Massage & Bodywork

July | August 2014

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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 107 The occipitoatlantal (O-A) joint is the uppermost weight- bearing synovial joint in the body and is the final junction for adapting to asymmetry or dysfunction from below. Mechanically, the head teeters on the two condyloid joints (shaped like cupped palms tipped slightly medially) that make up the O-A joint. This design allows the head to nod back and forth and side to side (Image 1). Since the O-A joint surrounds and attaches to the brain stem, which controls all basic body functions (including breathing and heartbeat), poor alignment has widespread consequences. For example, if the O-A joint on one side develops a restriction, the crooked occiput may set off local neurological reflexes that increase muscle tension in the suboccipitals, and which may compress and irritate the greater occipital nerve (Image 2). Clients presenting with occipital neuralgia commonly complain of pain referring up the back of the head and around the side, sometimes reaching into the orbital region. These headaches usually result from holding an awkward, static head posture. Prolonged, non-neutral postures with the head tilted on the neck can cause mechanoreceptor excitability in surrounding muscles, ligaments, and joint capsules as the O-A condyles are crammed closed on one side. Examples might include a plumber who works under a sink with his head cocked to one side or an office worker who secures a telephone with her shoulder and chin. Clients whose computer monitors sit either too high or too low may develop bilateral O-A restrictions leading to global head pain (Image 3). As these activities are unlikely to cause immediate discomfort, clients rarely attribute them as the source of their pain. But palpation by trained hands can tell another story. Suboccipital spasm, tenderness, nodular swellings, and a closing of the inferior nuchal ridge on the posterior arch of the atlas should alert the therapist to test for possible O-A jamming. THE BRUGGER TEST Before jumping in with knuckles and "fascia-mashing" the suboccipitals, one critical question must first be asked: is the unlevel O-A joint and accompanying suboccipital spasm the result of awkward head and neck positioning, as in the case of the plumber under the sink, or could it be compensation for misalignment elsewhere in the body? One way to help solve this mystery is to perform a Brugger Test. technique MYOSKELETAL ALIGNMENT TECHNIQUES Occipital Neuralgia Headaches Addressing the O-A Joint By Erik Dalton 2 A crooked O-A causes protective suboccipital spasm, which compresses greater occipital nerves. © 1 The occipitoatlantal (O-A) joint allows the head to nod backward, forward, and side to side. Permission Robert Acland, MD 3 Poor ergonomics and forward-head postures cause O-A compression. ©

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