Massage & Bodywork

MAY | JUNE 2019

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If we were to choose the right splenius capitis instead, then because it extends, right laterally flexes, and right (ipsilaterally) rotates the head and neck, we would similarly stretch it with flexion, left lateral flexion, and left (contralateral) rotation— the exact same head/neck motions as for the right-side levator scapulae. So how would we discern between targeting the levator scapulae and splenius capitis? We would use the stabilization component. The levator scapulae attaches to the shoulder girdle; the splenius capitis does not. Therefore, if we allow the right shoulder girdle to elevate during the stretch, the right levator scapulae would be slackened, increasing the likelihood that the stretch position of the head and neck would target the splenius capitis instead (Image 16). Therefore, the essence of performing a multiplane stretch for a specific target muscle within a functional group is to address each and every one of the cardinal plane components of the muscle at both attachments. And our ability to target one muscle within the group from another muscle within the group is to find and take advantage of a difference between the two muscles. AC STRETCHING APPLICATION Let's now look at applying AC stretching technique for the right lateral flexor functional group. Performing AC stretching is simply a matter of applying the protocol, which is to have the client actively contract the musculature that is antagonistic to the target musculature. In this case, the antagonistic action is left lateral flexion, so we ask the client to take in a breath, and as the client exhales, they actively move their neck into left lateral flexion (Image 17A). The client then relaxes and finishes breathing out as we further left laterally flex their neck (Image 17B). They then breathe in as we move their head and neck back to the starting position (Image 17C). This protocol is usually repeated for a total of 8–10 repetitions. The easy way to remember AC stretching is that the client does the stretch for us; we simply augment it once they relax. CR STRETCHING APPLICATION To apply the CR stretching technique to the same musculature (the right lateral flexor functional group), we first bring the client to tissue tension by stretching them into left lateral flexion (Image 18A). We then ask the client to take a breath in, and then, as they exhale, to isometrically contract the target right lateral flexion musculature against our resistance (Image 18B). The client then relaxes and finishes breathing out as we further stretch them into left lateral flexion until a new tissue tension position is found (Image 18C). This protocol usually has 3–4 repetitions. Neural Inhibition Breathing Pattern The breathing pattern for neural inhibition stretching techniques differs depending on the source. However, what is always consistent is that the client must be relaxed when the therapist applies the stretch force, and clients are best relaxed when exhaling; so whatever else differs, we always want the client to be breathing out when we add in the stretch force. WHY IS STRETCHING SO IMPORTANT? Regardless of the type of stretching protocol applied, I believe it is extremely important that stretching is added into every clinical orthopedic manual therapy session. Stretching is most optimally performed after the tissue has been warmed up with heat and/or massage. At this point, the tissue is most receptive to being stretched and the tissue can be effectively lengthened. Furthermore, it is likely that stretching helps relax the baseline tone of the target musculature by changing the "muscle memory" pattern that is mediated by muscle spindle activity, which is controlled by the gamma motor system in the brain. In effect, adding stretching to our massage session will help maintain the beneficial effects created by massage therapy. Joseph E. Muscolino, DC, has been a manual and movement therapy educator for more than 30 years. He is the author of multiple textbooks, including The Muscular System Manual: The Skeletal Muscles of the Human Body (Elsevier, 2017); The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns, and Stretching (Elsevier, 2016); and Kinesiology: The Skeletal System and Muscle Function (Elsevier, 2017). He is also the author of 13 DVDs on manual and movement therapy and teaches continuing education workshops around the world, including a certification in Clinical Orthopedic Manual Therapy (COMT), and has created LearnMuscles Continuing Education, a video streaming subscription service for manual therapists and movement professionals with new content added weekly. Visit www. learnmuscles.com for more information or reach him directly at joseph.e.muscolino@gmail.com. The essence of performing a multiplane stretch for a specific target muscle within a functional group is to address each and every one of the cardinal plane components of the muscle at both attachments. Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 77

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