Chapter 5 Head and Neck Copyright 2011 Wolters

Chapter 5 Head and Neck Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter Objectives • Overview of Head and Neck Region • Posterior Cervical Muscles • Anterior Cervical Muscles • Head and Face Muscles Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Overview • Muscle overview • Trigger points (TP) and referral zones • Trigger point activation • Stressors and perpetuating factors • Precautions and massage therapy (MT) considerations Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suboccipitals: The Rock and Tilt Muscles • Rectus Capitis Posterior Major and Minor • Obliquus Capitis Superior and Inferior • 4 pairs of short, small and posterior muscles • Indicated in severe headaches Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Attachment sites for the suboccipitals

Suboccipitals cont’d Suboccipitals TP: • Located in muscle belly – Difficult to distinguish from semispinalis trigger points Referral Zones: • Refer behind, above, in front of ear • Sensation extends forward unilaterally to occiput, and eyes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Subocciptals Trigger Point Map Trigger points and referral zones for the suboccipitals Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stressors and Perpetuating Factors Suboccipitals TP Activation: • Develop when trying to control neck flexion Stressors and Perpetuating Factors: • Whiplash • Any sustained awkward head position • Uncorrected nearsightedness or maladjusted glasses Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Precautions and MT Considerations Precautions: • Avoid chin poking and jabbing movements MT Considerations: • Treat tissue between C 1 and occiput • Treat area between C 1 and C 2 • Use wave-like motion at base of skull Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Levator Scapulae: The Stiff Neck Muscle • Inserts in two layers • Bursa found between two layers Attachment sites for the levator scapula Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Precautions and Massage Considerations Precautions: • Observe the transverse process of C 1 MT Considerations: • Use muscle stripping and friction • Tendonous attachment is fibrotic and easy to locate • Pay special attention to C 1 attachment site Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Trigger Points and Referral Zones Levator Scapulae TP: • Painful stiff neck often mimics torticollis Referral Zones: • Refer to the crook of neck • Sensation extends to vertebral border of scapulae and posterior shoulder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Levator Scapulae Trigger Point Map Trigger points and referral zones for the levator scapulae Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stressors and Perpetuating Factors Levator Scapulae TP Activation: • Postural stress, occupational stress or sleep position Stressors and Perpetuating Factors: • Overexertion in sports • Using crutches or a cane • Sleeping in a airplane seat Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sternocleidomastoid: Amazingly Complex SCM has both sternal and clavicular head • Controls posterior head and neck movements • Refer pain to face and head (not to neck) • Mimics atypical facial neuralgia • Mimics tension headaches Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

SCM Sternal Head Trigger Points cont’d Sternal head • Referral felt at mastoid process, occipital ridge and eyes Creates the following symptoms: • Blurred vision and sinus congestion • Unilateral deafness without tinnitus Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

SCM Clavicular Head Trigger Points cont’d Clavicular head: • Refer to the front of head and behind ears • Pain can extend to cheek and teeth on same side Causes the following symptoms: • Dizziness, vertigo, mimics tender lymph glands Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

SCM Trigger Point Map Trigger points and referral zones for the sternal head of the SCM Trigger points and referral zones for the clavicular head of SCM Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stressors and Perpetuating Factors SCM TP Activation: • Awkward head posture • Mechanical overload Stressors and Perpetuating Factors: • Sleeping on back with too many pillows • Drooping shoulders, slouched posture Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Precautions and Massage Considerations Precautions: • Avoid the carotid artery • Avoid the styloid process MT Considerations: • Rotate head toward the working side • Use a pincer compression Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Scalenes: Anterior, Medius and Posterior • Associated with thoracic outlet entrapment syndrome • Scalenes minimus exists in 50 -75% of population • Trigger points difficult to identify and treat Trigger points and referral zones for the scalenes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Scalenes Trigger Point Map Scalenes TP: • Common source of back pain Referral Zones: • Refer to chest, scapula, arm, elbow and thumb • Rarely refer to head Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stressors and Perpetuating Factors Scalenes TP Activation: • Activation secondary to SCM trigger points Stressors and Perpetuating Factors: • Pulling, lifting or carrying heavy items • Scoliosis • Respiratory issues Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Precautions and Massage Considerations Precautions: • Avoid direct pressure on brachial plexus and clavicle • Tight scalenes traps brachial plexus (TOS) • May mimic carpal tunnel symptoms MT Considerations: • Use gliding thumb strokes and rotate head Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anterior Suboccipitals • Anterior suboccipitals: rectus capitis anterior and lateralis Trigger points: • Refer to larynx, neck and mouth • Activated by controlled flexion • Stressors include vision problems • Avoid the styloid process Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Longus Capitis and Colli: Military Neck • Deepest anterior neck muscles Trigger points: • Activated by flexion/extension injuries • Causes difficulty with swallowing and sore throat • Avoid poking movements during massage • Use appropriate pressure Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suprahyoids • Suprahyoids: mylohyoid, geniohyoid and digastric Trigger points: • Refer to lateral side of tongue and side of jaw • Activated by chronic mouth breathing • Difficulty with swallowing or lump in throat sensation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Suprahyoids cont’d Attachment sites for the suprahyoids Trigger points and referral zones for the diagastric Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Occipitalis: The Scalp Tensor • Occipitalis and frontalis make the epicranius muscle Trigger points: • Refer deep in orbit of the eye and eyeball • Activated and stressed by glaucoma/decreased vision • Deactivate key trigger points in clavicular portion of SCM Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Frontalis • Also considered a scalp tensor Trigger points: • Refer pain in forehead • Activated by SCM and constant facial expression • Could create entrapment of supraorbital nerve Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Epicranius Trigger Point Map Trigger points and referral zones for the occipitalis Trigger points and referral zones for the frontalis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Corrugator Supercilii • Tiny facial muscle associate with eye headaches Trigger Points: • Refer behind the eyes • Activated by facial expressions of anger and surprise • Use the pincer grasp Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Attachment sites for corrugator supercilii Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Temporalis • Key player in TMJ Trigger Points: • Refer to teeth, maxilla, eyebrows • Causes hypersensitivity in teeth • Activated and stressed by bruxism and gum chewing Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Temporalis Trigger Point Map Trigger points and referral zones for the temporalis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Masseter • Strongest muscle of the body (for its size) Trigger Points: • Refer to teeth, inner ear and eyebrow • Significantly restrict jaw opening • Associated with unilateral tinnitus • Activated by teeth clenching, nail biting, an uneven bite Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Masseter Trigger Point Map Trigger points and referral zones for the masseter Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medial Pterygoid • Only small portion of muscle can be palpated Trigger points: • Refer to TM joint area, ears, throat, cheek • Activated by forward head posture • Stressed by thumb sucking and anxiety • Work very gently as muscle is extremely tender Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medial Pterygoid Trigger Point Map Attachement sites for the medial pterygoid Trigger points and referral zones for the medial pterygoid Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Lateral Pterygoid • The key muscle in managing TMJD Trigger Points: • Refer to the TM joint and maxilla • Activated as satellite trigger points of SCM • Stressed by bruxism, playing a wind instrument or violin • Work very gently as muscle is extremely tender Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Lateral Pterygoid Trigger Point Map Attachment sites for the lateral pterygoid Trigger points and referral zones for the lateral pterygoid Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Review The galea aponeurotica is associated with which of the following muscles? • A. SCM • B. Epicranius • C. Lateral pterygoid • D. Scalenes Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • B. Epicranius Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins