Advanced Massage Therapy for Head & Neck Muscles

1. Chapter 5 Head and Neck

2. Chapter Objectives • Overview of Head and Neck Region • Posterior Cervical Muscles • Anterior Cervical Muscles • Head and Face Muscles

3. Overview • Muscle overview • Trigger points (TP) and referral zones • Trigger point activation • Stressors and perpetuating factors • Precautions and massage therapy (MT) considerations

4. Suboccipitals: The Rock and Tilt Muscles • Rectus Capitis Posterior Major and Minor • Obliquus Capitis Superior and Inferior • 4 pairs of short, small and posterior muscles • Indicated in severe headaches Attachment sites for the suboccipitals

5. Suboccipitals cont’d Suboccipitals TP: • Located in muscle belly • Difficult to distinguish from semispinalis trigger points Referral Zones: • Refer behind, above, in front of ear • Sensation extends forward unilaterally to occiput, and eyes

6. Subocciptals Trigger Point Map Trigger points and referral zones for the suboccipitals

7. 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

8. 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

9. Levator Scapulae: The Stiff Neck Muscle • Inserts in two layers • Bursa found between two layers Attachment sites for the levator scapula

10. 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

11. 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 and posterior shoulder

12. Levator Scapulae Trigger Point Map Trigger points and referral zones for the levator scapulae

13. Stressors and Perpetuating Factors Levator Scapulae TP Activation: • Postural stress, occupational stress or sleep position Stressors and Perpetuating Factors: • Overexertion in sports • Using crutches or a cane • Sleeping in a airplane seat

14. 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

15. 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

16. 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

17. SCM Trigger Point Map Trigger points and referral zones for the sternal head of the SCM Trigger points and referral zones for the clavicular head of SCM

18. Stressors and Perpetuating Factors SCM TP Activation: • Awkward head posture • Mechanical overload Stressors and Perpetuating Factors: • Sleeping on back with too many pillows • Drooping shoulders, slouched posture

19. Precautions and Massage Considerations Precautions: • Avoid the carotid artery • Avoid the styloid process MT Considerations: • Rotate head toward the working side • Use a pincer compression

20. 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

21. 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

22. Stressors and Perpetuating Factors Scalenes TP Activation: • Activation secondary to SCM trigger points Stressors and Perpetuating Factors: • Pulling, lifting or carrying heavy items • Scoliosis • Respiratory issues

23. Precautions and Massage Considerations 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

24. 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

25. 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

26. 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

27. Suprahyoids cont’d Attachment sites for the suprahyoids Trigger points and referral zones for the diagastric

28. 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

29. 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

30. Epicranius Trigger Point Map Trigger points and referral zones for the occipitalis Trigger points and referral zones for the frontalis

31. 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

32. Attachment sites for corrugator supercilii

33. Temporalis • Key player in TMJ Trigger Points: • Refer to teeth, maxilla, eyebrows • Causes hypersensitivity in teeth • Activated and stressed by bruxism and gum chewing

34. Temporalis Trigger Point Map Trigger points and referral zones for the temporalis

35. 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

36. Masseter Trigger Point Map Trigger points and referral zones for the masseter

37. 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

38. Medial Pterygoid Trigger Point Map Attachement sites for the medial pterygoid Trigger points and referral zones for the medial pterygoid

39. 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

40. Lateral Pterygoid Trigger Point Map Attachment sites for the lateral pterygoid Trigger points and referral zones for the lateral pterygoid

41. Review The galea aponeurotica is associated with which of the following muscles? • A. SCM • B. Epicranius • C. Lateral pterygoid • D. Scalenes

42. Answer • B. Epicranius