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Specific Treatment for
Head and Neck Pain



Body Region: Head and Neck
Conditions Associated with TPs: Headache, stiff neck, eye strain pain, tinnitus
General Symptoms: Most common is headache. The severity can be great and lead a patient to believe it is a migraine. A true migraine has specific symptoms which a specialist should determine. A severe headache is NOT necessarily a migraine.
Common Causal Activities:

Any time there is any injury to the head/neck region is a manner to cause the head to bend forward and/or backward quickly there will be some ligament damage to the cervical structures. This "whiplash" leads to tightening of the muscles and can lead to TPs.

Non-traumatic causes involve anything the person is doing which causes them to hold the head in an unbalanced position in any direction for an extended time, i.e. computer work, typing, working at a table or desk, reading, bending forward to do work, etc. This puts a strain on the muscles of the neck to maintain it's position and can lead to TPs.

Anatomy Picture:
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Self Care:

Since the neck is affected by a wide area of muscles they should all be checked and treated. For initial instructions read the rest of the text below.

Posterior Cervical Muscles from the base of the neck to the bottom of the skull are best done in a seated reclining position with the head falling backward. Interlace the fingers together as in prayer and place the palms and fingers behind the head is a laid back relaxing posture. One palm will cup the head and hold it in place while the thumb of the other hand presses into the muscles in the area between the midline in back and midline on the side of the neck.

The next area is the lower portion of the cervical muscles which actually extend across the top of the shoulders and down the spine to about the middle of the shoulder blades. This is best done with a hook like on the end of a cane or with the fingers of one hand hooked pulling down on the top of the opposite side shoulder while the other hand grasps the wrist and helps pull the arm down.

The third area is the front of the neck. In particular the Sternocleidomastoid (SCM) muscle which runs from the large bone bump behind the ear diagonally down the side and front of the neck to the collar bone (clavicle). This is the muscle seen when a thin person grimaces. Pinch the muscle between the thumb and fingers trying to pinch underneath it and pull it to the surface. The last part of the muscle is under the collar bone and is best treated by pressing the fingertips or thumb into the depression above and behind the collar bone.

Therapist Care:

Since the head and neck involve different planes of the body each must be handled in a different way.The top of the shoulders is best treated with the patient face down or seated by a flat fingers to palm or thumb squeezing while grabbing as much if the muscle as possible. Do this from the base of the neck out to the top of the shoulder. The deeper muscles of the same region are best pressed into with a one or two fingertip point on a hooked hand. If the patient is standing use the other hand to press the treating hand down into the deeper muscles. If the patient is face down form a hook with you hand and pull from the head toward the feet (not from the floor to the ceiling).The lower cervical paraspinals are best treated as described in the Mid-Back instructions.The neck muscles are best treated with the patient face up. Cup your hands under the head with one index fingertip pressing into the muscles of the paraspinals and the suboccipitals. When doing this the head will have a tendency to roll away from the fingertip. Use the palm of the other hand to hold the head in place. Treat only one side at a time. For the suboccipital muscles make sure you are under (inferior) to the ridge of the skull. If you're correct the chin will elevate. If you're too high the forehead will elevate. Make sure you work out sideways to the mastoid process.

The anterior muscles usually only involve the SCM. Have the patient face up. Turn and extend the head just enough to have the SCM stand out. Pinch with fingertip to thumb tip behind the SCM to try to pull it out from the neck. This applies the pressure needed. You don't have to squeeze much - just enough to keep the SCM from slipping through your fingers.

Special Notes: Migraine headaches are due to a change in the blood flow within the brain. TPT does not affect true migraines. However, many times the migraine will be associated with tension of the cervical muscles which can be aided by TPT.

The neck is one of the more complicated regions to treat due to its differing muscles, locations and settings. The best position in which to treat a patient is the supine or face up position. This allows you to use gravity effectively for much of your work and allows you to sit during the process.
The first two hand positions are shown in the pictures to the left and right. The left shows the knife edge of the index finger being supported by the rest of the fingers. This position allows you to treat the base of the skull without using your fingers or thumb. It, also, allows the use of the heel of your hand as a fulcrum so that you can rock the fingers up into the back of the neck instead of lifting it forcefully. The picture to the right shows the hand positions for the balance of the posterior cervical muscles, from the base of the neck to the base of the skull. They are shown for work on the patient's left side. Reverse this process for the right side. The left hand is positioned with two fingers (strength in numbers, three works well, also) ready to press upward toward the ceiling. The right hand is cupped to support the head in position. The process is to set the finger tips in place with the back of the fingers resting on the table for support, then use the cupped hand to roll the head onto the fingers. Once this is accomplished, the fingers are then pressed toward the ceiling to lift the neck and head and to allow gravity to do the work for you. When treating the muscles of the neck, it is normal to have the head rolled onto the cupped hand first while the treating fingers use pressure and tissue slack to find TPs. Once a TP is found, then the head is rolled onto the treating fingers and pressure is applied upward.The two pictures to the right illustrate the head turned to the cupped hand while TPs are found and then rolled onto the fingers to treat the TPs. This process is used for the cervical paraspinal muscles and suboccipital muscles clear out to the Mastoid Process.One key to doing this correctly is to watch the elevation of the chin versus the forehead when elevating the fingers under the base of the skull in the suboccipital muscles. Your fingers should find, and then slide down under the base of the skull, before you press upward.

If not, you will not be getting into the deeper muscles you need to treat.The two pictures above illustrate the correct (left)and incorrect (right) head tilt when pressure is applied. The following video will help youunderstand some of this process.

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TISSUE SLACK



PROPER CHIN LIFT



LATERAL SUBOCCIPITAL

The front of the neck is mainly treating the SCM muscle. Since its purpose is to compliment the posterior muscles, it will tighten up and develop TPs if the ones in the back do so.By turning and raising the chin slightly,
the SCM can be found. Have the patient tense up the muscle a little to help locate and raise it to a position for treatment. Once it's located, use a pinch with the finger tips to get underneath it to lift it away from the rest of the neck. The action is not so much to squeeze or pinch the muscle, but to lift it with enough pinch pressure to keep it from rolling through your fingers and back into its normal position.The two pictures below show the pinch to lift the muscle and hold it away from the rest of the neck while the TPs fades. The second picture shows treating the insertion of the muscle under the clavicle. This is done with a flat thumb pressed lightly under the clavicle. Not much pressure is needed for this application.