1. Chapter 5
Head and Neck

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

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

4. 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

5. 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

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

7. 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

8. 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

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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

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

28. 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

29. 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

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

31. 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

32. Attachment sites for corrugator supercilii

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

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

35. 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

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

37. 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

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

39. 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

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

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

42. Answer
B. Epicranius