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Thursday, June 23, 2016

Manual Therapy for the Anterior Neck {Guest Post by Dawn Lewis}

Manual Therapy for the Anterior Neck
By Dawn Lewis

Recently I read an article about a woman suing a massage therapist and Massage Envy.  The woman believes that the massage therapist was aggressive enough on her anterior neck that it lead to a stroke.  I do not know if this is possible, but I do not know that it is impossible.  Since that article there have been multiple facebook postings about why bodyworkers should be afraid of the anterior neck.  This I completely disagree with.

We do not make bodywork safer for our clients by being afraid of their bodies or what is happening to them.  We make bodywork safer for our clients by being as educated as we can be.  There are times when we need to send our clients to medical professionals such as doctors, physical therapists, or chiropractors.  But when we see an apparently healthy individual and we are afraid to touch certain areas of their bodies, we do ourselves and our clients a disservice.

We do not make bodywork safer for our clients by being afraid of their bodies

The anterior neck, in particular, is an area we should all know how to work.  Why?  Because humans spend a good deal of their time right now with their necks in flexion and their heads down looking at their devices.  This leads to shortened, tight musculature in the anterior neck.  Shortened, tight musculature in the anterior neck can cause a multitude of issues.

First, a muscle named longus colli runs the length of the anterior cervical vertebrae.  When that muscle is tight, the cervical spine is in flexion.  This pulls the lordotic curve out of the cervical vertebrae, moving the vertebrae toward the posterior plane of the body.  As the neck straightens and moves posterior, the clavicles and sternal manubrium move posterior as well.  This position of the clavicles and manubrium moves the upper rib cage posterior and the scapulas into abduction.  As the scapulas move into abduction, the shoulders round forward.  This all started with a shortened longus colli.

Next, we could look at longus capitis.  Longus capitis originates on the transverse processes of C3 through C6 and inserts on anterior aspect of the bottom of the occiput.  Again, this muscle tightens when we have our head in flexion looking at our devices, reading a book or magazine, doing bodywork, etc..  But this muscle is attached to the head.  When it tightens, it pulls the anterior aspect of the head toward the chest (think chin toward chest).  The natural antagonist muscles to longus capitis are the suboccipital muscles.  In this position, the suboccipital muscles are in stretched position, leading to weakness, and the possibility for suboccipital headaches.

Finally, a head down position leads to tension in the muscles attaching to the hyoid bone in the anterior neck.  These muscles attach the sternum, thyroid cartilage, head, and scapula to the hyoid.  As the chin moves toward the chest, the hyoid is moved inferior and posterior, causing tension in all the hyoid muscles.  This can lead to pain and tension in the mandible, the temporomandibular joints, or the shoulders.

It is imperative that we learn to treat the anterior neck in an effective way.  I have been teaching anterior neck work for decades.  I teach Spontaneous Muscle Release Technique (SMRT), a positional release modality I made up a couple of decades ago.  I was always fascinated by the anterior neck, but while in basic training for massage therapy 23 years ago, I had a learning experience.

I was in my third level massage course, which happened to be neuromuscular.  Please understand that I am in no way being negative about neuromuscular therapy, I am simply telling you about an experience I had.  One day, another student and I decided that we really needed to practice.  We had been avoiding the neck work because we were not very comfortable receiving it in class.  But we had to know it to pass, so we needed to practice it.  I went first.

I did the full neuromuscular neck protocol on her.  It took about an hour.  That night we had class.  When I saw her in class, her neck was red and looked marbled.  It looked like hamburger, I thought.  She was in pain.  I felt terrible.  The red, marbled look and the pain lasted for almost three days.  This turned me off to doing deeper work on the neck.  When I began to develop SMRT, I spent many hours studying the neck and figuring out how I could affect the neck without causing pain.

If we look at our examples above, it is extremely easy to relieve tension in longus colli.  At one point in my career, I was taught to go into the anterior neck, move the esophagus to the side and cross fiber this muscle.  I have it more effective to place my hand on the top of head and manipulate the head position until I get a release in longus colli.  The pressure of my hand on the top of the head is minimal, as are the movements I make to find the correct position.  When longus colli regains length, the curve in the cervical spine begins to reappear.

When the flexion of the cervical vertebrae eases and the natural lordotic curve begins to re-establish itself, the cervical spine moves away from the posterior plane and into a more neutral position.  This allows the clavicles and manubrium to move into an anterior plane, and the scapulas to move to a more neutral position on the back. As a side note, when the clavicles and manubrium move to the posterior plane, as they do when the neck is too straight, a significant amount of tension is created in lower fibers of sternocleidomastoid.  Allowing the position of these bones to move toward a more natural anterior position, instantly eases the pressure on sternocleidomastoid.

In our next example, we had tension in longus capitis that was causing suboccipital muscle weakness and possibly headaches.  Many times this pattern leads to a report from the client that the "problem" is at the base of their head.  When we palpate the suboccipital area, it feels tight, so we work that area.  But, I find that by again placing my hand on the top of the head and moving the head into the needed position, longus capitis is able to release and allow the chin to come away from the chest, which lessens the stretch on and alleviates the pain in the suboccipital muscles.

In both of these examples, I do not have to work directly on the anterior neck.  In our third example, however, direct anterior neck work is beneficial.  SMRT allows us to do this work in a non-intrusive, gentle fashion, while still getting the desired results.  All of the hyoid muscles can be released and returned to normal tone by working with the position of the hyoid, the thyroid cartilage, and the sternum.

Some therapists believe that it is impossible to get the results a client needs by working with a light touch or by working remotely (i.e. using the head to release the neck muscles).  But I believe it is impossible to get the desired results without knowing the possible reasons for the tension in the muscles being addressed and while working in a way that causes pain and tension.  I have taught anterior neck work to almost 2000 therapists (and that number will continue to grow).  Anterior neck work is not something to be frightened of, it is something to be learned and understood.

In my last SMRT: head & neck class, there was a older woman who had been doing massage for over 30 years.  When we got to the anterior neck, she said to me, "I don't really want to practice this because I will never use it.  It scares me and I will never do it to my clients.  But I don't want to disappoint my partner either."  I encouraged her to try it in class, with the understanding that her partner would be very vocal about whether she was hurting her or not.

45 minutes later, by releasing the anterior neck muscles, she felt a significant change in the position of the hyoid and her partners chin had come into an anterior plane.  Her partner sat up, rotated her head around, sighed, and said, "that was awesome!  Thank you so much!  I slept funny last night.  I had a headache and that catch in my throat that makes you want to cough all the time, feels like a knife stuck in your throat.  It's all gone now.  That was great!"

When I see training experiences like this, I get rather irritated at the facebook posts that insight fear and tell us to stop treating this area immediately.  It is essential that we work on the anterior neck, yet most of the students in my SMRT courses do not work this area when they come to class.  Within the few hours that we concentrate on the anterior neck, they become confident in their ability to effect change without causing pain.  If you feel you do not know enough to work this area, by all means, don't - until you have taken a class, and then by all means, do work the anterior neck.

Dawn Lewis owns Full Circle School and teaches Spontaneous Muscle Release Technique or SMRT. Please check out the Full Circle website for live seminar dates, course videos, free sample videos, and other articles. 

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