Issue link: https://www.massageandbodyworkdigital.com/i/68012
MYOFASCIAL TECHNIQUES Once you've assessed AO freedom with small motions, ask your client to do larger nodding, as in looking up and down. With this larger motion, look for the ability of the posterior compartment of the neck to lengthen in flexion. One way to see this is to look for evenness of flexion and extension throughout the cervical column. When the posterior structures can't lengthen, larger nodding motions are driven lower in the neck, and the middle and upper cervicals have less flexion (Image 3). CERVICAL TRANSVERSOSPINALIS TECHNIQUE In a client who has limited neck flexion, as in the person on the right in Image 3, your next step will be to lengthen and release the strong, middle-level longitudinal structures (shown in Image 1). We'll use the knuckles of our proximal interphalangeal (PIP) joints to anchor and lengthen these mid-level layers (Image 4). Seated comfortably at the client's head, place your right forearm and wrist on the table for stability. With the PIP knuckles of your first two fingers, gently feel for longitudinal shortness in the various layers of the deeper neck structures, first on the right side of the neck. Anchor these short tissues in a caudad or foot-ward direction. Once you've comfortably placed your right hand, you can slowly bring your client's neck into a bit of flexion. With the left forearm braced against the edge of the table for stability, lift the head to slightly flex the neck. When you get your position and angles right, lifting the head is relatively easy, even if your client is bigger than you. If lifting the head feels like a strain for you or the client, reposition yourself until you find an easier way. Even though your right hand is stationary on the table, lifting The Nod Test. When the deep structures of the posterior neck are able to lengthen in the larger motions of cervical flexion, nodding happens primarily at the top of the neck (as on the left). When the posterior compartment cannot lengthen, cervical flexion is limited, and the motion of nodding gets driven into the base of the neck (as on the right). the head has the effect of dragging the tissues out from under your knuckles. Keep your pace slow and steady, feeling for restrictions in the posterior compartment of the neck, and waiting, rather than pushing, for release. Once you've made an initial pass or two, you can focus on detailed work into particularly tight or short structures by incrementally lifting, rotating, flexing, and extending the neck around the point of contact, all the while encouraging length up the back of the neck. Be thorough, working deeper through the various layers you encounter, all the way from the occipital ridge into the shoulders and base of the neck. By switching your hand position, you can work the left and right, as well as the central nuchal ligament (taking care not to apply an uncomfortable level of pressure directly to the spinous processes). POSTERIOR CERVICAL WEDGES TECHNIQUE It is one thing to release restricted tissues; it is another to help our clients find new ways of moving that will keep the restrictions from returning. This technique can do both. It is an effective way to release deep, soft-tissue restrictions, right down to the deepest articulations of the cervical spinal column. In the active-motion version, it will help your client find new movement possibilities that will support the structural work once the session is over. Use the fingertips of both hands to feel the space and tissue texture beside and between the spinous processes of two vertebrae, beginning at the base of the neck with C6 and C7. Work head-ward, checking each articulation that you can palpate. Gently lift with your fingertips into any restricted spaces between the spinous processes (Image 5). Keep your 124 massage & bodywork march/april 2009