Issue link: https://www.massageandbodyworkdigital.com/i/1234356
LOCATION ANTERIOR NECK The anterior triangle of the neck is defined by the medial edge of the sternocleidomastoid muscle and the midline of the neck. Valuable work can be done in the anterior triangle of the neck to assist with muscles involved in swallowing, speech, and breathing. However, many structures are vulnerable to damage here, and advanced education is necessary to work safely in this area. Medical literature shows many cases where inappropriate massage has caused damage to anterior neck structures, with potentially catastrophic consequences for clients (Image 3). Structures of Note • Common carotid artery • Jugular vein • Hyoid bone • Thyroid cartilage • Trachea • Thyroid gland • Cervical lymph nodes • Esophagus Common Carotid Artery This huge artery runs just deep to and alongside the medial sternocleidomastoid muscle, carrying blood upward to the brain. Downward (superior-to-inferior) pressure on or near the carotid artery may cause shearing of the arterial walls and a risk of blood clots and stroke. About level with the thyroid cartilage, the carotid artery splits into internal and external branches. This point of division, called the carotid sinus, is equipped with nerves that track blood pressure to ensure that adequate blood flow to the brain is always maintained. Manual pressure applied at the carotid sinus can interfere with this function, leading to dizziness and faintness. Atherosclerotic plaque is common in the carotid artery, which makes this area a special caution for any client with a history of, or risk for, cardiovascular disease. Jugular Vein The jugular vein also runs alongside the sternocleidomastoid muscle. Compression to this vessel is less likely to have a negative outcome, but it still should not be manipulated. The external branch of the jugular vein is also accessible as it crosses over the sternocleidomastoid. Hyoid Bone The delicate U-shaped hyoid bone is attached to the thyroid cartilage, just inferior to the mandible, and it moves with swallowing and vocalization. The hyoid bone anchors muscles of the tongue and neck that are associated with speech and swallowing. Thyroid Cartilage The thyroid cartilage or "Adam's apple" is a moveable piece of connective tissue that forms the anterior wall of the larynx. It bobs up and down as we modulate our voice and swallow. This cartilage is strong but compression here can elicit pain and a choking sensation. Trachea This tube is part of the respiratory system that carries air to the lungs. It is tough and resilient, composed of cartilaginous rings that keep the airway open. Pressure here causes an unpleasant choking sensation. Thyroid Gland The thyroid gland (which has nothing to do with the thyroid cartilage) is a butterfly- shaped organ that wraps around the trachea. It is an endocrine gland, secreting hormones that help control metabolism and calcium levels in the blood and bones. The tiny parathyroid glands are embedded within the thyroid. This whole structure is mostly made of delicate epithelial tissue, with little connective tissue protection. The thyroid gland may become enlarged for various reasons; this is called goiter, and may be clearly visible in some people. The thyroid gland may also develop single or multiple cysts or nodules. Very early studies in animals and humans suggest that manipulation of the thyroid may stimulate hormone release. This is flatly outside our scope of practice—massage therapists should not be trying to alter hormone secretion through manipulation of the thyroid gland. Cervical Lymph Nodes About 300 lymph nodes are located in the neck, in the posterior triangle, the anterior triangle, and under the mandible. Under normal circumstances lymph nodes do not require special adaptations in bodywork, but when they are hardened, enlarged, or painful for any reason they should be at least locally avoided. Esophagus The esophagus runs from the pharynx to the stomach. It is on the posterior side of the larynx and trachea, so it is seldom vulnerable to damage from massage— unless the practitioner is working deeply in the anterior triangle of the neck. LOCATION LATERAL NECK The posterior triangle of the neck, defined by the lateral sternocleidomastoid, medial trapezius, and middle one third of the clavicle, is not actually on the posterior aspect of the body. Rather, this label refers to the area between the lateral sternocleidomastoid, the medial trapezius, and the middle third of the clavicle (Image 4). Structures of Note • External jugular vein • Transverse processes of cervical vertebrae • Roots of brachial plexus • Spinal accessory nerve 48 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 2 0