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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    Saturday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ 2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Cherry Sara,Tracy & Cindy. Sara is young & slim with nice C Cups, trim waist, sexy bum and long hair. She is vary friendly uses her assets well. Cherry is slim and very beautiful, can deliver a great service experience. Tracy is an incredibly cute & pretty Japanese/Taiwanese mixed
  38. AliceSpa:
    SATURDAY 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. 4915 Steeles Ave. E, Scarborough 416-298-0898 [/color] Alice spa has 3 attractive honeys today. Open 10am to 9pm: CLOUDIA is Vietnamese, young, petite 5'2" & 96 Lbs, B Cup, best rim deep bbbj cim. $40 Room Fee + $80 (incl bbbj & fs). +$20 for rim/cim. Excellent open minded services. SHERRY : is a taller busty
  39. ใ™ใฟใพใ›ใ‚“:
    BESTU WELLNESS
    Yumi , โ€ŠMonicaโ€Š , Rachel , Lilly at BestU WELLNESS.
    CALL OR TEXT โ˜Ž๏ธ: (437) 830-0913 TO BOOK YOUR APPOINTMENT.
  40. HolidaySpa:
    Saturday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: AMY & MAGGIE. AMY is an attractive young lady with larger breasts and a nice bottom. She has outstanding oral skills, and is very popular. Donโ€™t miss out on her special skills! Maggie is sweet, slim and very talented. ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…HOLIDAY SPA๐ŸŒ…๐Ÿ˜Ž๐ŸŒด 3517 Kennedy Rd, Unit 4 (Kennedy Rd & Steeles Ave E)
  41. SugarLoveSpa:
    Saturday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: LINDA, LUNA, SARA, TIFFANY & VIVI. 1270 Finch Ave W (at Keele St), Unit 18. North York. LINDA is a beautiful young Asian mix girl, 60Kgs with big D Cup boobs with pointy nipples, very friendly, bbbj and many services. LUNA is a slim, VERY PETITE and capable Vietnamese beauty, nice natural 34C Cups. Luna can do everything. SARA is beautiful
  42. Spa in Markham:
    GOLDEN FS โ€“ 8380 Kennedy Rd ๐Ÿ“ž 905-258-0777 / 416-688-6886 ๐Ÿ‡ฎ๐Ÿ‡ณ AISHA, ๐Ÿ‡ป๐Ÿ‡ณ CICI (2PMโ€“2AM), ๐Ÿ‡ญ๐Ÿ‡ฐ JOJO (9PMโ€“2AM), ๐Ÿ‡ป๐Ÿ‡ณ MIKA, ๐Ÿ‡จ๐Ÿ‡ด MEGAN (9PMโ€“2AM), ๐Ÿ‡ญ๐Ÿ‡บ VANESSA ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookinggoldenlove
  43. FLOWER Spa - BLUEXADO | Thornhill | VAUGHAN:
    BLUEXADO FS โ€“ #06-1102 Centre St ๐Ÿ“ž 416-357-9797 / 416-678-8668 ๐Ÿ‡ป๐Ÿ‡ณ AMY, ๐Ÿ‡ธ๐Ÿ‡ฌ CANDY, ๐Ÿ‡ป๐Ÿ‡ณ JULIE ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingbluexadolove
  44. FLOWER Spa โ€“ PINK | Scarborough | TORONTO:
    PINK FS โ€“ 3300 McNicoll Ave ๐Ÿ“ž 416-299-5515 / 416-817-3839 ๐Ÿ‡ฎ๐Ÿ‡ท ELINA, ๐Ÿ‡ต๐Ÿ‡ญ MADY, ๐Ÿ‡ป๐Ÿ‡ณ KELLY, ๐Ÿ‡ญ๐Ÿ‡ฐ JOJO ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingpinklove
  45. bnwellness_wilson:
    We have 4 young girls are working today, young sweet Michelle 25โ€™s with big buttocks open mind and sexy flirty Yoyo 36DD with curly body 30โ€™s open mind, young pretty popular Kitty 26โ€™s with curve body open mind and cute GFE Lina are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
  46. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน Three girls every day ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ 5124 Dundas West Street, Etobicoke โ˜Ž๏ธ 416-817-3366 ๐Ÿ‘ Newโ—๏ธNew girl Angela ,so young Petite and pretty๐Ÿ˜‹ open service ๐Ÿ˜œ๐Ÿ˜œ Sexy girl Suki deep massage ๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ Hot and sexy body very provocative service ๐Ÿ˜๐Ÿ˜๐Ÿ˜๐Ÿ˜โค๏ธ You are welcome to make an appointment at any time or walk in directly through the back door. We have ample parking spaces available
  47. luckywellness:
    Lucky Wellness Center 4379721888 295 Eglinton Ave E,Unit 7,Mississauga Today we have two waitresses: Water and Mia. Water is young, beautiful, sexy, fluent in English, and good at massage. Mia is tall, plump, sexy, and has first-class massage skills. She is conscientious and responsible in her work, and has many repeat customers.
  48. Lulu_Villa_Spa:
    Mia new Vietnamese sweetheart girl with amazing personality Suki From Taiwan, sweet girl Bella She is Mexican Gorgeous face Yuki Sweet Singaporean Girl Cici Cute Vietnamese Gir โ˜Ž๏ธ647- 446-0886
  49. DareDevil:
    Blackpink Wellness โ™ฅ๏ธโ™ฅ๏ธ90 Marycroft Ave. Unit #2, Vaughan, โ™ฅ๏ธโ™ฅ๏ธON L4L 5Y1 (647) 395-3188. BEAUTIFUL AND SEXY GIRLS TODAY: ๐ŸŒน๐ŸŒนSuperstar Lisa, Sexy Indian Girl Radika and Beautiful Tiffany on duty๐ŸŒน ๐ŸŒน
  50. DareDevil:
    ARIA WELLNESS โ™ฅ๏ธโ™ฅ๏ธADDRESS: 360 HWY 7, UNIT #6, RICHMOND HILL,647-222-5683 โ™ฅ๏ธโ™ฅ๏ธ(PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : New young Lily, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! SPECIAL PROMO 30 MINS 2 GIRLS $70 ๐ŸŒน๐ŸŒน**TODAY'S PICKS OF THE DAY ARE ๐Ÿฌ๐Ÿญ LILY๐Ÿฌ๐Ÿญ**
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