14-1 Kinesiology for Manual Therapies Chapter 14 The Balancing Act: Structural Perspectives of the Head and Neck and Dimensional Massage Techniques McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-2 Learning Outcomes o 14-1 Define key terms. o 14-2 Explore on a partner the origins and insertions of the muscles of the head and neck specific to this chapter. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-3 Learning Outcomes (cont.)  14-3 Organize and list the agonists and antagonists that produce and oppose the movements of the head and neck.  14-4 Review general pathologies and conditions of the muscles of the head and neck. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-4 Learning Outcomes (cont.)  14-5 Discuss a treatment protocol for conditions of torticollis, stiff neck, whiplash, and tension headache.  14-6 Demonstrate safe body mechanics.  14-7 Practice specific techniques on the head and neck muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-5 Learning Outcomes (cont.)  14-8 Incorporate dimensional massage therapy techniques in a regular routine or use them when needed.  14-9 Determine safe treatment protocols and refer clients to other health professionals when necessary. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-6 Introduction  This chapter offers a close look at the structure and movement of the head and neck, specific information on pertinent muscles, injuries and overuse syndromes, and nerve complaints.  Treatment protocol and dimensional massage techniques for individuals with tension headaches are outlined for practice. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-7 Structural Perspectives of the Head and Neck  The head weighs pounds and perches on 7 cervical vertebrae and is supported by muscles, tendons, and ligaments.  Head and neck actions are complicated by the weight of the head and gravity. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-8 Structural Perspectives of the Head and Neck (cont.)  The posterior cervical muscles work hard to combat and oppose flexion in extension.  The muscles of the head and neck are in constant states of concentric and eccentric contraction depending on the position of the head. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-9 Structural Perspectives of the Head and Neck (cont.)  Analyzing the actions of the muscles, the agonists, synergists, antagonists, and stabilizers are important to taking a dimensional approach to the head and neck region. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-10 The Muscles  Muscles listed are involved in tension headaches, stiff necks, and postural problems.  Refer to Chapter 4 and review the muscles of the shoulder girdle. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-11 The Muscles (cont.) Trapezius  The upper and lower trapezius acts as its own agonist and antagonist.  It provides a connection between the thoracic region and the head and works to bilaterally extend the head.  The weight of the extremities pulls on the trapezius. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-12 The Muscles (cont.) Levator Scapulae  The levator scapulae elevates the scapula.  Repetitive action of elevating the scapula could result in a pull on the cervical vertebrae affecting the curve.  The muscle’s hypertonicity could contribute to tension headaches and stiff necks. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-13 The Muscles (cont.) Rhomboids  Rhomboids lengthen with rounded shoulders and head-forward postures.  This posture puts a lot of stress on the posterior cervical muscles leading often to tension headaches. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-14 The Muscles (cont.) Splenius Capitis and Splenius Cervicis  These muscles work both bilaterally and unilaterally.  Splenius capitis rotates the head to the same side and assists the SCM in lateral flexion.  Both muscles extend the head bilaterally. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-15 The Muscles (cont.) Splenius Capitis and Splenius Cervicis  Splenius cervicis torques on the cervical spine.  These muscles have the unique ability to rotate the head while other side extends the neck.  Both muscles are involved in whiplash injuries, tension headaches, and stiff necks. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-16 The Muscles (cont.) Longissimus Capitis  The longissimus capitis is part of the erector spinae network.  It bilaterally extends the head and unilaterally flexes and rotates the head to the same side.  It is layered beneath the splenius capitis and SCM making a tender area near the occipital bone. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-17 The Muscles (cont.) Semispinalis Capitis and Cervicis  The semispinalis capitis cushions the trapezius and together they both support the head with extension.  The semispinalis capitis can entrap the greater occipital nerve as it travels to the scalp. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-18 The Muscles (cont.) Rotatores and Multifidi  The rotatores and multifidi are deep paraspinal muscles.  Bilaterally they help extend the spine and unilaterally they help rotate the spine to the opposite side.  The multifidi contribute to lateral flexion. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-19 The Muscles (cont.) Suboccipitals  The suboccipitals provide support for the 1 st and 2 nd cervical vertebrae and are the deepest layer of muscles in the posterior neck.  Rectus capitis posterior minor extends the head bilaterally and is often a source of tension and soreness. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-20 The Muscles (cont.) Occipitofrontalis  The occipitofrontalis is a combination of the frontalis and occipitalis.  The posterior cervical muscles affect the tension of the occipitofrontalis through the connection at the occiput. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-21 The Muscles (cont.) Temporalis  The temporalis is shaped like a shell and covers the side of the head extending superiorly above the ears.  It can develop trigger points in individuals with tension headaches and those who suffer from temporomandibular joint (TMJ) syndrome. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-22 The Muscles (cont.) Sternocleidomastoid  SCM bilaterally flexes the head, laterally flexes to the same side, and rotates to the opposite side.  It extends the head bilaterally at the atlanto-occipital joint.  It shares the accessory nerve with the trapezius. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-23 Injuries and Overuse Syndromes Whiplash  Whiplash is an injury resulting from a sudden impact that causes a violent hyperextension of the head and neck followed by hyperflexion and perhaps an additional hyperextention.  Muscles involved may include the SCM, scalenes, longus colli, suboccipitals, splenis capitis and cervicis, levator scapulae, and many posterior cervical muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-24 Injuries and Overuse Syndromes (cont.) Torticollis  Torticollis or wry neck refers to a spasmodic contraction of the neck muscles mostly the trapezius and sternocleidomastoid, as they both share the spinal accessory nerve.  Clients with torticollis need a diagnosis and it may or may not be contraindicated for massage therapy. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-25 Injuries and Overuse Syndromes (cont.) Headaches  A headache is defined as a diffuse pain in various areas of the head where the pain is not confined to the distribution of a nerve.  There are 13 different classifications of headaches and two basic categories that physicians use for diagnosis. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-26 Injuries and Overuse Syndromes (cont.) Headaches  The primary category includes classifications of migraine, tension-type, and cluster headaches.  The secondary category includes headaches associated with structural lesions, trauma, vascular disorders, nonvascular intracranial disorders, substances or withdrawal from them, metabolic disorder, facial and cranial pain, and cranial neuralgias. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-27 Injuries and Overuse Syndromes (cont.) Headaches  Tension headaches can be caused by shoulder tension as a result of repetitive action and/or posture.  The Touch Research Institute has shown that massage between headache episodes can reduce the number of headaches, decrease pain intensity, lower stress hormone levels, increase regular sleep patterns, and increase serotonin levels. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-28 Other Soft-Tissue Issues Stiff Neck  The stiff neck is a catchall for limitations in neck movements.  Causes include: sleep positions, posture, repetitive actions, compensatory changes from other injuries, and postoperative and viral infections. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-29 Nerve Complaints Occipital Nerve Entrapment  Occipital nerve entrapment occurs when the greater occipital nerve becomes entrapped by semispinalis capitis and subsequently the trapezius.  Sufferers complain of numbness, pain, and tingling in the back of the head. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-30 Nerve Complaints Scalenes  Scalenes are anterior cervical muscles that insert into the 1 st and 2 nd ribs.  The are synergists to the SCM and are involved in respiration.  They also surround the brachial plexus and are capable of entrapping the plexus. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-31 Arthritis, Osteoarthritis, Degenerative Disk Disease, and Cervical Subluxations  Pain, numbness, and tingling with passive movement may help distinguish a problem in the cervical region.  If a cervical involvement is suspected it is appropriate to refer. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-32 Unwinding the Muscles of the Head and Neck  Relieving the tension in the head, neck, and shoulders helps to balance the head on the neck, assists with appropriate postural alignment, supports chiropractic adjustments, increases range of motion, and reduces pain and/or soreness. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-33 Unwinding the Muscles of the Head and Neck (cont.)  Use the headache questionnaire in the Appendix for individuals complaining of tension headaches.  Do not treat a client who is experiencing a migraine during treatment time.  Refer clients who present with a headache and high blood pressure. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-34 Unwinding the Muscles of the Head and Neck (cont.)  Do not work with a new client who is experiencing a headache - reschedule.  Successfully working with clients with headaches requires a careful approach, complete information, good observation skills, critical thinking, excellent palpations, and appropriate techniques.  Review Treatment Protocol. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-35 Sequence for a Tension Headache  No heavy smells or scented lubrications  Use a fairly dark unlit room  No music  Leave time for the client to rest  Use a cervical roll at the end of the treatment  Support the client with comfort and appropriate bolster McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-36 Dimensional Massage Therapy for the Muscles of the Head and Neck  Center yourself well  Wash your hands well  Start supine  Begin with soft soothing strokes on the face  Check the shoulders for roundness, palpate hypertonic tissue, passively shorten muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-37 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Circular Friction on the Frontalis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-38 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Circular Friction on the Temporalis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-39 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Holding Techniques McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-40 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Holding Techniques McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-41 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Circular Friction on the Occipitofrontalis and Scalp Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-42 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Circular Friction on the Occipital Ridge McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-43 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Alternating-Hands Neck Stretch McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-44 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Hands Under the Back McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-45 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Hands Under the Back McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-46 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Edging the Upper Trapezius McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-47 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Effleurage Around the Shoulders McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-48 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Petrissage of the Trapezius McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-49 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Opposite-side Petrissage of the Trapezius McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-50 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Closed-Palm Shaping McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-51 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Cervical Work McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-52 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Neck Stretch to Side McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-53 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache The Neck Rock McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-54 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Treating the Sternocleidomastoid McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-55 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Stripping the Scalenes Starting Position McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-56 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Stripping the Scalenes End Stroke McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-57 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Treating the Deeper Posterior Cervical Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-58 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache  Treat the rectus capitis posterior minor and major and other suboccipitals.  Finish with effleurage around the client’s shoulders.  Place a cold cloth over the eyes and a cervical roll under the neck.  Allow the client to rest for a period of time. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-59 Dimensional Massage Therapy for the Muscles of the Head and Neck (cont.) Techniques During a Tension Headache Cervical Roll McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-60 Chapter Summary  This chapter discussed the structural perspectives of the head and neck and discussed specific muscles that should be treated for soft-tissue problems.  Injuries and overuse syndromes including whiplash, torticollis, and tension headaches was discussed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-61 Chapter Summary (cont.)  Soft-tissue issues and nerve complaints were explored.  Arthritis, osteoarthritis, degenerative disk disease, and cervical subluxations were reviewed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-62 Chapter Summary (cont.)  Treatment protocol and sequence of the muscles of the head and neck areas were outlined for unwinding these muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-63 Chapter Summary (cont.)  Dimensional Massage Therapy techniques for the muscles of the head and neck were depicted for the supine position. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-64 Chapter Review  The Chapter Review is divided into true and false, short answers, and multiple choice questions.  The questions are designed for the students to test their knowledge. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-65 Explore and Practice  Activities in this section are for practice and demonstration.  Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

14-66 Explore and Practice  Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved