neuromuscular technique chapter05

8/3/2019 Neuromuscular Technique Chapter05

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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 5

Head and Neck




Chapter Objectives

• Overview of Head and Neck Region• Posterior Cervical Muscles

• Anterior Cervical Muscles

• Head and Face Muscles




Overview

• Muscle overview

• Trigger points (TP) and referral zones

• Trigger point activation

• Stressors and perpetuating factors

• Precautions and massage therapy (MT) considerations




Suboccipitals: The Rock and Tilt Muscles

• Rectus Capitis Posterior Major and Minor

• Obliquus Capitis Superior and Inferior

• 4 pairs of short, small and posteriormuscles

• Indicated in severe headaches

Attachment sites forthe suboccipitals




Suboccipitals cont’d

Suboccipitals TP:

• Located in muscle belly

– Difficult to distinguish from semispinalis triggerpoints

Referral Zones:

• Refer behind, above, in front of ear

• Sensation extends forward unilaterally to occiput, andeyes




Subocciptals Trigger Point Map

Trigger points and referral zonesfor the suboccipitals


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Stressors and Perpetuating Factors

Suboccipitals TP Activation:

• Develop when trying to control neck flexion

Stressors and Perpetuating Factors:

• Whiplash

• Any sustained awkward head position

• Uncorrected nearsightedness or maladjusted glasses



Precautions and MT Considerations

Precautions:

• Avoid chin poking and jabbing movements

MT Considerations:

• Treat tissue between C1 and occiput

• Treat area between C1 and C2

• Use wave-like motion at base of skull



• Inserts in two layers

• Bursa found between two layers

Levator Scapulae: The Stiff Neck Muscle

Attachment sites forthe levator scapula



Precautions and Massage Considerations

Precautions:

• Observe the transverse process of C1

MT Considerations:

• Use muscle stripping and friction

• Tendonous attachment is fibrotic and easy to locate

• Pay special attention to C1 attachment site



Trigger Points and Referral Zones

Levator Scapulae TP:

• Painful stiff neck often mimics torticollis

Referral Zones:

• Refer to the crook of neck

• Sensation extends to vertebral border of scapulae andposterior shoulder



Levator Scapulae Trigger Point Map

Trigger points and referral zonesfor the levator scapulae




Levator Scapulae TP Activation:

• Postural stress, occupational stress or sleep position


• Overexertion in sports

• Using crutches or a cane

• Sleeping in a airplane seat



Sternocleidomastoid: Amazingly Complex

SCM has both sternal and clavicular head

• Controls posterior head and neck movements

• Refer pain to face and head (not to neck)

• Mimics atypical facial neuralgia

• Mimics tension headaches



SCM Sternal Head Trigger Points cont’d

Sternal head

• Referral felt at mastoid process, occipital ridge and eyes

Creates the following symptoms:

• Blurred vision and sinus congestion

• Unilateral deafness without tinnitus



SCM Clavicular Head Trigger Points cont’d

Clavicular head:

• Refer to the front of head and behind ears

• Pain can extend to cheek and teeth on same side

Causes the following symptoms:

• Dizziness, vertigo, mimics tender lymph glands



SCM Trigger Point Map

Trigger points and referralzones for the sternal head

of the SCM

Trigger points and referralzones for the clavicular head

of SCM




SCM TP Activation:

• Awkward head posture

• Mechanical overload


• Sleeping on back with too many pillows

• Drooping shoulders, slouched posture




Precautions:

• Avoid the carotid artery

• Avoid the styloid process

MT Considerations:

• Rotate head toward the working side

• Use a pincer compression




Scalenes: Anterior, Medius and Posterior

• Associated with thoracic outlet entrapment syndrome

• Scalenes minimus exists in 50-75% of population

• Trigger points difficult to identify and treat

Trigger points and referral zones for the scalenes




Scalenes Trigger Point Map

Scalenes TP:

• Common source of back pain

Referral Zones:

• Refer to chest, scapula, arm, elbow and thumb

• Rarely refer to head





Scalenes TP Activation:

• Activation secondary to SCM trigger points


• Pulling, lifting or carrying heavy items

• Scoliosis

• Respiratory issues





Precautions:

• Avoid direct pressure on brachial plexus and clavicle

• Tight scalenes traps brachial plexus (TOS)

• May mimic carpal tunnel symptoms

MT Considerations:

• Use gliding thumb strokes and rotate head




Anterior Suboccipitals

• Anterior suboccipitals: rectus capitis anterior and lateralis

Trigger points:

• Refer to larynx, neck and mouth

• Activated by controlled flexion

• Stressors include vision problems

• Avoid the styloid process




Longus Capitis and Colli: Military Neck

• Deepest anterior neck muscles

Trigger points:

• Activated by flexion/extension injuries

• Causes difficulty with swallowing and sore throat

• Avoid poking movements during massage

• Use appropriate pressure




Suprahyoids

• Suprahyoids: mylohyoid, geniohyoid and digastric

Trigger points:

• Refer to lateral side of tongue and side of jaw

• Activated by chronic mouth breathing

• Difficulty with swallowing or lump in throat sensation




Suprahyoids cont’d

Attachment sites for thesuprahyoids

Trigger points and referralzones for the diagastric




Occipitalis: The Scalp Tensor

• Occipitalis and frontalis make the epicranius muscle

Trigger points:

• Refer deep in orbit of the eye and eyeball

• Activated and stressed by glaucoma/decreased vision

• Deactivate key trigger points in clavicular portion of SCM




Frontalis

• Also considered a scalp tensor

Trigger points:

• Refer pain in forehead

• Activated by SCM and constant facial expression

• Could create entrapment of supraorbital nerve




Epicranius Trigger Point Map

Trigger points and referralzones for the occipitalis

Trigger points and referralzones for the frontalis




Corrugator Supercilii

• Tiny facial muscle associate with eye headaches

Trigger Points:

• Refer behind the eyes

• Activated by facial expressions of anger and surprise

• Use the pincer grasp




Attachment sites for corrugator supercilii




Temporalis

• Key player in TMJ

Trigger Points:

• Refer to teeth, maxilla, eyebrows

• Causes hypersensitivity in teeth

• Activated and stressed by bruxism and gum chewing




Temporalis Trigger Point Map

Trigger points and referral zonesfor the temporalis




Masseter

• Strongest muscle of the body (for its size)

Trigger Points:

• Refer to teeth, inner ear and eyebrow

• Significantly restrict jaw opening

• Associated with unilateral tinnitus

• Activated by teeth clenching, nail biting, an uneven bite




Masseter Trigger Point Map

Trigger points and referral zonesfor the masseter




Medial Pterygoid

• Only small portion of muscle can be palpated

Trigger points:

• Refer to TM joint area, ears, throat, cheek

• Activated by forward head posture

• Stressed by thumb sucking and anxiety

• Work very gently as muscle is extremely tender




Medial Pterygoid Trigger Point Map

Attachement sites for themedial pterygoid

Trigger points and referral zonesfor the medial pterygoid




Lateral Pterygoid

• The key muscle in managing TMJD

Trigger Points:

• Refer to the TM joint and maxilla

• Activated as satellite trigger points of SCM

• Stressed by bruxism, playing a wind instrument or violin

• Work very gently as muscle is extremely tender




Lateral Pterygoid Trigger Point Map

Attachment sites for thelateral pterygoid

Trigger points and referral

zones for the lateral pterygoid




Review

The galea aponeurotica is associated with which of thefollowing muscles?

• A. SCM

• B. Epicranius

• C. Lateral pterygoid

• D. Scalenes



Answer

• B. Epicranius

neuromuscular technique chapter05

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