resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
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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