the superior angle of the scapula. Among other actions, the levator scapulae unilaterally flexes the head and rotates the head to the same side. This muscle can be treated with directional massage, myofascial release, trigger point therapy, and some stretches. Once again, directional massage and myofascial release will be done from the head towards the body. Trigger point therapy may be more beneficial, though, as trigger points are exceedingly common near or at the muscle’s insertion. Stretches for the levator scapulae should involve mostly passive stretches, as AC and CRAC stretches involve the contraction of too many muscles to be practical, time management wise. Finally, the suboccipital muscles are eight muscles (four on each side) that lie just inferior to the skull’s occipital bone, deep to the upper trapezius. These muscles serve to rotate, extend, and laterally flex the head. By themselves, this muscle group is relatively weak, making it prone to sprains and strains. When these muscles are injured, the resulting pain is almost always accompanied by inflammation and is tender to the touch. (As always, avoid hot stones if inflammation is present.) The application of ice before massaging the suboccipitals will do much to ease the athlete’s discomfort when performing the necessary cross fiber friction along the inferior portion of the occipital bone and moving towards the mastoid process. Trigger points can routinely be found by applying finger pressure in this area (as if trying to reach under the occipital bone), which will result in a pain referral to the area behind and above the ear. The suboccipital muscles are not particularly well-suited for stretches. While it is not uncommon for neck muscles to be injured during competition, sometimes an injury is more serious and involves an injury to the cervical spine itself, such as a herniated disc. Massage therapists are only qualified to work on soft tissue structures such as muscles, tendons, and ligaments. Therapists should never attempt to fix a herniated disc by pushing the disc back into place. In such cases, therapists may either massage to relieve the tension in muscles surrounding the herniated disc or otherwise follow a course of action outlined by the athlete’s physician. Additional treatment and prevention NSAIDs will help alleviate the inflammation associated with a suboccipital injury. Kinesio tape has been shown to be a very effective aid for the upper trapezius and levator scapulae. Tension in the upper trapezius and scalenes can be reduced with the application of heat, such as a hot towel around the upper shoulders and neck. Cervical injuries are most common in contact sports such as football, hockey, and wrestling, as well as several non-contact sports such as diving and power lifting. It is estimated that among football players alone, a minimum of 10-15 percent of players will suffer a neck injury some time during their career due to the greater body weights colliding against each other at high velocity. a concussion, it is not always diagnosed. However, athletes who suspect a concussion should be diagnosed by a physician as undiagnosed and untreated concussions often increase the chance of returning to their sport and suffering a secondary concussion which may be more traumatic to the brain and possibly even fatal. Among the massage techniques listed in Section I, none will provide any specific relief for the symptoms of a concussion. Craniosacral massage therapy, in which the large bones of the skull (the frontal, parietal, occipital, and temporal bones, respectively) are manipulated to help move cerebral
with directional massage, myofascial release, stretches, and trigger point therapy. Note that doing direction massage and myofascial release will be done from insertion towards origin with this muscle and that because of this muscle’s proximity to the trachea (windpipe), it can be uncomfortable for the athlete. Trigger point therapy (if trigger points are indicated by pain behind or in the ear, or by pain just above the eyebrow) can be done by pinching the SCM between the thumb and fingers and drawing the SCM away from the trachea which may be a slightly more comfortable approach to an SCM injury. Passive stretches are most suitable for stretching the SCM; therapists should avoid AC and CRAC stretches, as these techniques are often reported as being uncomfortable for SCM injuries. Next, the scalenes group (anterior, medial, and posterior scalene muscles) collectively originate from the transverse processes of C2 to C7 and insert onto the first and second ribs. An injury to one or more of the scalene muscles may be indicated by pain when flexing the neck to the same side as the scalenes, or by pain upon inhalation, as the scalenes assist breathing by elevating the first two ribs. Treating the scalenes can be done with deep tissue, directional massage, hot stones, myofascial release, stretching, and trigger point therapy. Therapists can apply deep tissue massage to the scalenes with a thumb or the first two fingers, working from insertion to origin. As with the SCM, deep tissue, directional massage, myofacial release, and trigger point therapy (if trigger points are indicated by pain to the upper arm or thumb and index finger) for the scalenes should be done from the head towards the body, although it is not expected that the insertion at the ribs will always be reached, particularly if an athlete has well-developed upper trapezius or pectoralis muscles. Particularly tense scalenes are a prime candidate for the application of long, flat hot stones to reduce tension. Any stretching technique is also suitable for the scalenes, although CRAC stretches are particularly beneficial since CRAC stretches utilize opposing scalene groups to relieve their own tension. The upper trapezius muscles originate at the occipital protuberance and medial superior nuchal line and insert at the spine of the scapula, the acromion, and the lateral one- third of the clavicle. In relation to other neck muscles, the upper trapezius muscles are strong, and it is uncommon for them to be sprained or strained. When a strain does occur near the trapezius muscle’s origin, the injury is actually to the suboccipital muscles, which are much weaker. However, the upper trapezius can become extremely tense due to their long and broad nature. Tension in the upper trapezius is best treated with petrissage, hot stones, and trigger point therapy, with petrissage and hot stones targeting the belly of the muscle. Conversely, trigger point therapy (if trigger points are indicated by pain in the posterior neck or temples), will usually be found near the insertion at the acromion and lateral third of the clavicle. Levator scapulae, below the upper trapezius, originates from the transverse processes of C1 to C4 and inserts at Concussion Concussions result from a blow to the head and are common in contact sports. Although there are several grades of concussion, the general symptoms include amnesia, confusion, difficulty concentrating, depression, disorientation, dizziness, headaches, fatigue, feelings of lost time, a loss of balance, pressure or pounding in the head, sensitivity to light or noise, tinnitus, nausea, vomiting, and vision problems. In some cases, a concussion will be accompanied by a loss of consciousness, though a loss of consciousness does not necessarily indicate more severe symptoms. Due to the number of symptoms involved with
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