their strength if the therapist is unable to keep the target muscle from shortening during its contraction). Next, the antagonistic muscle is resisted using the same process. This cycle is repeated one more time on the target muscle. The resulting stretch on the target muscle usually has a greater effect and lasts longer than passive stretching. (The client may also feel pain at a location away from the trigger point at this time if the trigger point is active. Trigger points that do not refer pain away from their general area are considered latent.) Pressure is maintained until the twitching stops – indicating that the perpetuating electrical signal has been interrupted – and the pain has subsided to at least a 2 to 3 on a scale of 10. Trigger point therapy should not be used if a client is too sensitive to their trigger points being palpated regardless of how beneficial the technique may be. And, as is the case with deep tissue massage, avoid trigger point therapy when your client has a blood disorder or is taking medication that causes hemophilia (prevents blood from clotting) or thrombophilia (increased blood coagulation) since the latter condition may lead to the development of a thrombosis (blood clot).
first taken to the middle of its ROM, then the client is asked to contract the muscle with 90 percent of their strength for seven to 10 seconds against resistance (PNF stretches cannot always be performed, though, as they are contraindicated if a client experiences acute or substantially uncomfortable pain during the stretch’s execution. The client should be asked to reduce Trigger point therapy Sometimes referred to as a form of neuromuscular therapy (NMT), this technique addresses irritable muscle bundles (commonly referred to as knots ) that cause not only local pain, but pain distant from the site of palpation as well. These are clinically referred to as trigger points , electrically active tight spindles of muscle in the general muscle tissue. The tightness and electrical activity found in trigger points helps them to become self-perpetuating; the tightness stimulates an electrical impulse to the muscle spindles and the electrical impulses cause the spindles to contract, causing tightness. Trigger point therapy attempts to relieve these sources of pain through a particular pressure application that requires holding pinpoint pressure upon the irritable muscle bundle until the trigger point begins to throb or twitch. Once this occurs, more pressure is applied until the client says that the pain is about 7 to 8 on a scale of 10. Before beginning the sections on orthopedic tests, note that the specific muscle(s) or joint(s) being tested is given first, followed by how to perform the test and then what the results indicate. Anterior neck flexors test Tests for a dysfunction of the sternocleidomastoid/SCM and/ or the anterior scalene muscle. Begin by having the client in the supine (face up) position on the table with their arm abducted (raised laterally) to 90 degrees and their elbow flexed to 90 degrees with the back of their hand resting on the massage table. The client lifts their head off the table, attempting to tuck their chin to their chest and hold it there. The anterior Anterior-lateral neck flexors test Tests for dysfunctions of the sternocleidomastoid/SCM and/or scalene group. With the client supine on the table, their arm is abducted to 90 degrees and their elbow flexed to 90 degrees with the back of their hand resting 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 Posterior-lateral neck flexors test Tests for dysfunctions of the upper trapezius, levator scapula, splenius capitis, semispinalis capitis and/or the longissimus muscles. The client is supine on the table while the massage therapist lifts their head; the client’s neck should be relaxed and not maintaining the position or assisting the hold. The client will then abduct their arm to 90 degrees with the elbow flexed to 90 degrees, the back of their hand resting on the table. The client Cervical rotation lateral flexion test Tests for hypomobility of the first rib as a cause or contributor of thoracic outlet syndrome. The client should be sitting on the massage table or in a chair with their head rotated away from the side of the body experiencing thoracic outlet pain; e.g. lateral or anterior neck pain, shoulder, arm or hand pain, or numbness Cervical compression test Tests for a cervical nerve compression in the lower cervical spine. The client should be sitting on the table or in a chair with their neck relaxed. The massage therapist is behind the client with their fingers interlaced 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
ORTHOPEDIC TESTS FOR THE NECK
Finally, an ancillary note may be given in addition to test results in the appropriate cases.
neck muscles are considered weak or may be dysfunctional if the client cannot hold their head in flexion against gravity. If a client cannot tuck their chin to their chest, this may also be an indication that the upper trapezius, the levator scapulae and/or the shorter posterior cervical muscles that extend the head are bilaterally hypertonic. head toward their chest, against gravity. The anterior-lateral neck muscles may be weak or otherwise be dysfunctional if the client cannot keep their head in flexion against gravity. This may also be an indication that the upper trapezius, the levator scapulae, splenius capitis, and/or semispinalis capitis on the non-tested side are hypertonic. then actively extends and rotates their neck toward the side being tested while the therapist holds their head in the starting position. Weak or possibly injured posterior-lateral neck flexors are indicated when the client is unable to maintain any strength against the therapist’s resistance. This result may also be caused by extreme hypertonicity of the SCM muscle on the side of the neck not being tested. or tingling in these areas. As the client rotates their head, they will be asked to laterally flex their head towards their chest. Inability to laterally flex their head is likely due to an elevation or other displacement of the first rib caused by hypertonicity of the anterior and middle scalene muscles. is indicative 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 can help relieve stress on the cervical vertebrae that are compressing a nerve. With the client supine on the table, the therapist gently grasps the client’s head at the occiput (base of skull) and temporal area and slowly provides traction (pulling away from the body) for 30 seconds. Pain or numbness due to cervical compression should subside.
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Book Code: MTX1324B
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