section will focus on some of the most accurate and widely used tests in order to help therapists gain insight into the value of Assessments for the head and neck muscles Anterior neck flexors test (Tests for dysfunctions of the sternocledomastoid aka SCM and anterior scalenes.) The therapist begins by having the client in the supine (face up) position on the table with their arm abducted (raised laterally) to 90 degrees, elbow flexed to 90 degrees and with the back of their hand resting on the massage table. Client lifts their head off the table, attempting to tuck their chin to their chest and holding it there. The anterior neck muscles are weak or injured if the client cannot keep their head in flexion against gravity. Anterior-lateral neck flexors test (Testing for dysfunctions of the anterior-lateral neck muscles.) The client is supine on the table with their arm abducted to 90 degrees, elbow flexed to 90 degrees, with the back of their hand resting on the table. The client rotates their head away from the side being tested. Client tries to laterally flex their head against gravity. The anterior-lateral neck muscles are weak or injured if the client cannot keep their head in flexion against gravity. Posterior-lateral neck flexors test (Testing for dysfunctions of the posterior-lateral neck flexors.) The client is supine on the table with their arm abducted to 90 degrees, elbow flexed to 90 degrees, with the dorsal surface of their hand resting on the table. Client extends their neck and rotates their head towards the side being tested while the therapist holds the head in position at the temporalis muscle (above the ear). Weak or injured posterior-lateral neck flexors are indicated by the client not being able to hold their head against (Testing for cervical nerve compression in the lower cervical spine.) The client is sitting with neck relaxed, and the therapist is behind the client. Therapist compresses the head inferiorly. A positive result is indicated by pain or numbness radiating down one arm, or pain or numbness locally to the neck or shoulder. Cervical distraction This is not a test, but it is used to relieve stress on cervical vertebrae that are compressing a nerve. The client is supine on the table. Therapist gently grasps the client’s head at the occiput (Testing for dysfunctions of the upper trapezius muscles.) The client is supine on the table. Client abducts their arm to 90 degrees, flexes at the elbow to 90 degrees, and places the back side of their hand on the table. The therapist rotates the client’s head away from the side being tested, then applies light anteriorly directed pressure while the client resists the motion. Weak or injured upper trapezius muscles will be indicated by the client being unable to resist the therapist’s pressure. Middle trapezius strength test Assessments for the shoulder Upper trapezius strength test (Testing for dysfunctions of the middle trapezius.) The client is in the prone (face down) position on the table. Their arm is abducted to 90 degrees then their elbow is flexed to 90 degrees. The client is asked to hold this position, then extend their arm (moving their elbow toward the ceiling) while the therapist resists the movement. Weak or injured middle trapezius muscles are indicated by the client being unable to hold their arm in abduction or pain when moving their elbow. Rhomboid strength test (Testing for the dysfunctions of the rhomboid muscles.) The client is in the prone position on the table. Their arm is abducted between 45 and 90 degrees and the client’s arm is flexed at the elbow to 90 degrees. The client holds their arm in this position, then the client resists the therapist’s forward motion at the elbow. Weakness or injury of the rhomboid muscles is indicated the therapist’s resistance. Cervical compression test
assessments during the interview process of treatment planning. Initial treatment protocols are given in each case as well.
(base of skull) and temporalis and slowly provides traction (pulling away from the body) for 30 seconds. Pain or numbness due to cervical compression should subside. Swallowing test (Testing to see if difficulty swallowing is due to trigger points in the SCM.) The client is supine on the table. The therapist grasps one side of the SCM between their first two fingers and their thumb and asks the client where the most tender point in the SCM is. Once the most tender point has been found, the client is asked to swallow. A trigger point will be indicated by reduced pain or tenderness when the client swallows. Note: Difficulty swallowing may also by a symptom of an infection, hematoma, boney cervical growth, or a tumor. Three knuckle test (Testing for hypomobility of the Temporomandibular Joint aka TMJ.) The client may either lay supine or stand. Client is asked to open their mouth as far as possible. Then, they are asked to fit as many of their flexed fingers (in the form of a fist) into their mouth. The TMJ is considered hypomobile (low ROM) if the client can only fit one to two flexed fingers in their mouth. Employ active-assisted movements to strengthen muscles. First rib mobility test (Testing for displacement of the first rib.) The client is supine on the table with their arm abducted to 90 degrees, elbow flexed to 90 degrees, with the back of their hand resting on the table. The client rotates their head away from the side being tested. Client tries to laterally flex their head against gravity. Limited neck flexion may indicate a displacement of the first rib or hypertension of the scalene muscles. Obicularis oculi strength test Testing for Bell’s Palsy aka inflammation of Facial Nerve VII.) The client is in the supine position or seated and closes eyes. The therapist attempts to open the affected eye with clean or gloved hands while the client resists. Bell’s Palsy may be indicated by the client being unable to keep their eye closed against the therapist’s resistance. If Bell’s Palsy is suspected, the client should be referred to a physician after lymphatic drainage is used on the face to reduce inflammation. by the client’s inability to hold arm in abduction or if they cannot resist the therapist’s directed pressure. Shoulder adductors test (Testing for the hypomobility of the teres major and latissimus dorsi muscles.) The client is supine on the table. The client bends their knees to 45 degrees so that their feet are resting flat on the table. The client then fully flexes their arms over their head until their arms are resting on the table. Hypomobility of the teres major and latissimus dorsi muscles is indicated if the client cannot rest their arms on the table. Employ active-assisted movements to strengthen muscles. Pectoralis major length test (Testing for the hypomobility of the pectoralis major muscle.) The client is in supine position on the table with the client’s arm passively abducted to 90 degrees. Hypomobility is indicated by the arm not dropping below table level. To test the sternal fibers of the pectoralis major, the client’s arm is abducted to 150 degrees. Hypomobility is indicated by the arm not dropping below table level. Employ active-assisted movements to strengthen muscles. Pectoralis minor length test (Testing for the hypomobility of the pectoralis minor muscle.) The client is supine on the table. The therapist sits at the head of the table and observes the position of the shoulders. Hypomobility of the pectoralis minor will be indicated by a forward motion
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