Anterior-lateral neck flexors endurance test This tests for a weakness of the sternocleidomastoid (SCM) and the scalenes group. With the client supine on the table, the client rotates their head 90 degrees (or a far as possible) away from the side being tested. The client then tries to laterally flex their head toward their chest, against gravity. The anterior-lateral neck muscles are considered weak if the client cannot keep their head in flexion against gravity for less than 20 seconds. This may also be an indication that the upper trapezius, the levator scapulae, splenius capitis, and/ or semispinalis capitis on the nontested side are hypertonic. As in the previous test, applying directional massage, myofascial release, or PNF stretches to the hypertonic muscles may improve neck flexor endurance (Cleland et al., 2020). Posterior neck extensors endurance test Tests for a weakness of the upper trapezius, levator scapula, splenius capitis, semispinalis capitis, and/or longissimus muscles. The client is supine on the table while the massage therapist lifts their head 1 inch off the table; the client’s neck should be relaxed and not maintaining the position or assisting the hold. The client then actively extends and rotates their neck toward the side being tested while the Cervical rotation and lateral neck flexion test This tests for hypomobility of the first rib as a cause or contributor of thoracic outlet syndrome, which involves the brachial nerve plexus. The client should be sitting with their head rotated away from the side of the body experiencing thoracic outlet pain, such as neck, shoulder, arm, thumb, or index finger pain or numbness, tingling, or burning in these areas. As the client rotates their head, they will be asked to laterally flex their head toward their chest. Inability to laterally flex their head is often due to an elevation or other displacement of the first rib caused by hypertonicity of Cervical compression test This tests for a cervical nerve compression in the lower cervical spine (regarded as C3-C7). The client should be seated with their neck relaxed. Standing behind the client, the therapist will interlace their fingers on top of the client’s head. The therapist then gently compresses the head inferiorly. A positive result typically comes in one of two forms: The first is pain or numbness radiating down or toward one or both arms; the second is pain or numbness locally in the neck region. Pain or numbness radiating down or away from the neck region is indicative Costoclavicular syndrome test This tests for a compression of the brachial plexus (and/ or the subclavian artery) between the clavicle and first rib. The client should be seated. The therapist stands behind the client and passively depresses and retracts the scapula. Swallowing test This tests to see if difficulty or pain upon swallowing is due to trigger points in SCM. The client should be supine on the table. The therapist will grasp one side of the SCM between their first two fingers and their thumb and palpate the length of the muscle while asking the client where the most tender point in the SCM is. Once the most tender point has been found and compressed to 7 on the pain scale of 10, Three knuckle test This tests for hypomobility of the temporomandibular joint (TMJ). The client may either lay supine, sit, or stand. The client will open their mouth as wide as possible. Then, they are to try and fit as many of their flexed fingers (in
Healthcare Consideration: Any orthopedic test that involves contraction of the anterior-lateral scalene muscles (anterior and middle scalene) may innervate the brachial nerve plexus that runs through the two muscles. Numbness, tingling, burning, or sharp pain down the arm would be reliable indicators that hypertonic scalenes are compressing the brachial nerve plexus. Myofascial release and PNF stretches are the most appropriate manual techniques to release these muscles as directional massage and trigger point therapy risk further compression of these muscles (Cleland et al., 2020). therapist holds their head in the starting position. Weak posterior-lateral neck flexors are indicated when the client is unable to maintain strength against the therapist’s resistance. This result may also be caused by bilateral hypertonicity of the SCM muscles. PNF stretches and trigger point therapy (via pinching of the muscle) may relieve SCM’s hypertonicity (Cleland et al., 2020). the anterior and middle scalene muscles. The client should consult a physician for a diagnosis before proceeding with any manual therapy (Cleland et al., 2020). Healthcare Consideration: In cases where a skeletal structure is involved in a dysfunction, even if a muscle is suspected of being the primary cause of such a dysfunction, thus making the dysfunction both a structural and functional issue, a client should consult a physician for a diagnosis (Cleland et al., 2020). of a nerve root impingement while local pain or numbness is more symptomatic of joint or cervical disc damage. In the case of a nerve root impingement, the cervical distraction technique (that is, traction of the head away from the body for 30 seconds or longer) can help relieve stress on the cervical vertebrae that are compressing a nerve. Any pain or numbness due to a cervical compression should subside and is a further indicator of a nerve root compression. The client should consult a physician for a diagnosis (Cleland et al., 2020). Numbness, tingling, or burning down one or both of the client’s arms indicates a neurovascular compression. This is normally a structural issue that manual techniques in the course cannot treat (Cleland et al., 2020). the client is asked to swallow. Difficulty or pain swallowing due to a trigger point will be indicated by reduced pain or tenderness when the client swallows. Trigger point therapy as a course of treatment is indicated. Note that difficulty or pain swallowing may also be a symptom of a local infection, a hematoma, a boney cervical overgrowth, or a tumor (Cleland et al., 2020). the form of a fist) as possible into their mouth. The TMJ is considered hypomobile (low ROM) if the client can only fit one to two flexed fingers in their mouth. Both the masseter and temporalis muscles should be examined bilaterally
EliteLearning.com/Massage-Therapy
Book Code: MPA0825
Page 80
Powered by FlippingBook