Stretches Stretches are used to lengthen muscles, thereby increasing a person’s ROM and allowing their joints to move more freely. There are several stretching methods a massage therapist is likely to use: Passive (or static) stretching; and two types of proprioceptive neuromuscular facilitation (sometimes referred to as PNF stretches or facilitated stretches) . Passive stretching should be a part of every massage therapist’s training and will not be covered here. Passive stretches also pale in comparison to the usefulness of the PNF stretches. The first PNF stretch reviewed here is known as an antagonist contract (AC) stretch. This type of stretch utilizes a reflex known as reciprocal inhibition (RI) to relax a muscle. When performing this stretch, the massage therapist brings the client’s target muscle into its shortest length. Then, keeping the muscle at its shortest length, the client actively contracts the target muscle’s antagonist against the therapist’s resistance for three to four seconds with approximately 20 percent of their strength. This 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 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 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 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 head toward their chest, against gravity. 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 then actively
process is repeated eight to 10 times. The second type of PNF stretch is the contract relax antagonist contract (CRAC) stretch. This stretch takes a client through several rounds of contracting a target muscle and then its antagonist while resisting the client’s ability to move the muscle through its full ROM. The target muscle is 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 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. of 10. (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).
ORTHOPEDIC TESTS FOR THE NECK
results indicate. Finally, an ancillary note may be given in addition to test results in the appropriate cases.
hold it there. The anterior 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. 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. 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.
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