This treatment can dramatically alter muscular proprioception resulting in spasms in an easily overloaded muscle. Have the client move slowly and carefully when first getting up from the massage table and for a short time afterward. Clients with sensitivity during head and neck movement may brace with protective muscle guarding. Be aware of these guarding possibilities, and make sure that your treatment encourages relaxation.
Soft-Tissue Treatment: Overview Supine Positioning Sit at the head of the table facing down toward the feet Work on one side of the neck at a time Work with one hand. Hold the head with the other hand Slightly rotate the head away from the side that you are massaging Cervical Superficial fascia assessment Myofascial release Repeat on the other side Swedish Effleurage One thumb fulling Deep longitudinal stripping Trigger point deactivation Lamina groove deep longitudinal stripping Repeat on the other side Deep longitudinal stripping with active lengthening Cervical extensors Cervical lateral flexors Repeat on the other side Stretches Neck lateral flexion Neck rotation Repeat on the other side
Positioning o Sit at the head of the table facing down toward the feet o Work on one side of the neck at a time o Work with one hand. Hold the head with the other hand o Slightly rotate the head away from the side that you are massaging
Cervical superficial fascia assessment o Work without lubricant o Use your palm and fingers to apply light tangential pulling pressure o Place your fingertips flatly on the skin surface o Press in just enough to traction the superficial fascia without sliding o Slowly traction in all directions taking note of restrictions o Use before and after treating superficial fascia to gauge progress
Cervical myofascial release o Work without lubricant o Place both hands flatly on the skin surface about 4-6 inches apart o Use your fingers or palms to apply light tangential pulling pressure o Press in just enough to traction the superficial fascia without sliding o Hold. Wait for a subtle tissue release or indication from the client o Repeat in different directions and areas to address restrictions in the anterior, lateral, and posterior cervical areas.
Cervical Swedish o Effleurage longitudinally along all cervical muscles o Fulling with one thumb across the cervical muscle fibers o Repeat until the muscles are thoroughly warmed and softened
Cervical deep longitudinal stripping o Be cautious of blood vessels, nerves, and the trachea o Use fingertips or thumb to work in 2-4 inch sections o Work in either a superior or inferior direction o Pause or repeat in areas of palpated or reported tension o Progress from moderate to deep pressure within client comfort o Address the anterior, lateral and posterior cervical muscles
Cervical trigger point deactivation o Use client report and palpation to locate trigger points o Melt in using the steps of the fulcrum. Hold points for 8 seconds repeat to address all trigger points
Lamina groove deep longitudinal stripping o Use your thumb or fingertips. Work inferiorly in 2-4 inch sections o Pause or repeat in areas of palpated or reported tension o Progress from moderate to deep pressure within client comfort
Cervical extensor deep longitudinal stripping with active lengthening o Continue to hold the client’s head, but bring it back to neutral o Instruct the client: • “Using moderate pressure (25%), press your head back into the hand that is holding it.” (isometric neck extension) • “Slowly relax your head” (post-isometric relaxation) • “Now lift your head up and bring your chin toward your chest.” o As the client does this, strip the cervical extensors inferiorly with the fingertips of the free hand o Repeat a few times.
Cervical lateral flexor deep longitudinal stripping with active lengthening o Allow the client’s head to rest on the table. o Stand along the side of the table by the waist facing toward the head o Place your hand along the side of the head to resist lateral flexion o Instruct client: • “Keeping your nose pointing toward the ceiling, slide your left/right ear toward your left/right shoulder.” • “Use moderate pressure (25%) to press the side of your head into my hand that is resisting the movement.” (isometric) • “Slowly relax the head” (post-isometric relaxation) • “Now slowly slide your head toward the opposite shoulder.” o As the client does this, strip the lateral flexors inferiorly with the fingertips of the free hand o Repeat a few times.
Lateral neck flexion stretch Neck rotation stretch
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