Seeking help treating stiff necks

[thorn105]

I was wondering if any of you here could share some information regarding what you have found successful in treating really stiff necks. You now, the dreaded "torticollis" clients. I feel like my work in this area could use some improvement so any help would be appreciated.

If you could recommend any DVD's, books, classes or protocols I would be very grateful. I have been treating people with this for years and sometimes I can make it better and other times I am not sure I have made any difference at all and that's frustrating.

Anybody got an magic fool proof remedies they'd like to share?

 

[jonathan.moreno14]

Breathing exercises during stretches. Inhale, hold the breath, then they exhale as you work your hand down the length of their neck, on into their traps, to their shoulder.

Work each muscle in the neck, working both up and down in your strokes. Release each TrPt.

There's a gruesome one just below and to the left and right of the client's neck that I work supine. Once you've contacted it, have them shrug their shoulder up toward their head--a fellow MT showed me that one, and it dang near killed me, but it cleared it out like nothing else.

Subscaps are crucial on about 95% of the people I work on. Work medially and laterally.

Finally, as odd as it may sound, clear the TrPts at the medial tendons just below the knees. My clients report on a regular basis how effective it is, and when it was done to me, I could actually feel my neck releasing.

That's my two cents...

 

[soum]

Guess what I'm going to say ...

Wait for it ...

Wait for it ...

....

....CranioSacral Therapy. I know, shocking isn't it?

CST helps to address the muscular and facial component as well as the nervous system involvement - helping release facilitated segments. Working with imagery and dialogue can help the release process.

Also, if the torticollis is acquired (vs congenital) CST can help find and release the underlying cause allowing for more effective treatment of the symptoms.

From a massage perspective it is very important to work the SCM (as well as scalenes, traps, etc,etc.) on the effected side. Massage and facilitated stretching can be very effective. It can be good to even teach the client how to properly stretch that side and to do contract-relax stretching on their own.

 

[lrd00a]

If it is 'torticollis', SCM on the affected side will be tight.


The best thing you can do for treating necks is understand posture. Not just at the head but over the entire body. DON'T CHASE PAIN! To many therapists just say "okay, it hurts there so I will massage there". In stead, try to find out WHY it hurts and then work on that. Why is their head tilted to the side and why does it hurt on the opposite side of their neck? Is it due to an upslip in the pelvis? A rotation at the pelvis? The muscles are painful because they are in a stretched position rather than a contracted one etc....

A symptom (like pain) just tells you something is wrong. It doesn't necessarily tell you WHAT is wrong.

Patrick

 

[Hammy]

Oh Brian you slay me.... : Thanks for the laugh, I needed it this morning!

And Patrick W, your reply reminds me of what John Barnes says, "Find the pain, look elsewhere for the cause."

elsewhere, hope you find a few gems from the thread to help your client...

 

[summer is almost over]

Bowen work in conjunction with CST might be helpful. Had a severely spasming client that I referred out to a colleague who is extremely skilled with Bowen work. Between my CST and her Bowen work, the spasming subsided considerably.

That's not saying it will "fix" torticollis", but, it might just be able to give some relief.

Thought just came to mind: Is the individual with torticollis on meds? My autistic client is on meds that really, quite literally bend his neck so far to the side and then back that you would think it would snap off at the shoulders. When he's not on the meds, or they are greatly reduced, then the torticollis isn't so pronounced.


FWIW

 

[fghi594]

Wow, this is all really helpful, thanks so much everyone. I appreciate the time you took to share your methods. Gives me some great stuff to think about.

You know what I have found to be one of the problems leading to this? Many of my clients with this symptom sit too long at a computer with their heads leaning stretched out over their necks as they hyper extend to lean towards the computer screen. Poor ergonomics. I see this with some people who do graphic design or edit films and sit in one place for 12 hours looking at a computer screen. Yikes!

But then there are other causes too. It's such a weird malady. maybe with your help I can be more successful in treating this.

Thanks again.

 

[rposzich]

Positional release works well for a lot of my folks -- counter-intuitively taking the body farther in the direction of the spasm usually...also if a neck if cranked over like that, I often find that the fascia of the entire hand/arm/shoulder complex is also quite bound and shortened, so releasing all of that slowly FIRST helps a lot of my neck-bound folks.

Also maybe for those computer-using folks, think about which hand they're mousing with (if it's on the same side as the spasm, that's adding to the problem). And which is their dominant eye? That often contributes to the direction they're holding their head, even if the screen is right in front of them (which it often isn't).

Good grief could I say "folks" more often in one post

 

[J-Charm]

Also, with regard to the whole computer thing and hand they are mousing with.....

Look for typical signs of 'handedness posture' and the compensations that go along with that. Ask which hand the write with and which ear they hold the phone too. Typically people write with the same hand of the ear that they hold the phone too (and the phone is held by having that same side shoulder elevate and keep it into place). Think about how that causes them to shift weight at the pelvis and how that can rotate or upslip the pelvis, which then can have an affect on their normal posutre as they try and change head position to look straight, when the posture is crooked. Sitting all day furthers these postures as the hip flexors are in constant shortening. Think about how that can affect overall posture and what is happening at the neck.

What is your evaluation process like for those with nagging neck pain?

A great book that you may want to check out is by Florence Kendall, Muscles: Testing and Function with Pain and Posture

Patrick

 

[saved1986]

Good stuff Patrick thanks. That book sounds like a good tool, I'll have to get it.

As far as my evaluation goes my situation is kind of weird. Most of my clients I have seen for many, many years (I don't take on many new clients at all anymore) and I already know them intimately so my evaluation is sort of an ongoing progression of my relationship with them. Most I see weekly or twice monthly which is great because communication is already established as well as intimate and I already know their bodies and hearts very well.

That said when they come in crooked I ask a lot of pertinent questions, check for rotation and flexibility and since I already know their personal life try to see how much stress they are under so I can figure out the root or radical cause of their impacted areas. Having that kind of open intuitive communication from a body/mind perspective has always been kind of how I approach things. In short my protocols can often vary from person to person.

Any other tips you might have would be much appreciated.

 

[Pompal 09.]

I like to begin with Lymph Drainage Therapy. I find that when the lymph is flowing, the muscles respond much more quickly to massage - the muscles just melt. PNF stretching after the massage is also a good way to test & release remaining restrictions.

 

[Vampire Lord]

I also like to address the SCM, especially on the affected side; then strip the scalenes bilaterally and follow them into the 1st and 2cnd ribs.
Then like the other posters I like using PNF or positional release.

Like BJB-LMP I have found that working the tight fascia along the shoulder girdle/arm/hand along with chest and upper thoracics seems to help to release the tightness in the neck.

While taking an advanced clinical massage class the instructor had us address the serratus anterior, that literally freed up my neck more than any other bodywork, whenever I work on someone with a chronic stiff/ sore neck I work their serratus a. and it usually gives them relief.

 

[awallofstars]

In my (admittedly limited) experience, it's the levator scapulae that is the usual culprit, especially when the person complains of a "crick." I'll cradle the neck with one hand while working on the same-side levator with the other. To find it, you'll need to search the transverse processes of the cervicals, looking for a ropey, squirmey muscle that's posterior to the SCM that can be pushed posteriorly to the transverse processes (which is a good way to trap it for deep work).

The best way to make contact with it consistently is to find it on yourself. One good way is to extend your shoulder as far as you can (reaching for a wall behind your butt, for instance) while palpating the side of your neck. This is basically just a way of elevating the scapula without overinvolving trapezius. Once you find it, feel how you can twang back and forth over it and follow it from the side of the neck to the superior angle of the scapula. On people with inflammation or high muscle tone, you can actually pinch and lift it.

To work this, I'll just sink in and hold for several seconds, then move an inch up or down and repeat until I've traveled the length. In someone with bad neck problems, I'll hold longer, waiting for them to indicate that sensation has decreased. I imagine that there are more sophisticated ways of working on it, so any tips would be appreciated.

The reason I feel so sure about this is the sheer number of people who exclaim, "that's it!" or "that's the pain" or "what the hell is that?"