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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 63 Note: As with the sternohyoid, the anterior neck is a very sensitive region for many clients, so verbal consent should be attained before approaching this area. It is also important to check in often with the client regarding the depth of pressure. STRETCHING Together, the longus colli and longus capitis flex and laterally flex the head and neck at the spinal joints, so they are stretched by extending and laterally flexing the head and neck to the opposite side (Image 17). Note: as with the sternohyoid, stretching the longus musculature by bringing the client's neck into extension should not be done unless the vertebral artery competency test (VACT) has first been performed (see Vertebral Artery Competency Test, page 60). CASE STUDY: LONGUS COLLI AND CAPITIS "Andrew" was a 45-year-old fast-paced executive who presented with pain in his anterior neck. He said the pain had begun approximately 12 months before and that he didn't recall any precipitating trauma; the pain began insidiously and had steadily increased over time. Although there did not seem to be a consistent pattern to when the pain was felt, he most often experienced it when swallowing. He said he had been to multiple medical doctors, ruling out nearly every possible pathologic condition of the chest, neck, and throat. Nothing had been found. Needless to say, Andrew was quite concerned about the cause of his pain. I examined all the joints and musculature of his neck. Although he did have tight musculature in his posterior neck, palpation and engagement of this musculature did not reproduce his characteristic pain pattern. However, when I palpated anteriorly into his longus musculature, he immediately felt the pain he had been experiencing for the past year or so. He had tight longus musculature. When I explained to Andrew what the cause of his pain was, he was greatly relieved to learn his condition was not life-threatening in any way. Because of his work demands, and knowing that the condition was not dangerous, he declined to come in for a regimen of treatment because of the time it would take away from his work. In lieu of treatment, I advised him to gently massage and stretch the area. I never saw Andrew again, but his wife, who was a regular client of mine, told me his pain had gradually dissipated over the course of a few months. A DEDICATION TO FURTHER EXPLORING AND LEARNING The goal of clinical orthopedic manual therapy is to resolve the musculoskeletal condition with which our client presents. However, this is not possible if we do not THE UNUSUAL SUSPECTS Palpation of the right longus muscles. Note: caution is advised when palpating the longus musculature so the carotid artery is not compressed. Stretching the right longus muscles. Note: caution is advised whenever bringing the client's head down into extension. 16 know which muscle or muscle group is involved. To determine this, an accurate and thorough assessment is needed; and this requires knowledge and awareness of not only the usual suspects but also the unusual suspects. Toward this end, the goal of this feature has been to whet our appetites by presenting a number of unusual suspect muscles for consideration, but many more exist. It is only with a dedication to exploring and learning all the musculature of the body that we can assure ourselves of having a lasting and successful clinical orthopedic manual therapy practice. 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 12 DVDs on manual and movement therapy and teaches continuing education workshops around the world, including a certification in Clinical Orthopedic Manual Therapy (COMT). He has created Digital COMT, a video streaming subscription service. Visit www.learnmuscles.com for more information or reach him directly at joseph.e.muscolino@gmail.com. 17