resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Medication Primer for Alternative Health Care Practitioners (Part 2)
Morphine is arguably the greatest drug of all time, at least in the sense that it is so powerful in relieving pain.
Weaving Eastern & Western Medicine Together: Q&A with Beijing's Dr. Kezhen Zhang
Dr. Kezhen Zhang M.D., is currently the founder and president of Beijing Taijitang Traditional Chinese Medicine Hospital.
A Solution for the Primary Care Crisis?
A white paper generated by the ACCAHC Primary Care Project and UCLA Center for Health Policy Research Senior Research Scientist, Michael Goldstein, PhD, addresses a clear oversight noted in recent workforce analyses designed to assess the nation's primary care needs.
Healing the Qi: The Boston Marathon Bombing
On Monday, April 15 2013, locals and visitors from around the globe gathered for the world's largest marathon in the city of Boston. With 23,000 participating in the race and many more on the sidelines, the marathon represents a Boston institution.
It's About the Word
The new patient was already a fan of chiropractic. "I liked the guy a lot," he said of the previous DC he had consulted. "But he is on the other side of town, and I just can't get there after work. So he sent me to you, since you're his buddy."
Becoming a Concussion Expert in Your Community: What You Need to Know (Part 2)
What makes an individual an expert in concussions? Obtaining education about concussions and treating concussed patients are two factors that lead to expertise.
Pre-Conception Wellness: What Do Your Patients Need to Know?
Deciding to have a baby is one of the most important decisions a woman will ever make. But how many women are really prepared for a healthy pregnancy?
Obesity is a Shen Problem
The expressions "obese" and "obesity" are not pejorative terms. They are scientific terms, determined solely by the Body Mass Index scale, which combines a person's height and weight in a mathematical formula. A number of 30 and above denotes "obesity."
Treating Rib Joints to Protect Thoracic Stability
It is an exciting world that awaits us when we go to work every day. We deal with all types of people who present with varying health conditions we can (hopefully) help alleviate.
Extraordinary Vessels and Emotional Healing
In addition to the 12 primary Organ-related meridians in the body, there are other energy circulation channels that have been mapped out by Traditional Chinese Medicine. Probably the most significant of these are called the Eight Extraordinary (or Extra) Vessels.
Lateral Femoral Cutaneous Nerve Entrapments
The lateral femoral cutaneous nerve arises from the 2nd and 3rd lumbar nerves. It is formed in the psoas muscle and emerges from its lateral border to cross the iliacus muscle and exit the pelvis.
The Physiology of Anger
Most of us recognize and have felt anger at some point in our lives. Anger can be seen as a natural response to some kind of pain, whether emotional or physical.
Three Essential Herbal Products For Your First-Aid Kit
There are three Chinese patent medicines that belong in everyone's first aid kit. All three are for topical application, and all three provide extraordinary benefits unavailable from any domestic over-the-counter.
Study: Acupuncture for Acute Low Back Pain More Effective Than Drugs
New research by Korean doctors of Oriental Medicine suggested that an acupuncture method could reduce acute lower back pain faster and more effectively than conventional drug injections.
We Get Letters & E-Mail
The "Great Opportunity" for Chiropractic: Expanded Scope of Practice; The SOAP Note: An Effective Tool for Documentation; Treating Patients Goes Beyond Following Established Protocol.
Protein and Weight Loss
Recently I was asked by the staff at Dynamic Chiropractic to referee some of their water-cooler discussions regarding nutrition. Topping their list was this one about protein and weight loss: "Why is protein important for weight loss and how much should I eat?"
If you visit the website of the JAMA and search on the word chiropractic, more than 200 results appear. If you sort that list chronologically and look at the oldest entry, you will find "Medical News" that includes the following.
Dry Needling is Acupuncture: But What of Education? What of Public Safety?
One of my patients told me recently, that their physical therapist used a "dry needle" and that it wasn't acupuncture. Apparently, physical therapists (PT) are taught to tell their patients that "only acupuncturists practice acupuncture."
10 Life Lessons That Will Change the Way You Practice
"What would you do if you knew you couldn't fail?" I have posed this question for years to groups I've spoken to across the country and around the world.
News in Brief
In Remembrance: A Moment of Silence for Robin McKenzie (1931-2013); DC Re-Elected to Co-Chair AMA Code Review Board; WFC Celebrates 25 Years.
Maintaining Professional Boundaries in a Facebook World: Social Media Guidelines for DCs
A few months ago, I received an unexpected message on my Facebook account: "Hi Doc, do you remember me? I'm so happy to find you here on Facebook. It's been years since I have seen you and I'm glad to reconnect with you.
Weight Training: Are Cheat Reps Worth It?
While resting between exercises at the gym recently, a young lifter asked me for a spot on a set of barbell bench presses. The bar was loaded with a moderately heavy amount of weight that at first glance appeared to be too heavy for his frame.
Chiropractic Care for Veterans: Serving Those Who Served (Pt. 2)
To what extent do you think the role of chiropractors in the VA can serve as a model for greater chiropractic integration elsewhere in the American health care system? That's a very important question.
Keeping Up With Western Medicine Advancements: The Amazing World of Imaging Studies
When patients with neuromuscular problems come to you for treatment there is usually a lot you can do for them to improve their mobility or reduce their pain, whether it is a middle age woman with a frozen shoulder.
The Monkey on Your Back
Many practitioners run their clinic without any extra help—at least initially. I've always been pretty good at multi-tasking. Having nine kids taught me how to wear multiple hats and juggle a lot of responsibilities. Running a clinic is similar.
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
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