Chapter 5 Head and Neck

Chapter Objectives Overview of Head and Neck Region Posterior Cervical Muscles Anterior Cervical Muscles Head and Face Muscles

Overview Muscle overview Trigger points (TP) and referral zones Trigger point activation Stressors and perpetuating factors Precautions and massage therapy (MT) considerations

Suboccipitals: The Rock and Tilt Muscles Rectus Capitis Posterior Major and Minor Obliquus Capitis Superior and Inferior 4 pairs of short, small and posterior muscles Indicated in severe headaches Attachment sites for the suboccipitals

Suboccipitals cont’d Suboccipitals TP: Located in muscle belly Difficult to distinguish from semispinalis trigger points Referral Zones: Refer behind, above, in front of ear Sensation extends forward unilaterally to occiput, and eyes

Subocciptals Trigger Point Map Trigger points and referral zones for the suboccipitals

Stressors and Perpetuating Factors Suboccipitals TP Activation: Develop when trying to control neck flexion Stressors and Perpetuating Factors: Whiplash Any sustained awkward head position Uncorrected nearsightedness or maladjusted glasses

Precautions and MT Considerations Avoid chin poking and jabbing movements MT Considerations: Treat tissue between C1 and occiput Treat area between C1 and C2 Use wave-like motion at base of skull

Levator Scapulae: The Stiff Neck Muscle Inserts in two layers Bursa found between two layers Attachment sites for the levator scapula

Precautions and Massage Considerations Observe the transverse process of C1 MT Considerations: Use muscle stripping and friction Tendonous attachment is fibrotic and easy to locate Pay special attention to C1 attachment site

Trigger Points and Referral Zones Levator Scapulae TP: Painful stiff neck often mimics torticollis Referral Zones: Refer to the crook of neck Sensation extends to vertebral border of scapulae and posterior shoulder

Levator Scapulae Trigger Point Map Trigger points and referral zones for the levator scapulae

Stressors and Perpetuating Factors Levator Scapulae TP Activation: Postural stress, occupational stress or sleep position Stressors and Perpetuating Factors: Overexertion in sports Using crutches or a cane Sleeping in a airplane seat

Sternocleidomastoid: Amazingly Complex SCM has both sternal and clavicular head Controls posterior head and neck movements Refer pain to face and head (not to neck) Mimics atypical facial neuralgia Mimics tension headaches

SCM Sternal Head Trigger Points cont’d Referral felt at mastoid process, occipital ridge and eyes Creates the following symptoms: Blurred vision and sinus congestion Unilateral deafness without tinnitus

SCM Clavicular Head Trigger Points cont’d Refer to the front of head and behind ears Pain can extend to cheek and teeth on same side Causes the following symptoms: Dizziness, vertigo, mimics tender lymph glands

SCM Trigger Point Map Trigger points and referral zones for the sternal head of the SCM Trigger points and referral zones for the clavicular head of SCM

Stressors and Perpetuating Factors SCM TP Activation: Awkward head posture Mechanical overload Stressors and Perpetuating Factors: Sleeping on back with too many pillows Drooping shoulders, slouched posture

Precautions and Massage Considerations Avoid the carotid artery Avoid the styloid process MT Considerations: Rotate head toward the working side Use a pincer compression

Scalenes: Anterior, Medius and Posterior Associated with thoracic outlet entrapment syndrome Scalenes minimus exists in 50-75% of population Trigger points difficult to identify and treat Trigger points and referral zones for the scalenes

Scalenes Trigger Point Map Scalenes TP: Common source of back pain Referral Zones: Refer to chest, scapula, arm, elbow and thumb Rarely refer to head

Stressors and Perpetuating Factors Scalenes TP Activation: Activation secondary to SCM trigger points Stressors and Perpetuating Factors: Pulling, lifting or carrying heavy items Scoliosis Respiratory issues

Precautions and Massage Considerations Avoid direct pressure on brachial plexus and clavicle Tight scalenes traps brachial plexus (TOS) May mimic carpal tunnel symptoms MT Considerations: Use gliding thumb strokes and rotate head

Anterior Suboccipitals Anterior suboccipitals: rectus capitis anterior and lateralis Trigger points: Refer to larynx, neck and mouth Activated by controlled flexion Stressors include vision problems Avoid the styloid process

Longus Capitis and Colli: Military Neck Deepest anterior neck muscles Trigger points: Activated by flexion/extension injuries Causes difficulty with swallowing and sore throat Avoid poking movements during massage Use appropriate pressure

Suprahyoids Suprahyoids: mylohyoid, geniohyoid and digastric Trigger points: Refer to lateral side of tongue and side of jaw Activated by chronic mouth breathing Difficulty with swallowing or lump in throat sensation

Suprahyoids cont’d Attachment sites for the suprahyoids Trigger points and referral zones for the diagastric

Occipitalis: The Scalp Tensor Occipitalis and frontalis make the epicranius muscle Trigger points: Refer deep in orbit of the eye and eyeball Activated and stressed by glaucoma/decreased vision Deactivate key trigger points in clavicular portion of SCM

Frontalis Also considered a scalp tensor Trigger points: Refer pain in forehead Activated by SCM and constant facial expression Could create entrapment of supraorbital nerve

Epicranius Trigger Point Map Trigger points and referral zones for the occipitalis Trigger points and referral zones for the frontalis

Corrugator Supercilii Tiny facial muscle associate with eye headaches Trigger Points: Refer behind the eyes Activated by facial expressions of anger and surprise Use the pincer grasp

Attachment sites for corrugator supercilii

Temporalis Key player in TMJ Trigger Points: Refer to teeth, maxilla, eyebrows Causes hypersensitivity in teeth Activated and stressed by bruxism and gum chewing

Temporalis Trigger Point Map Trigger points and referral zones for the temporalis

Masseter Strongest muscle of the body (for its size) Trigger Points: Refer to teeth, inner ear and eyebrow Significantly restrict jaw opening Associated with unilateral tinnitus Activated by teeth clenching, nail biting, an uneven bite

Masseter Trigger Point Map Trigger points and referral zones for the masseter

Medial Pterygoid Only small portion of muscle can be palpated Trigger points: Refer to TM joint area, ears, throat, cheek Activated by forward head posture Stressed by thumb sucking and anxiety Work very gently as muscle is extremely tender

Medial Pterygoid Trigger Point Map Attachement sites for the medial pterygoid Trigger points and referral zones for the medial pterygoid

Lateral Pterygoid The key muscle in managing TMJD Trigger Points: Refer to the TM joint and maxilla Activated as satellite trigger points of SCM Stressed by bruxism, playing a wind instrument or violin Work very gently as muscle is extremely tender

Lateral Pterygoid Trigger Point Map Attachment sites for the lateral pterygoid Trigger points and referral zones for the lateral pterygoid

Review The galea aponeurotica is associated with which of the following muscles? A. SCM B. Epicranius C. Lateral pterygoid D. Scalenes

Answer B. Epicranius