client w/ neck pain

Young A

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client of mine has trouble fully flexing neck to shoulder. he feels pain down neck front of pec to shoulder to all the way around the back of shoulder. it's all in that area. what would you suggest, how about heat or cold, when and how should it be used. and what muscles do you think I should concentrate on. He believes he might have just slept the wrong way. thanks...
 
client w/ neck pain

When I wake up from sleeping in a funky position all night I tend to get a neck or back ache. I love those adhesive heating patches made specifically for the low back or the neck. You can wear it right into work under your clothing (though a thin layer of clothing between the skin is recommended). Perfect!Gaiam.com has a sale on their microbead neck warmer that pops into the microwave. It covers the shoulders, collarbone and extends a bit down the chest and back for plenty of yummy warm heat.
 
client w/ neck pain

As long as your client does not have any neuropathic signs & symptoms and you are SURE he does not need to be referred to a MD, I would say working on the SCM, scalenes, and traps I for starters.
 
As long as your client does not have any neuropathic signs & symptoms and you are SURE he does not need to be referred to a MD, I would say working on the SCM, scalenes, and traps I for starters.
I agree. ย Also if you are not trained in trigger point therapy, you might want to refer them to someone who is. ย With all the radiating pain, most likely there are plenty of them helping to cause the pain.For your massage, focus on the cervicals (SCM, Scalenes, Levator scap., Splenius capitus, ect). ย Make sure to include the pecs and the trapezius. ย I would also recommend paying attention to all the attachments at the clavical. ย 
 
Be careful with those adhesive heat patches, Dragonflies. ย Just a few weeks ago one of my clients ended up with a terrible burn from one of those things. ย The blisters took forever to heal. ย Not sure if the patch was defective or if my client is more sensitive to heat than most... ย  Either way, it was enough to make me steer clear of the heat patch permanently ย :(
 
I agree with Masthera and Gaspen. ย I would pay particular attention to the scalenes and pec minor and see if there is any possible brachial plexus entrapment going on. ย Trigger points in these muscles as well as the entrapment could refer pain to where you speak of. ย I would also pay attention to see how severe this clients upper-crossed syndrome might be. :)
 
That sounds to me like your client is suffering from cervical facet irritation. ย Try some long axis traction (sustained) on the cervical spine along with some deeper soft tissue work to the areas where the pain is referring. ย Also before starting do a lower quadrant test to see if he is positive for facet irritation.HTH-Krystyne
 
client w/ neck pain

Your client is feeling pain down the neck to the pecs and shoulder then to the back?Is the pain down the anterior or posterior neck? Is the pain radiating under the arm, in the ribs? It definitely sounds like facet irritation like hockeygirl said, but if the irritation radiates around the body to the back, it could be more of a thoracic facet irritation due to a vertebrae locked in an extended, rotated, sidebent position. Let me know...Jay
 
Hey hockeygirl and Jay, can you explain this lower quadrant test for facet irritation? ย It sounds interesting and I don't believe I've run across it before.
 
The quadrant test as I learned it, ย may be different from how hockeygirl performs the test.The whole concept behind the quadrant test is to basically close the facets of the affected side by placing the vertebrae into an extended, sidebent, rotated position. ex. Suspected closed facet dysfunction on the left - extend, sidebend, and rotate the neck to the left. Apply a light downwards pressure on the neck. A positive sign is irritation on that side.So, if a facet is stuck closed, closing it further and applying pressure down will irritate it. Conversely, you could also create irritation on the OPPOSITE side, in which case, the other side is stuck OPEN, iliciting irritation. To sum it up, make the joint do what it can't do. If it hurts, its a problem.Confused? It is a little tough to explain without showing.Jay
 
So when you say make the joint do what it cannot, in the example that you have given, do you mean flex the head, sidebend to the right and then rotate to the right? ย And if this is correct what is done then? Do you just hold it and wait for the feeling of some sort of release?? ย Sorry to ask so many questions but this is really interesting! ย Thanks by the way for the your reply, I do appreciate it Jay!
 
client w/ neck pain

In the quadrant test, you would extend and then compress the cervical spine by applying pressure to the top of the head. This is merely a test for irritation on the facets.

eg. If you SB right, rotate right and extend the vertebrae and apply the pressure, you may create irritaition on the right, signalling pain due to a locked closed facet.

If you create pain on the left, it could be from the left facet being stuck open. Remember, the left facet would be open as far as possible.

Yes moving to flexion would be doing what it can't do. My mistake for lack of clarity. But remember a vertebrae would be fully closed in extension not flexion.

Moving the head into flexion would be describing a mobilization/manipulation/adjustmant, and we wouldn't want that now would we?

;) ;)

Jay
 
This is very interesting Jay, but Im still not clear as what to do for an intervention if one is to find a facet irritation. ย Do we wait for a release like luckygrl said, or is there some kind of manipulation we can do on it?
 
client w/ neck pain

Treatment of a facet dysfunction proceeds generally like that of a facet dysfunction of the thoracic or lumbar. Identify the muscles of dysfunction. These would be the scalenes on both sides (however, three of the six will be considerably worse, depending on the type of dysfunction. The assessment is fairly simple using translations, but quite difficult to explain. If you'd like I could try... but it might be tough) as well as the longus colli behind the esopagus. Multifidi and rotatores are going to be an issue on the posterior section, obviously. Treat the scalenes in a passive stretch for greater results, using sidebending of the neck to increase as need be. Longus colli is treated by grasping the esophagus and moving it out of the way and using side-to-side transverse frictions. Be careful not to go up and down due to possibility of damage to the ganglia. Stretch out the affected muscles, and apply traction which works great. Isometrics at specific vertebral levels will help increase ROM.In order to do a manipulation, you need to know the specific level and the type of dysfunction, whether its flexion based or extension. You can however use oscillations on the articulating pillar to rock the facet open and closed aiding in the movement of the joint.Again, translatory assessment on the vertebrae is required for manipulations and even those don't always compare to a good adjustment... which is of course beyond our scope...Jay
 
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  35. Moneylee:
    Full season wellness center: New Young girl Big-breasted big Big boobs big butts May, Young girl big breasted beautiful buttocks charming temperament big boobs Vita ,Young girl big boobs beautiful face deep massage Bobo, Young beautiful face sexy body and good deep massage maggie,Enchanting sexy petite deep massage Mary. 2560 Shepard ave Mississauga unit 1 .โ˜Ž๏ธ4379857899 ๐Ÿ‘„๐Ÿ‘„๐Ÿฆต๐Ÿฆต๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿ‘…๐Ÿ‘…
  36. Sunrise Spa:
    ๐Ÿ˜˜ We have a wonderful Asian spa in downtown Toronto ๐Ÿ˜˜ 302 Adelaide St W, 2nd Floor ๐Ÿ˜˜ Today is Mika, Apple and Kitty ๐Ÿ˜˜ 416-916-7276
  37. #203MoMo&Beauty:
    MoonMoon spa/416 887 8801/8131Yonge st #203 white skin Latin Spanish girl &Asian girl today /// Young curvy body Colombia girl in Tuesday
  38. Sparkling Spa:
    Sexy Korean Massage Girl Summer is working at Sparkling Spa with Service Queen Zoe today. Real pictures of Summer & Zoe๐Ÿ’ฏ๐Ÿ’ฏCall or text to book appointment ๐Ÿ“ฒ โšก๏ธ๐ŸŒŸSPARKLING SPAโšก๏ธ๐ŸŒŸ โœ…50 Lockridge Ave Unit 8โœ… ๐Ÿ‘ŒMarkham, ON L3R 8X4๐Ÿ‘Œ โ˜Ž๏ธ (905) 604-8186 Spa Land Lineโ˜Ž๏ธ โ˜Ž๏ธ (437) 446-6688 NEW Spa Cell Phoneโ˜Ž๏ธ (West of Warden & 16th Ave) OPEN 10am to 9pm MONDAY to SUNDAY
  39. wonderspa:
    ๐ŸŒบ๐Ÿ’„๐Ÿ˜ป Wonder spa [9421Jane st unit 127)Please โ˜Ž๏ธ4165000-800,4young girl working every day,๐Ÿ’„Amy is Vietnamese young sex girl,open maid,๐Ÿ’„Mimi is younge sexy girl beautiful face long leg,most of all she know how to make man happy,๐Ÿ’„Mina is36DCup smooth skin ,she can provide back walking nice body slide,get more experience soft to medium, must try๐Ÿ˜๐Ÿ˜๐ŸŒบ
  40. Red Rose Spa:
    ๐ŸŒธ We have 5 hot brown girls today ๐ŸŒธ LUCY, ASHA, NISHA, ANGEL, MEERA, DIYA, NUR, PAYAL PEARL, MIMI ๐ŸŒธ 2588 Birchmount ๐ŸŒธ 2 Invergordon ๐ŸŒธ 647-702-8800 ๐ŸŒธ Please visit for a great erotic massage
  41. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅTODAYโ€™s ROSTER INCLUDES: Rose๐ŸŒน - A sexy new addition to our lin
  42. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Today๐ŸŒธYoyo๐ŸŒธCarly๐ŸŒธTiffany๐ŸŒธLynda๐ŸŒธTania Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  43. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Meet๐ŸŒธIvy๐ŸŒธKim๐ŸŒธCassyCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  44. bnwellness_wilson:
    We have 4 young beautiful girls are working today, young new cute Lily with curve boys 25โ€™s and young slime super GFE 30โ€™s open mind, pretty Ella and sexy Coco are providing deep tissue and sensual massage, pls call 416-3985777 book appointment and walk in always welcome, back entrance and parking available, 350 Wilson Ave North York
  45. AliceSpa:
    MONDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—”, 4915 Steeles Ave. E, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿฎ๐Ÿต๐Ÿด-๐Ÿฌ๐Ÿด๐Ÿต๐Ÿด. 3 Sexy Young Girls Today at Alice Spa, : AMY (12pm โ€“ 9pm) is a young, petite short & slim Taiwanese, former dance instructor, firm natural B Cups, pretty face, firm natural titis, super play good, bbbj, cim, rim, dfk, all services. LISA (12pm-9pm): is a Korean internet celebrity, young early 20โ€™s, milky white skin
  46. See You Health Center:
    Sasa Very Sexy Vietnamese friendly and milfy . body is amazing Natalie she is CBC/filipina mixed Petite school girl 5โ€™ 2โ€, 100 lbs black Hairโ€จGFE, BBbj, DFK Judy is a gorgeous model type Vietnamese Girl โ˜Ž๏ธ416-988-2950
  47. Lulu_Villa_Spa:
    Candy She is a Vietnamese๏ผŒ Face and body to die for. Her smile will make you melt. Sami Gorgeous Model Type CBC Vietnamese School Girl Cici Cute Skinny Sexy Vietnamese Girl With Voluptuous Huge C Melons Provides Amazing Service โ˜Ž๏ธ647- 446-0886
  48. New Oriental Health Centre:
    โค๏ธ Nayla & New Girl Kelly is here today๐Ÿ’„~๐Ÿ“žCall ๐Ÿ“ฒ Text: (647) 381-2688 ๐Ÿ’„Make Your Day Incredibly Delicious ๐Ÿ‘ Our girls provide lots of service options & are Extremely Open-Minded ๐Ÿค— We're Open 9am - 2am everyday! Drop in to Unit 26, 10 East Wilmot Street, Richmond Hill.
  49. Endless Joy Spa:
    โœจโœจโœจโœจโœจ[GRAND OPENING]โœจโœจโœจโœจโœจ ๐Ÿ’žEndless Joy Spa๐Ÿ’ž ๐ŸŽ‡ (155 East Beaver Creek Rd Unit #8, Richmond Hill) 416-731-8565๐ŸŽ‡10am-2am, New First Day Young Slim Petite Chinese Vivi, Tall Slim Sexy Chinese Kelly, Sexy Chinese Coco, Young Sexy Chinese Abie, Young Sexy CBC Rachel.
  50. Sunrise Health Centre:
    ๐Ÿซฆ Angela & Noor are here Today! ๐Ÿ“ž๐Ÿ“ฒ (647) 325-8086 ๐Ÿ’ฆ We have Hot & Sexy Girls Every Day. ๐Ÿ’‹ They all do Extra Services & are Very Open-Minded ~ Drop In Anytime ๐Ÿšถโ€โ™€๏ธ๐Ÿšถโ€โžก๏ธ Walk-Ins Are Always Welcome! Unit 27, 10 East Wilmot Street, Richmond Hill
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