Cranial Nerve XI

Another name for Cranial Nerve XI is Spinal Accessory nerve, the XI being
the 11 cranial nerve, this is a motor nerve.
The Spinal Accessory nerve is responsible for movements as well as
innervating the trapezius as well as the sternocleidomastoid. If any injury
were to occur to this nerve a person wouldnt be able to raise their shoulders or turn
their head to the side as well as loss of blood to the trapezius and
sternocleidomastoid (Lundy-Ekman, 2013).

The Spinal Accessory Nerve has two portions: the cranial and the
spinal. The cranial part (accessory portion) is the smaller of the two. Its
fibers arise from the cells of the nucleus ambiguus and emerge as four or
five rootlets from the side of the medulla oblongata, inferior to the roots of
the vagus nerve. It follows laterally to the jugular foramen, where it becomes
united to the spinal portion for a short distance.
The spinal parts (spinal portion) fibers arise from the ventral horn cells in
the cord between C1 and C4 of the cervical plexus. The fibres emerge from
the cord laterally between the anterior and posterior spinal nerve roots to
form a single trunk, which ascend into the skull through the foramen
magnum. It then exits the skull through the jugular foramen. (Hacking &
Wahba, n.d.)

How to test the Spinal Accessory nerve:

1. Rotate the head away from the side of the contracting sternocleidomastoid
muscle.
2. Tilting of the head toward the contracting sternocleidomastoid muscle.
3. Flexion of the neck by both sternocleidomastoid muscles. (to test for the
sternocleidomastoid)

1. Elevation of the shoulder by the trapezius.

2. Drawing the head back so the face is upward by the trapezius muscles. (to test for
the trapezius) (Walker, 1990)

References
Hacking, C., & Wahba, M. (n.d.). Spinal accessory nerve. Retrieved from
Radiopaedia: http://radiopaedia.org/articles/spinal-accessory-nerve
Lundy-Ekman, L. (2013). Cranial Nerves. In Neuroscience: Fundamentals of
Rehabilitation, 4th edi (p. 342). St. Louis.
Walker, K. H. (1990). Chapter 64: Cranial Nerve XI: The spinal Accessory Nerve . In
K. H. Walker, D. W. Hall, & W. J. Hurst, Clinical Methods: The History, Physical
and Laboratory Examinations. 3rd editions. Reed Publishing.

Nerve Assignment Reflection

What I learned from this assignment is that many of the cranial nerves in our body
also have a different function that what most people assume. That if anything were
to happen to one of the nerves then many of the things we take for granted like
taste or smell or even hearing could be lost to us. This made me realise how every
person is really a very complicated structure of nerve bundles and it really made me
appreciate how I have all of my nerves in tact.

Piriformis Syndrome
1.

The reason that I chose the lunge as the warm up is because it would
be active during flexion and adduction of the hip. The reason that warm-ups
need to be done in the first place is because the muscle needs to be ready in
order to really function properly for the exercises that you plan on doing so
the muscle doesnt tear or get elongated to quickly.

2.

Superior Gumelus, gluteus minimus or quadratus femoris could be

tight and short but Piriformis Syndrome is mainly associated with the
piriformis muscle compressing the sciatic nerve. I would target most of these
muscles because it s his gluteal and lower leg region that hell feel this pain
in and so I want to target the muscles that might be tight and ease some of
the tension and increase his range of motion as well as his overall muscle
tone in that area (Associates, 2013). The reason that they should stretch
before a workout or general exercise is because the patient needs to activate
their muscles so that they muscle itself can get used to the fact that its
about to be used. They also stretch before so they dont cause any microtears within the muscle fibre. The reason the stretch after is to get the body
back in its natural alignment that it should be. The reason I chose my
stretches is because it not only gets the piriformis active but it also includes
the other muscle groups of the gluteal region associated with piriformis
syndrome.

3.

The muscles that would be lengthened would be gluteus minimus

and the weak muscles would be superior gumelus, and piriformis. I would
target some of those muscles because most of them are deep and below the
sciatic nerve as to not damage the nerve and impinge it. The exercises that I
picked would mainly strengthen the muscles that are around the piriformis. I
would have them do it against gravity and if they still werent able to do it
than I would help them or have them do it against an object that they could
press up against.

4.

The goal of my exercise program is to strengthen the piriformis muscle

so that it will be active again and in its regular length. My parameters are set
so that they can do it for endurance and that trains the muscle to be
stronger, I have done this through more reps and less sets and having the
weight be significantly low so the patient can endure the actual exercise.
Some parameters are different, for example my stretches are all the same
but my weighted exercises have one more set. The reason that my stretches
are the same length is because the muscle needs to be active and in its
proper position so that the muscle can get used to staying n that lengthened
position. The reason that the exercises are weighted is because now that
their muscles are in the proper position they can properly work on
strengthening them.

References
Associates, T. (2013). Piriformis Syndrome. Retrieved from Therapeutic Associates :
http://www.therapeuticassociates.com/wpcontent/uploads/GFLF_Rehab_Piriformis.pdf

Piriformis Syndrome Reflection

What I learned with this is that there are a lot of things that can go wrong and really
effect the body or one part of it if a nerve can be impinged. It made me realise how
in sync and in tune our bodies really have to be in order to really work well together
and order for us to move and be comfortable in any movement.

Movement Analysis
Marvin Appiahene-Afriyie & Tristan Boccitto
November 26 2015
Humber College School of Technology and Advanced Learning

The following movement that is broken down is a dive performed from a 3 meter spring
board. The name of this dive is the front 4 pike. It consists of 4 and a half front flips while in
the pike position. This movement contains 5 main phases; the power step, the hurdle, the takeoff,
the flight phase and finally the entry (Rubin, 1999). Any movements discussed in this paper are
done in the sagittal plane and horizontal axis.
Power Step
This is the first momentum based movement in the pike. This movement is performed
with a powerful lunge towards the end of the springboard with their dominant leg followed by a
strong push downwards with the same leg. How this movement is performed is by having the
posterior deltoids, triceps brachii and latissimus dorsi concentrically contract to extend the
shoulder joint. This will help the diver bring their arms back to produce the force of the forward
swing that is needed for the Take Off Phase. The biceps brachii would need to be flexible in
order for the movement to be efficient and smooth. The muscles of the hip in the dominant leg
would be flexed in order to provide the upward force needed for the Flight Phase. The
Iliopsoas, Sartorius, Tensor Fascia latae, Pectineus, Adductor Longus, Adductor Brevis, as well
as the Gracilis concentrically contract in order to flex the hip into that lunge position needed for
the push off for the Flight Phase. The muscles of the knee in the dominant leg would need to
be flexed as well in order to facilitate the push off needed for the flight phase. The Sartorius,
Biceps femoris, Semitendenosis, semimembranosus concentrically contract to flex the knee, the
muscles that would need to be flexible to help facilitate this movement would be Vastus
Lateralis, Vastus Medialis, and Vastus Intermedius. The ankle would be dorsiflexed, helping the
diver get into the Lunge Phase. The Gastrocnemius, Plantaris, Soleus would concentrically
contract to dorsiflex the ankle and the muscle that would need to be flexible to allow for this

movement to be efficient. The opposite leg would have the hips going into a slight hip extension
to continue with the forward momentum, this movement would be caused by the eccentric
contractions of Gluteus Maximus, Semitendinosis, Semimembranosis, Biceps Femoris , the
muscles that would need to be tight to allow this movement would be iliopsoas, Sartorius, Tensor
fascia latae, and Adductor Longus & brevis. The knee of that same leg would need to go into an
ecentric extension as well to help facilitate this movement, the muslces involved to provide this
movement of the knee are Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedius
the muscles that would need to be flexible are biceps femoris as well as semimembranosus and
semitenednosis. The diver then plantar flexes the ankle of the same leg to continue the
momentum to proceed with the next step to move into The Hurdle Phase. This movement is
achieved by the concentric contraction of Sartorius, Biceps Femoris, Semitendenosis, and
Semimembranosus. The muscle that would need to be flexible to allow for this movement is
Peroneus Longus. This movement occurs very quickly and is done in a matter of milliseconds.
The joints involved for this movement are the shoulders, hip, knee and ankle.
The Hurdle:
The hurdle contains the primary 3 steps that place the diver at the front of the diving
board. This is considered the start of the actual pike. This involves the diver lunging forward
with their dominant leg towards the front end of the diving board, placing their knee into flexion
and ankle into dorsiflexion while having both of their shoulders extended back. The diver then
forcefully brings the hip and knee of the opposite side into concentric flexion, taking the ankle
into concentric plantarflexion. The shoulders are then forcefully put into extension as the diver is
about to take off and become air born. As the diver proceeds to come down onto the board he
places his ankles into eccentric plantarflexion. As the diver is landing they place their ankles into

dorsiflexion as well as eccentrically contracting their knees into flexion as they land on the
board, they extend their shoulders slightly and begin to bring their shoulders back into a neutral
position in order to begin the Take Off Phase. The joints involved in this movement are the
shoulder, hips, knees and ankles.
Take off:
After the hurdle phase the diver proceeds into the takeoff phase. This is when the diver
explodes off of the spring board into the air to perform their dive. This involves a forceful jump
off of the springboard and also a powerful swing of the arms forward. First the diver will slightly
flex the trunk and lean forward to ensure forward movement. The muscles acting in this
movement are iliopsoas, rectus abdominis, and the internal & external obliques. The diver will
then jump off the board, this starts with knee extension followed by plantar flexion of the ankle
and finally a slight extension at the hips (refer to chart in appendix for muscles active). Just as
the diver is leaving the spring board he will forcefully extend his arms from an overhead position
to about chest level and fully extend at the elbow joint, this is done to generate enough torque for
the movement of the dive (refer to chart in appendix for active muscles). The take off phase of
the movement is done under the force of gravity pulling the diver down from the hurdle phase
and also from the spring board pushing up on the diver, the take off happens almost
instantaneously and will be missed by the blink of an eye. The joints involved in this motion are
shoulder, elbow, lumbar vertebral, hips, knees and ankles.

The flight phase:

Immediately following the takeoff phase comes the flight phase. In this phase the diver is
completely airborne for the entire movement. The diver will enter the pike position and hold it
until he sees the roof for the fourth time. To enter the pike position the diver will continue to lean
forward from the previous motion. As the diver leaves the board he will bring his legs straight up
until they touch his chest, then wrap his arms around his legs to ensure that he stays in the pike
position (refer to chart in appendix for muscles active). This movement is done against the force
of gravity pulling down and also the legs wanting to come out of the pike position as the arms
must hold them in place, the flight phase happens relatively quickly and lasts about 2-3 seconds
at the most. The joints involved in this movement are, lumbar vertebral, hip, knee, ankle,
shoulders and elbows.
The Entry Phase:
During this phase the diver is still air born and beginning to come out of their rotation as
they descend head first into the water. Once the diver sees the roof for the fourth time he begins
to put his shoulders into full extension in an overhead position as he comes out of his forward
rotation, he extends his elbows fully and brings his trunk and hips into extension. His legs will
remain in that extended position. The diver will continue to hold his feet in plantarflexion., as he
begins to hit the water he must hold this linear position to have the least amount of force while
entering the water (refer to chart in appendix for muscles active). This part of the movement is
done against the force of the body spinning as the diver tres to stop the rotation, the entry phase
is done very quickly and in less than a quarter of a second. The joints involved in this movement
are the shoulder, elbow, lumbar vertebrae, hips, knees and ankles.

Impairment
A common impairment that many divers suffer from is patellar tendonitis also commonly
called jumpers knee (Rubin, 1999). This is due to the constant repetitive movement of jumping
and putting stress on the quadriceps muscle group (King, n.d.). An exercise program to help a
diver rehabilitate from patellar tendonitis would include starting with flexibility exercises then
moving to strengthening exercises (King, n.d.) followed by proprioceptive exercises.
The first step in the rehabilitation process would be to gain all range of motion back in
the affected knee. As the therapist I would do all the range of motion exercises (active, resisted,
and passive) to the knee until it has its complete range back. Once full range of motion is
obtained I would then move to working on the flexibility of the quadriceps. For this I would have
the patient in prone and passively bring his knee into flexion and hold for 30 seconds. Once I feel
that the patient has progressed passed this stage I would move him into doing a proprioceptive
neuromuscular facilitation (PNF). I would have him do a contract-relax stretch of the quadriceps
group in prone. As home care it would be good to have him stretch all the other muscles in the
area along with the quadriceps group (Sports Injury Clinic, 2014). For the quadriceps stretch I
would have the patient hold their foot to their glute and push his hips forward and hold for 30
seconds. For the hamstrings I would get the patient to cross one leg other another and touch (or
attempt to touch) their toes and hold for 30 seconds. For gastrocnemius I would get the patient to
put their foot in a dorsiflexed position up against a wall and get them to lean into the wall and
hold for 30 seconds. To stretch soleus I would have the patient with one foot dorsiflexed against
a wall and one foot back kept flat, then the patient brings their knee of the side with the foot back
down to the floor until he feels a stretch and hold for 30 seconds. I would want him to do these
stretches 3 times a day (when he wakes up, middle of the day and before bed).

Once range of motion and stretches are all pain free it would be time to strengthen the
quadriceps group. In order to do this I would have the patient doing squats. I would have him
start with 3 sets of 8 reps. Once he can achieve that I would have him add weight with a bar over
his shoulders to the squats; starting at 45 pounds and increasing the weight gradually as he
progresses. I would also have him doing plyometric exercises later on in his rehabilitation. For
this, squat jumps would be very beneficial in strengthening the muscles used when jumping on
the springboard when diving. I would have him do 5 separate jumps then eventually do 5
consecutive jumps. For all exercises I would have the patient take a 90 second break in between
each set.
Another part of the rehabilitation process would be proprioceptive exercises. For these I
would have the patient do squats on an upside down Bosu ball. 3 sets of 5 reps would be good as
he learns to balance himself. Once he gets better increase to 3 sets of 8 reps (90 second break
between each set). After he can do this I would progress him further by standing on the ball,
catching a medicine ball, doing a squat and then throwing it back. (90 second break between
each set)

References

King, W. (n.d.). Patellar tendonitis (jumpers knee). Retrieved from

http://www.pamf.org/sports/king/PatellarTendonitis.pdf
Rubin, B. (1999). The basics of competitive diving and its injuries. Clinics in Sports Medicine,
18(2), 293-301.
Sports Injury Clinic. (2014). Jumpers knee rehabilitation. Retrieved from
http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/jumpers-knee/rehabilitationjumpers-knee

Appendix
POWER STEP CHART

Joint

Description of Movement

Action of Muscle

Muscles involved

Flexible Muscles

Shoulder

As the diver begins his initial

step he has his shoulder in a
neutral position and as he
continues with his step he
brings his shoulders back to
gain momentum

Shoulder extension

Posterior Deltoid,
Triceps Brachii,

Biceps Brachi

The hip is slightly flexed

forward as the diver begins this
movement towards the end of
the board

Hip Flexion

Hip

Latissimus Dorsi,
Anconeus
(Concentric)
Iliopsoas,
Sartorius,Tensor
Fascia latae,
Pectineus, Adductor
Longus, Adductor
Brevis, Gracilis

Illiacus, Gluteus
Maximus

(Concentric)
Knee

The diver proceeds to flex his

knee in order to gain more
momentum with his run/step

Knee Flexion

Iliopsoas, Sartorius,
Tensor Fascialate,
Pectineus, Adductor
Longus, Adductor
Brevis, Gracilis
(Concentric)

Quadricep muscles
(Vastus Lateralis,
Vastus Medialis,
Vastus Intermedius,
and Rectus femoris)

Ankle

The diver plantar flexes his

ankle to continue with the
momentum gained from the
slight hip flexion and knee
flexion to better propel him
forward to the edge of the
springboard

Ankle Plantar Felxion

Sartorius, Biceps
femoris,
Semitendenosis,
semimembranosus
(Concentric)

Peroneus Longus

The hurdle phase chart

Joint

Description of Movement

Action

Active Muscle

Flexible Muscle(s)

Shoulder

As the diver begins their

lunge, they extend the

Shoulder
Extension and

Posterior Deltoid,
Triceps Brachii,

Biceps Brachii

shoulders as far back as they

can.

Flexion

Latissimus Dorsi

Hip Flexion and

Hip Extension

Iliopsoas,
Sartorius, Tensor
Fascialate,
Pectineus,
Adductor Longus,
Adductor Brevis,
Gracilis

Illiacus, Gluteus
Maximus

Knee Flexion

Sartorius, Biceps
femoris,
Semitendenosis,
semimembranosu
s

Quadricep muscles
(Vastus Lateralis,
Vastus Medialis,
Vastus Intermedius,
and Rectus femoris)

Dorsiflexion
and
Plantarflexion

Gastrocnemius,
Plantaris, Soleus

Peroneus Longus

During the second phase of

this lunge they begin to
swing their shoulders into
extension to help propel
them up
Hips

As the diver lunges forward

with the dominant leg, the
hips are brought into flexion.

During the second phase of

this lunge the hips on the
opposite leg are forced into
flexion while the hips on the
opposite side are now in a
normal position.
Knee

During the lunge, the knee of

the dominant lunging gets
put into extension as the leg
is thrust towards the end of
the diving board.

At the second have of this

lunge as the diver comes out
they thrust the opposite leg
into flexion as well as the
knee.
Ankle

During the lunge phase while

the dominant leg is planted
onto the diving board the
ankle is put into dorsiflexion.

At the second phase of the

lunge the opposite leg is
placed into plantar flexion as
the diver prepares for the
Take Off

Take off phase chart

Joint

Description of movement

Action

Shoulder

As the diver lands on the board he

will fully flex the shoulder to the
point to where his arms are over his
head

Shoulder flexion

As the diver leaves the board he

forcefully extends his entire arm from
an overhead position to about chest
level to generate torque to complete
the movement of the dive. The diver
will do this under no load.

Muscles active
Biceps Brachii

Flexible muscles
Posterior Deltoid
Triceps Brachii
Latissimus Dorsi

Shoulder extension

Posterior Deltoid

Biceps Brachii

Triceps Brachii
Latissimus Dorsi

Elbow

Lumbar
vertebrae

Hips

Knee

As the diver is doing shoulder

extension in this phase the diver will
also kick out is forearms in an
extremely forceful fashion. The diver
will do this under no load.

Elbow extension

As the diver is riding the board back

up and prepares to jump off the board
the diver will flex his trunk forward to
create momentum going forward to go
through with his dive and also ensure
that he will jump out forward.

Trunk flexion

As the diver is riding the board up he

will start to extend his legs slightly to
get an extra push off the springboard
to allow himself to go a lot higher in
the air, thus giving himself more time
to do the movements in the flight
phase of his dive. This is done under
the force of the board pushing up on
the divers legs.

Slight hip extension

Just before the diver completes the

extension of the hip he will fully
extend his knee as he is riding up the
board, this will also give the diver
more height for his dive. This is done

Knee extension

Triceps Brachii,

Biceps Brachii

Anconeus

Iliopsoas

Erector Spinae Group

Rectus Abdominis

(Iliocostalis,
Longissimus, Spinalis)

Internal & External

Obliques

Gluteus Maximus
Semitendinosis
Semimembranosis
Biceps Femoris

No muscles need to be
flexible for this part of
the movement as it is
such a slight movement
that it would not require
any muscles to be
flexible.

Rectus Femoris

Semitendinosis

Vastus Lateralis

Semimembranosis

Vastus Medialis

Biceps Femoris

against the force as the springboard

pushes up on the divers legs

Ankle

Just as the diver is about to leave the

board he will give himself more of a
push by plantar flexing his ankle. This
is under tremendous force of the
springboard pushing on the diver as
most of the force is going to the ankle.

Vastus Intermedius

Ankle Plantarflexion

Gastrocnemius

Tibialis Anterior

Soleus

Extensor Hallucis
Longus

Plantaris
Flexor Hallucis longus

Extensor Digitorum
longus

Flexor Digitorum longus

Tibialis Posterior

Flight phase chart

Joint

Description of movement

Action

Lumbar
Vertebrae

As the diver leaves the board he will

continue to keep his trunk flexed as he
is in the air.

Trunk flexion

Hip

Once the diver completely leaves the

board he will then bring his legs all
the way up to his chest forming the
pike position.

Hip flexion

Muscles active

Flexible muscles

Rectus Abdominis

Erector Spinae Group

Internal & External

Obliques

(Iliocostalis,
Longissimus, Spinalis)

Iliopsoas

Biceps Femoris

Sartorius

Semitendinosis

Tensor Fascia Latae

Semimembranosis

Pectineus
Adductor Longus
Adductor Brevis
Gracilis
Knee

In this phase the diver will keep the

knee in the same position as when he
left the springboard.

Knee extension

Rectus Femoris

Semitendinosis

Vastus Lateralis

Semimembranosis

Vastus Medialis

Biceps Femoris

Vastus Intermedius

Ankle

The diver will keep his ankle in the

same position as when he leaves the
board in the takeoff phase.

Ankle plantarflexion

Gastrocnemius

Tibialis Anterior

Soleus

Extensor Hallucis
Longus

Plantaris
Flexor Hallucis longus

Extensor Digitorum
longus

Flexor Digitorum longus

Tibialis Posterior
Shoulder

Elbow

From the position that the diver left

his arms in after the takeoff phase
(straight infront about chest level) he
will then wrap his arms around his
legs.

Horizontal adduction

The diver will flex his arms while in

the air in order to hold his legs up
against his chest, this will also allow
him to hold the pike position. This is
done against the force of the
hamstring group pulling the legs back
down.

Elbow flexion

Anterior Deltoid

Rhomboids

Coracobrachialis

Middle Trapezius

Pectoralis Major

Infraspinatus

Brachialis

Triceps Brachii

Biceps Brachii

Entry phase chart

Joint

Description of Movement

Action

Active Muscles

Flexible Muscle(s)

Shoulder

As the diver is coming out of

their rotation, they are going
from horizontal adduction into
extension.

Shoulder Extension

Pectoralis Major,
Anterior Deltoid,

Middle Trapezius,
Latissimus Dorsi

Elbow

As the diver brings the shoulder

into extension, the elbows move
from flexion into extension
along with the shoulders to make
the diver more parallel.

Elbow Extension

Triceps Brachii,
Anconeus

Brachialis

Lumbar
Vertebra

As the diver goes into the decent

into the water, they will open up
from trunk flexion into full trunk
extension

Trunk Extension

Rectus Abdominus,
Internal & External
oblique

Erector Spinae
Group (Iliocostalis,
Longisimus,
Spinalis)

Hips

As the trunk is now in extension

the diver will put their hips into
trunk extension to facilitate the
movement.

Hip Extension

Gluteus Maximuss,
Semitendenosis,
Semimembranosus,
Biceps femoris

Piriformis,
sartorius

Knees

As the hips are being extended,

the knees would stay in the
extended position

Knee Extension

Rectus Femoris

Semitendinosis

Vastus Lateralis

Semimembranosis

Vastus Medialis

Biceps Femoris

Vastus Intermedius

Ankle

As the upper half of the body is

not straight the lower extremities
begin to follow in a straight line
with the ankles remaining in
plantar flexion

Ankle
Plantarflexion

Gastrocnemius

Tibialis Anterior

Soleus

Extensor Hallucis
Longus

Plantaris
Flexor Hallucis
longus

Extensor
Digitorum longus

Flexor Digitorum
longus
Tibialis Posterior

Movement Analysis Reflection

What I learned doing this assignment was that there are a lot of muscles that are
being used for a simple action. That something that we deem as a standard
movement such as walking or jumping, really does take a lot of muscle to be done

and that if any muscle was to not work in sync then the whole movement wouldnt
get done. This also taught me about the importance of team work and how
communication is key to a great group project.

Problems

Head forward posture, history of tension headaches

Pain in neck *radiates to upper back*
Bilateral headache in temporal and occipital region
Stiff head/neck movements
Trapezius and anterior neck muscles tender
Pain with extension and rotation of the neck to the right

Initial Complaint

Pain in the neck

Bilateral headache
Stiff Head/Neck movements

Posture

Head forward posture

Hyperkyphosis

Assessment:

Report of tender *upper* Trapezius and anterior neck muscles

Pain with extension and rotation *to the right* of the neck
Tight neck extensors
AROM, RROM, PROM of Neck

Muscles *possibly* Involved:

Upper Trapezius
Sternocleidomastoid
Splenius Capitis

Range of motion:

Muscles that are shortened *right side*

o Upper Trapezius
o SCM (Sternocleidomastoid)
o Levator Scapulae
o Splenius Capitis
o Semi-Spinalis Capitus
o Mulifidi
Muscles that can be Lengthened
o Rhomboids

Muscle Impairments
Tight/contracted muscles of the upper back:
o Upper trapezius
o SCM
o Leator Scapulae
o Splenius Capitus
o Semi-Spinalis Capitus
o Multifidi
o Pectoralis Major/Minor
o Seratus Anterior
Stretched/Lengthened muscles:
o Rhomboids

Functional Limitations

Stiff neck/head movements

Pain with rotation *bilaterally*
Temproal/occipital headaches

SOTs & MMTs

Spurling
Distraction, Compression

Possible Diagnoses:

Whiplash

Treatment Plan:

Alternative Treatments:

Xylocaine Injections *numbing medicine*

Ice/Heat *reduce swelling*
Rest
Physiotherapy
Neck Collar *3-hour max use to keep neck stationary relief pressure off
ligaments*
Pain medication *reduce pain*
Acupuncture *offer relief from some neck pain*
Transcutaneous Electrical Nerve Stimulation (TENS) *mild electric current to
skin*
Muscle relaxants
Strengthening exercises are required to improve enough muscle strength to be able to hold the
head and neck in positions of good posture at rest and during activity. This will also improve
the range of motion.
Educating the client on proper body mechanics
Medications are helpful for symptom control
Spinal injections can be helpful in carefully selected patients

Muscles that refer to the mid line of the scapula:

Trapezius *ascending fibres*
Rhomboids

Temporal/occipital referral pattern:

Sternocleidomastoid
Suboccipital muscles
Levator scapulae

Possible Diagnoses:

Whiplash

Muscles to strengthen/treat:

Upper Trapezius
Splenius Capitis
Rhomboids
Levator Scapulae
Sternocleidomastoid

Assessment:

AROM, RROM, PROM of Neck

Rule our shoulder and Jaw
Distratction
Spurlings
Compression

Hadgkins Kennedy

Treatment Plan:

Range of motion:

Muscles that are shortened *right side*

o Upper Trapezius
o SCM (Sternocleidomastoid)
o Levator Scapulae
o Splenius Capitis
o Semi-Spinalis Capitus
o Mulifidi
Muscles that can be Lengthened
o Rhomboids
o Prior lengthening
o Serratus Anterior, Pectoralis Major/Minor *tight*
SOTs & MMTs
Spurling
Distraction, Compression

Muscle Impairments
Tight/contracted muscles of the upper back:
o Upper trapezius
o SCM
o Leator Scapulae
o Splenius Capitus
o Semi-Spinalis Capitus
o Multifidi
o Pectoralis Major/Minor
o Seratus Anterior
Stretched/Lengthened muscles:
o Rhomboids

Functional Limitations

Stiff neck/head movements

Pain with rotation *bilaterally*

Temproal/occipital headaches

Alternative Treatments:

Xylocaine Injections *numbing medicine*

Ice/Heat *reduce swelling*
Rest
Physiotherapy
Neck Collar *3-hour max use to keep neck stationary relief pressure off
ligaments*
Pain medication *reduce pain*
Acupuncture *offer relief from some neck pain*
Transcutaneous Electrical Nerve Stimulation (TENS) *mild electric current to
skin*
Muscle relaxants

References
http://www.mayoclinic.org/diseases-conditions/whiplash/basics/alternativemedicine/con-20033090
http://www.mayoclinic.org/diseases-conditions/whiplash/basics/treatment/con20033090
http://orthoinfo.aaos.org/topic.cfm?topic=A00410
http://www.integrativehealthcare.org/mt/archives/2008/09/a_whiplash_guid.html

Case Reflection
What I learned with theses cases is that everything isnt always so cut a dry. That
even if the patient comes in complaining of a very common problem, it could
actually be more complex then it seems. That not all patients may come in with the
same complaints but in fact that they have much more complex complaints that
may seem easy to solve. This is where deductive reasoning and proper assessment
come into play, that the better your assessment the better your actual outcome of
figuring out what the patient has and how to go about treating it properly and
safely.

Massage Therapy Awareness day Reflection

Marvin Appiahene-Afriyie
Humber College
Submission Date: November 22nd, 2016

Massage Therapy Awareness Day Reflection

On November 15th 2016 we held our annual Massage Therapy Awareness day. My
group set up our station because I was late arriving due to traffic. When I got there,
it was approximately 8:36 am, and there werent that many people there. They were
simply passing by and not really interested and so what we did was prepare a little
example of what our booth was about and how wed explain it to anyone who was
interested in knowing more about our booth of Remedial Exercise. Later during the
morning, it started to pick up and we explained what Remedial Exercise is: The use
of your body to get better range of motion and increase strength as well as range of
motion. The example that we came up with is healing from a sprained ankle as well
as trying to gain more range of motion in your shoulder. Some of the questions that

passers by asked was what exactly the benefit of remedial exercise is and how they
can do remedial exercise even if they dont have any weight equipment laying
around. We told them about how they can use everyday objects such as a broom
handle and a regular bag of rice or a soccer ball or a sphere of any kind if they want
to increase rotation and range of motion. After more people came I started to get
nervous because I noticed that our professor from the actual Therapeutic exercise
class was going to look on our board and ask me questions. When our Therapeutic
Exercise professor came and I explained to him what remedial exercise was, he said
that I did a great job in explaining what it was and how it benefits the patients and
different form of remedial exercise depending on the available equipment for the
patient to use. My fellow group members didnt do that much because they didnt
feel as prepared as I was when it came to talking about remedial exercise. What I
had some trouble with was actually getting people to get more interested in viewing
not only our board but also asking questions. Some of the rarer questions that were
asked were about how to stretch certain areas of the body or if remedial exercise is
another form of non-drug based therapy to relieve stress and increase range of
motion. I gave them the knowledge of how to stretch certain areas and for how long
to stretch them for, as well as give them advice on certain remedial exercises to
help decrease stress, which would be Yoga. For most of the morning it was me that
was doing the talking and demonstrating because I was the one who had the most
knowledge of the subject. Throughout the duration of the actual Awareness day
presentations my other group members were talking to other groups trying to figure
out a way of enticing passers by into coming to our section so that we may explain
what remedial exercise is. The morning was a success after 9am because everyone
was going to class but before that everyone was just preparing their talking points
and figuring out how to go about teaching their respective topics. I personally feel
like I did most of the explaining and interaction during the duration of the
Awareness day but besides that, the morning and the actual event was fantastic. As
it neared closer to the actual finishing time of the awareness day Tonia told us some
tips for the next time we present and have a board, what she said was that we
needed a better visual display as well as an actual way of drawing in more people
with maybe a gimmick of some sort like a broom stick or a ball to actually show how
remedial exercises can be performed. After we got the advice it was time to wrap up
our station and then we had a mini dance party to get rid of the last-minute
anxieties that we had throughout the duration of the Awareness day.