resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
Climbing the Ladder of Opportunity (Part 1)
President Obama spoke of building "ladders of opportunity" in his State of the Union and Inauguration addresses.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
New Knee, New Pain (Part 2)
The patient presented to the chiropractic clinic with symptoms of genu varum and pain on the medial aspect of the tibiofemoral joint.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
Putting Public Health Into Action: Thinking Globally, Acting Locally
The Chiropractic Health Care section of the American Public Health Association (APHA) met at the 141st APHA Annual Meeting and Exposition in Boston late last year, and it was another triumph for chiropractic and its public health advocates.
We Get Letters & E-Mail
Let's Restore Integrity to Health Care – Starting With Us; MDs Offer More – So Can We.
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
News in Brief
Parker Announces Executive Director of Parker Professional; Athletic TIPS Program Getting Financial Support; ANJC Award Recipients Named.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
The Many Faces of Cervical Compression
When evaluating the neck, there are any number of orthopedic tests to be considered.
Why Stretching Doesn't Work
Like most chiropractors, a good part of my day is spent working with sedentary office workers who spend eight to 12 hours a day glued to a desk chair in front of a computer.
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
Increased Breast Cancer Risk: Another Implication of High Cholesterol
In addition to being a known risk factor for heart and cardiovascular disease, recent studies have highlighted the link between high cholesterol and increased risk of breast cancer. Breast cancer is the second most common malignancy in women after skin cancer.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
An Introduction to Evidence-Based Clinical Practice - Again
One of your patients is in for treatment and catches you off guard by asking you a question about a news article she recently read. It seems that a new intervention for back pain was found to reduce the rate of serious side effects by 50 percent.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Betraying Patients and the Profession
Imagine flying from New York to Paris on a jumbo 747. Your thoughts are on your vacation and experiencing the City of Lights. Midway over the Atlantic Ocean, you overhear the flight attendants talking in muffled voices.
Ask and You May Receive
A friend of my mother has had a problem with her ears for almost 20 years. Whenever the wind blows, it sends shooting pain through her jaw. She has seen any number of medical specialists over that time, but with no relief.
Look, Listen and Learn to Code
Study of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) coding system can leave a doctor of chiropractic a bit confused. The description of the five new-patient and five established-patient examination codes takes up several pages in most coding books. The degree of detail and charts used to describe the codes can be overwhelming.
October, 2012, Vol. 12, Issue 10
Neck Pain: You Just Have to Move Like Jagger
By Sheri Wells
Have you ever seen an old video of Mick Jagger performing on stage? One of his vintage moves was to strut across the stage with one hand on his hip while moving his head forward and backward like a chicken.An article appearing in the Wall Street Journal titled: "Neck Pain? Skip the Pills, Just Stretch Like a Chicken" is about the first large federally funded study on neck pain. This published study found that simple home exercises, increasing cervical range of motion, are more effective at relieving acute and sub acute neck pain than medication. Dr. Bronfort, the lead author, said that a neck retraction exercise, or chicken-like maneuver of the head, in which people pull their heads back and then tilt their chins slightly downward "seemed to be especially useful." Maybe Mick Jagger was practicing preventative neck pain exercises?
Neck pain affects around 70 percent of people sometime during their lives. This is a common condition that you most likely see in your clients every day. Neck pain can be caused by many factors including:
Along with the above factors, as we age we begin to lose the fight with gravity and the head starts to slowly, progressively move forward on the neck and shoulders. Part of the problem is that the cervical muscles are simply not strong enough to resist the force of gravity. According to Erik Dalton's article, "Forward Head Posture: The 42 Pound Head," for every inch of forward head posture, the weight of the head on the spine is increased by an additional ten pounds. Through basic anatomy and physics, he explains that a normal head centered on the spine weighs about twelve pounds, but once it starts to move forward on the neck by just an inch, it weighs approximately 22 pounds. In comparison, a gallon of milk weighs about eight pounds. What would happen if you carried a gallon of milk in your hands out in front of you all day long? Wouldn't the muscles of the arms be extremely tired and possibly sore or painful by the end of the day? So, why wouldn't we expect the neck to start to complain with an additional ten pound load on it? Plus, realize that if the head is tilted or shifted to one side that this also increases the weight of the head on the spine and creates compensation patterns traveling down the body as the brain tries to keep the eyes level with the horizon.
As manual therapists, what can we do about this condition? First, educate your clients with the pain problems caused by forward head posture. You will see them immediately try to pull their head backward, but they may not be able to sustain this posture for very long. There are three main problems that need to be solved. The short term "fix," is for you to manually release the tight muscles creating forward head posture and to rebalance the head on the neck. Then, you need to gently stretch the tight muscles to restore normal cervical range of motion (ROM). Finally, the long term solution is to have the clients strengthen their weak anterior deep flexor muscles that are allowing the forward head posture to occur. Basically, to achieve and then maintain normal neck/head alignment, your ultimate goal, you must:
The above mentioned neck pain study involved teaching clients gentle, controlled movements including neck flexion, extension, lateral flexion, rotation and neck retraction. But, do not teach stretches or strengthening exercises if you feel that is outside your scope of practice or if your state does not allow it. As a manual therapist, however, you are allowed to assess and to restore normal cervical range of motion. And, if you are going to correct a neck problem this means you can gently mobilize/stretch your clients during a session to achieve normal ROM.
So, what is normal range of motion of the cervical spine and how do you assess it? Different publications vary with the ideal amount and a great reference is James Waslaski's book "Clinical Massage Therapy." He lists the normal ranges of motion, naming the muscles involved, along with a detailed twelve-step program of soft tissue work that can eliminate or prevent painful neck conditions.
Normal ranges of motion involving single plane movements for the cervical spine are: (Figures 1-4)
It is best to assess active range of motion before you begin your session with the client standing or seated. First, show the client the movement you would like them to perform; flexion, extension, lateral flexion or rotation. Ask them to only move their head as far as they can go without any discomfort. Note the amount of ROM and if it was normal or limited. Use a goniometer or simple plastic school protractor to determine the degree of ROM. If any of the motions had less than normal ROM, then have them gently repeat that same movement again several times and see if their ROM improves. Usually, it will improve 5-10 degrees just through this self mobilization. Make note of any limited ROM you find and your strategy will be to release the tight muscles/fascia that are restricting normal ROM.
Please note that as you restore normal cervical range of motion, you may also need to address forward shoulder posture and any other problems that may have contributed to forward head posture. You must treat the body as an entire structure to achieve better, long lasting results.
Once you have performed soft tissue work and created normal range of motion of the cervical spine, the next steps are to teach your client two simple exercises to stretch their tight cervical muscles: sternocleidomastoid, scalenes and suboccipitals and to strengthen their weak anterior neck flexors longus capitis, longus colli, platysma, sternohyoid and sternothyroid. This "homework" is what I have found is the most important part of correcting and maintaining normal head posture and what I teach every one of my clients (of all ages). If you teach your clients these corrective exercises, it empowers them to take charge of their own healing/wellness. You only see your client for an hour or so at a time and this gives them additional tools to use every day to maintain the normal ROM and structural alignment you achieved during your session.
First, teach them a corrective neck retraction stretch. Have them sit or stand upright and relax their shoulders moving them down and slightly backward (neutral posture). Then, have them place one finger on their chin. Ask them to slightly tuck their chin, and then move their head backward like a "chicken" or like Mick Jagger; whichever cue you prefer, while gently pressing on their chin. Have them hold this position for about two seconds and then release. They can repeat this stretch several times. Advise them to perform this gently and that mild discomfort is not ok. (Figures 5, 6)
The best times to perform this stretch is after daily activities that involve forward head posture: working on the computer, eating, watching TV, etc. Precaution note: this is rare, but if the client indicates pain or neurological symptoms (tingling, numbness in their neck, shoulders or arms), during this stretch, immediately have them return their head to neutral and refer them out.
Once the client has mastered the corrective stretch, teach them a corrective strengthening exercise they can perform every day in their car; "neck press backs." Advise them they can only perform this exercise if there is no discomfort or they are not allowed to do it. Before they start their car, tell them to sit upright and relax their shoulders down and backward (neutral posture). Then, have them slightly tuck their chin and move their head backward like a "chicken" or like Mick Jagger, while pressing back into their headrest (neck retraction). Have them hold this isometric contraction for 5 to 10 seconds, repeating this 2 to 3 times. They could also practice this when they are waiting at a stop light. I don't advise performing it while the car is moving. This is an easy exercise and something that they can and must do every day to help prevent or reverse forward head posture and the resultant pain that accompanies it. (Figures 7, 8)
According to the neck pain study, Dr. Bronfort says that for relief from neck pain "it's good news for patients that there's something they can do themselves." So, if you teach your clients to move like Mick Jagger; retracting their head, it may be one of the most important things you can do to help them relieve and prevent occasional and chronic neck pain.
Sheri Wells is a licensed massage therapist (LMT), and advanced personal trainer (CPT) with a Masters degree in education and a B.S in physical education. She specializes in orthopedic muscle balancing and therapeutic massage for injury rehab, scar tissue mobilization, and postural/structural alignment; restoring pain free normal range of motion throughout the body. She has been an upper level teaching assistant for James Waslaski for more than 10 years. She lives in Dallas and can be reached at
comments powered by Disqus