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myofascial techniques

By Til Luchau

Cross section of the neck at


C5, from below. Shortened,
middle level, soft-tissue
structures of the posterior neck,
here colored green, can contribute
to limited flexion and increased
cervical lordosis. These structures
include the outer splenius and
trapezius (medium green), the
central nuchal ligament (dark green),
and the deeper transversospinalis
group (bright green).
Image ©Primal Pictures Ltd.
Used with permission.

122 massage & bodywork march/april 2009


Working with the Cervical Core

In the previous article As in the first article, I’ll draw on the This simple small-nodding test
myofascial work as taught in my workshop helps you find where most of your
(Myofascial Techniques: series. You can see video related to these client’s cervical flexion and extension
techniques and tests by visiting Massage typically occurs. By implication, you
“Preparing the Neck and & Bodywork’s digital edition, which can determine if there is freedom at
features a video clip from the 2009 DVD the topmost joint of the neck, the AO
Shoulders for Deep Work,” Advanced Myofascial Techniques for joint. When the soft-tissue structures
the Neck, Jaw, and Head from Advanced- around the AO are free, small nodding
Massage & Bodywork, January/ Trainings.com. The link is available on motions will happen primarily here,
ABMP.com and Massageandbodywork.com. allowing the head to balance and
February 2009, page 120), rock on the atlas like a seesaw (Image
Nod Test 2). When it is present, this top-of-
I talked about how taking The Nod Test allows us to assess the-neck freedom gives a sense of
three important things: lightness and poise. If the motion
time to release superficial • Freedom at the atlantooccipital looks like it is happening lower in the
(AO) joint. neck instead of at the AO, it could
restrictions, before working • The ability of the posterior indicate restrictions in the suboccipital
compartment of the neck or transversospinalis muscles.
deeper structures, can increase (Image 1) to lengthen.
• The degree of participation of
your effectiveness and give the “prevertebral” muscles along
the front of the cervical spine.
longer-lasting results. In this These each contribute to the
alignment, flexibility, and stability
article, we’ll look at ways to of the neck, particularly in head-
forward positions (cervical lordosis).1
assess and release deeper neck Begin with your client sitting or
standing. While looking at his or
restrictions. Since it is part her profile, ask for small nodding
motions. We want just a little bit of
two of the earlier article, I’ll movement—too much will make the
initiation of movement hard to see.
assume you’ve done some work Ask yourself: Which neck joint moves
When the soft-tissue structures around the
first? Which joint or joints are flexing
atlantooccipital joint are free, small nodding
to release and prepare the and extending in these small nodding
motions will happen primarily at the top of
motions? If it is hard to see these
the neck, allowing the occiput to balance
superficial fascial layers before things, ask your client to make even
and move on the atlas like a seesaw. 2
smaller motions, while you look for the
attempting the techniques here. very first joints that move. You can also
use your hands to feel for this initiation,
if it still isn’t clear to your eyes.

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

124 massage & bodywork march/april 2009


hands relaxed on the table to avoid
straining; lift with just the fingertips.
When the neck flexes, the space
between these cervical spinous
processes opens. In a neck that has
lost flexion, like the one on the right
in the Nod Test photo (Image 3),
some of these spaces between the
spinous processes will be crowded and
tight (most often between the third
and fourth cervical vertebrae). Your
fingertips are the wedges that can
help invite more space at each joint.
However, don’t drive the wedge in, like
splitting a piece of firewood. Rather
than forcing the joint open, let your
fingers be like a flashlight, showing your
client where new space and length are
possible. At each tight space, wait for
Anchor and Lengthen. In the cervical transversospinalis technique, you’ll slowly lift the client’s the client’s tissues and nervous system
head while gently anchoring shortened structures of the posterior neck. The knuckles provide to respond as you lift. Be sure to spend
a strong, sensitive, and stable tool. Be sure to keep your wrist as straight as possible. time at the top joint of the neck, the
AO, especially if your small-nodding
test showed movement restriction here.
In the passive version of this
technique, simply find the shortened
spaces between the spinous processes
of the neck, and in each place, wait for
the cervical joints to open and release.
In the active variation, once you find a
shortened space between two cervical
vertebrae, ask for small, subtle nodding
motions. Coach your client until you
both feel the first movement of nodding
occurring right at the joint space in
question. In addition to releasing
shortened tissues, your client gains
proprioceptive access to the joints that
weren’t opening as much as others.
It may be difficult at first for
your client to focus the nodding
motion at the articulations that aren’t
accustomed to moving. Some of the
verbal cues you can use include:
• “Use very small movements
to let this space open.”
Posterior Cervical Wedges Technique. Use the fingertips of both hands to feel beside and • “Leave your head heavy on the table.
between the spinous processes of each neck vertebra for any crowded or shortened spaces. Wait
for each joint to open and lengthen, rather than trying to drive the wedge of your fingers in.
Let the movement begin right here.”
• “Let the back of your head
move upward on the table to
gently open this space.”

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myofascial techniques

Incidentally, the back-of-the- Habits of posture and body use


neck lengthening that we’re looking can be slow to change. So, don’t be
for involves more than just releasing discouraged if you find neck issues
the posterior joint spaces—it also that don’t seem to respond at first.
involves engaging the prevertebral Think bigger, learn more, refer to
muscles along the anterior side of a Rolfer or other practitioner who
the spine: the longus capitis, rectus specializes in big-picture, integrative
capitis, and longus colli (Image 6). work, or in movement and posture
These deep, front-side antagonists reeducation. And don’t be afraid
to the posterior neck extensors help to experiment with these ideas and
balance and coordinate cervical make them your own. Your clients’
flexion and extension. In a cervical and your own level of satisfaction
lordosis pattern, they are typically will undoubtedly benefit.
underutilized. The active version of
the wedge technique automatically Til Luchau is the director and a lead
engages these prevertebral muscles; instructor at Advanced-Trainings.com Inc.,
you’ll be increasing their participation which offers continuing education seminars
in movement and posture when throughout the United States and abroad. The
you’re helping your client find originator of Skillful Touch Bodywork (the Rolf
flexion at each restricted joint. Institute’s own training and practice modality),
Engaging Prevertebral Muscles. The active
In a hypererect or military neck Luchau is a Certified Advanced Rolfer and a
version of the Posterior Cervical Wedges
pattern, use the active wedge technique Rolf Institute faculty member. He welcomes
technique engages the prevertebral
in reverse, encouraging more extension your comments or questions at info@
muscles along the front of the spine
(posterior closing) between cervical advanced-trainings.com.
(arrows) to help open any narrowed spaces
vertebrae. Find the most open or flexed
between posterior spinous processes. 3
vertebral spaces. Then, as you use Notes
your wedge to indicate these places 1. Arguably, the most common challenges to neck
alignment involve shortened structures in the posterior
to your client, coach him or her to
neck and relative lack of engagement of the deep
gently pinch or close right around your prevertebrals in front. Together, these cause the
fingers. Go for subtlety, specificity, neck to rest in an extended, head forward, or lordotic
You may need to start with
and the ability to initiate extension position. In the opposite pattern, such as the true
other joints, where there is already military neck, there is diminished cervical extension
right at the joint in question. Of
obvious flexion and extension with and a straighter neck. Although military neck is a
course, is it important to avoid over-
nodding. Once you and your client common diagnosis, in our experience problems
extending the neck, so stay focused arising from a hyperstraight neck are less common
can both feel the motion at a mobile
on local extension at specific joints. than those arising from lordotic neck patterns, so
articulation, you can move up or
working with a lordotic pattern is emphasized here.
down into the more restricted joints.
Big Picture 2. Seesaw image courtesy Eric Franklin, originator of the
Another pointer: often, practitioners
These techniques are quite effective, Franklin Method (www.franklin-method.com), from
and clients start with movements his book Dynamic Alignment Through Imagery
and you’ll see satisfying results by using
that are too large to allow the needed (Human Kinetics, 2006). Used with permission.
them. Of course, alignment of the neck
specificity. We’re teaching the ability 3. Prevertebral image from Ibrahim Adalbert
and head often involves more than just
to initiate flexion and extension at Kapandji, Physiology of the Joints, Volume III
freeing local restrictions. The neck
specific cervical joints, and this almost (Churchill Livingstone, 2008). All rights owned
reflects what is happening in the rest of by Elsevier, Inc. Used with permission.
always involves asking our clients to
the body. Issues such as eyestrain, jaw
slow down, and to make even smaller
issues, shoulder patterns, rib or pleural
movements than they’re accustomed Correction
pulls, spinal rotations, hip or pelvis
to. Be patient, stay in conversation with In the January/February 2009 Myofascial
asymmetries, or even support issues
your client, and encourage him or her Techniques column, the photo captions on
involving the lower limbs, will show up
whenever you feel movement at the Images 5 and 6 were transposed (page 125).
as neck alignment problems. Other neck
restricted joint. Although subtle, the
structures, particularly the scalenes and
movement will be clear and tangible to
sternocleidomastoids may be involved.
both of you when you’ve established it.

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