Massage & Bodywork

NOVEMBER | DECEMBER 2015

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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 103 from muscle spasm, trigger points, or bones out of place. As discussed in my San Diego Pain Summit column ("Changing the Brain's Mind About Pain," Massage & Bodywork, July/August 2015, page 101), clients simply need to be reassured they are in a safe place, and that everything is all right, right now. Notes 1. N. Bogduk, "Anatomy and Physiology of Headache," Biomedicine & Pharmacotherapy 49, no. 10 (1995): 435–45. 2. F. Scali, E. S. Marsili, and M. E. Pontell, "Anatomical Connection Between the Rectus Capitis Posterior Major and the Dura Mater," Spine 36, no. 25 (December 2011): E1612–4. Erik Dalton is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, Dalton has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. Lacking are studies investigating the relationship between prolonged stomach sleeping and dural damage, but it seems plausible that altered cervical mechanics could prohibit the suboccipitals from safeguarding the dura from motion-related stress, tension, and inflammation. The following case study details how neck and head pain may arise in stomach-sleeping clients and offers suggestions for addressing this condition. BIOMECHANICAL EXPLANATIONS In this scenario, the stomach-sleeping client rises from bed and attempts to left rotate his head back to neutral. Optimally, the atlas vertebra rotates with the head, but with a neurologically shortened right OCI, the atlas drags the axis with it. Left untreated, an "atlas wedge" causes chronic OCI spasm that fixates C1 on C2 (Image 3). If the head is forced to left rotate, the joint jamming moves down the chain to C2–3. With the dura firmly attached to only three spinal segments (foramen magnum, C2–3, and sacrum), the brain abhors bony disturbances at this key neurological center. Mechanoreceptive and nociceptive bombardment from overstretched spinal ligaments, joint capsules, and suboccipital muscles may wreak enough havoc to convince the brain to protectively guard or elicit pain. Images 4, 5, and 6 demonstrate an effective MAT routine for releasing hypercontracted right-side OCI muscles, a gentle atlas-axis alignment technique, and a graded exposure stretch to relieve sympathetic guarding. Since the nervous system directs all bodily functions, it behooves today's therapist to acquire skills for treating mechano-sensitivity in neural structures. Some therapists engage the nervous system via gentle skin manipulation, some through fascial stretch, and others, such as myself, include mobilizations for bones attaching to the dura mater. Clients must understand that the brain is their best friend, and pain is there to protect their body from further perceived insult. It's tempting but counterproductive to tell clients their pain results Graded exposure stretch. Keeping the client's head flexed at 45 degrees, the therapist uses a counterforce to slowly rotate and drag the neck fascia superiorly. Repeat. 4 5 6 The therapist's right thumb contacts the C2 spinous process and glides slightly superolaterally on the OCI (fingers drape face). The client inhales while gently right rotating his head against the thumb and hand resistance. The client exhales and the thumb maintains sustained OCI pressure as the client slowly left rotates the head. Repeat. With elbows on the table, the therapist flexes the client's head 45 degrees and left rotates to the first restrictive barrier. The client gently right rotates against the therapist's resistance to a count of five, rests, and left rotates to the new restrictive barrier. Repeat.

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