Head and Neck

Chapter Objectives

• Overview of Head and Neck Region

• Posterior Cervical Muscles
• Anterior Cervical Muscles
• Head and Face Muscles
Overview

• Muscle overview
• Trigger points (TP) and referral zones
• Trigger point activation
• Stressors and perpetuating factors
• Precautions and massage therapy (MT) considerations
Suboccipitals: The Rock and Tilt Muscles
• Rectus Capitis Posterior Major and Minor
• Obliquus Capitis Superior and Inferior

Attachment sites for

• 4 pairs of short, small and posterior the suboccipitals

muscles
• Indicated in severe headaches
Suboccipitals cont’d
Suboccipitals TP:
• Located in muscle belly
– Difficult to distinguish from semispinalis trigger
points

Referral Zones:
• Refer behind, above, in front of ear
• Sensation extends forward unilaterally to occiput, and
eyes
Subocciptals Trigger Point Map
Trigger points and referral zones
for the suboccipitals
Stressors and Perpetuating Factors
Suboccipitals TP Activation:
• Develop when trying to control neck flexion

Stressors and Perpetuating Factors:

• Whiplash
• Any sustained awkward head position
• Uncorrected nearsightedness or maladjusted glasses
Precautions and MT Considerations
Precautions:
• Avoid chin poking and jabbing movements

MT Considerations:
• Treat tissue between C1 and occiput
• Treat area between C1 and C2
• Use wave-like motion at base of skull
Levator Scapulae: The Stiff Neck Muscle
• Inserts in two layers
• Bursa found between two layers
Attachment sites for
the levator scapula
Precautions and Massage Considerations
Precautions:
• Observe the transverse process of C1

MT Considerations:
• Use muscle stripping and friction
• Tendonous attachment is fibrotic and easy to locate
• Pay special attention to C1 attachment site
Trigger Points and Referral Zones
Levator Scapulae TP:
• Painful stiff neck often mimics torticollis

Referral Zones:
• Refer to the crook of neck
• Sensation extends to vertebral border of scapulae and
posterior shoulder
Levator Scapulae Trigger Point Map
Trigger points and referral zones
for the levator scapulae
Stressors and Perpetuating Factors
Levator Scapulae TP Activation:
• Postural stress, occupational stress or sleep position

Stressors and Perpetuating Factors:

• Overexertion in sports
• Using crutches or a cane
• Sleeping in a airplane seat
Sternocleidomastoid: Amazingly Complex
SCM has both sternal and clavicular head

• Controls posterior head and neck movements

• Refer pain to face and head (not to neck)
• Mimics atypical facial neuralgia
• Mimics tension headaches
SCM Sternal Head Trigger Points cont’d
Sternal head
• Referral felt at mastoid process, occipital ridge and eyes

Creates the following symptoms:

• Blurred vision and sinus congestion
• Unilateral deafness without tinnitus
SCM Clavicular Head Trigger Points cont’d
Clavicular head:
• Refer to the front of head and behind ears
• Pain can extend to cheek and teeth on same side

Causes the following symptoms:

• Dizziness, vertigo, mimics tender lymph glands
SCM Trigger Point Map

Trigger points and referral Trigger points and referral

zones for the sternal head zones for the clavicular head
of the SCM of SCM
Stressors and Perpetuating Factors
SCM TP Activation:
• Awkward head posture
• Mechanical overload

Stressors and Perpetuating Factors:

• Sleeping on back with too many pillows
• Drooping shoulders, slouched posture
Precautions and Massage Considerations
Precautions:
• Avoid the carotid artery
• Avoid the styloid process

MT Considerations:
• Rotate head toward the working side
• Use a pincer compression
Scalenes: Anterior, Medius and Posterior
• Associated with thoracic outlet entrapment syndrome
• Scalenes minimus exists in 50-75% of population
• Trigger points difficult to identify and treat

Trigger points and referral zones for the scalenes

Scalenes Trigger Point Map
Scalenes TP:
• Common source of back pain

Referral Zones:
• Refer to chest, scapula, arm, elbow and thumb
• Rarely refer to head
Stressors and Perpetuating Factors
Scalenes TP Activation:
• Activation secondary to SCM trigger points

Stressors and Perpetuating Factors:

• Pulling, lifting or carrying heavy items
• Scoliosis
• Respiratory issues
Precautions and Massage Considerations
Precautions:
• Avoid direct pressure on brachial plexus and clavicle
• Tight scalenes traps brachial plexus (TOS)
• May mimic carpal tunnel symptoms

MT Considerations:
• Use gliding thumb strokes and rotate head
Anterior Suboccipitals
• Anterior suboccipitals: rectus capitis anterior and lateralis

Trigger points:
• Refer to larynx, neck and mouth
• Activated by controlled flexion
• Stressors include vision problems
• Avoid the styloid process
Longus Capitis and Colli: Military Neck
• Deepest anterior neck muscles

Trigger points:
• Activated by flexion/extension injuries
• Causes difficulty with swallowing and sore throat
• Avoid poking movements during massage
• Use appropriate pressure
Suprahyoids
• Suprahyoids: mylohyoid, geniohyoid and digastric

Trigger points:
• Refer to lateral side of tongue and side of jaw
• Activated by chronic mouth breathing
• Difficulty with swallowing or lump in throat sensation
Suprahyoids cont’d

Attachment sites for the Trigger points and referral

suprahyoids zones for the diagastric
Occipitalis: The Scalp Tensor
• Occipitalis and frontalis make the epicranius muscle

Trigger points:
• Refer deep in orbit of the eye and eyeball
• Activated and stressed by glaucoma/decreased vision
• Deactivate key trigger points in clavicular portion of SCM
Frontalis
• Also considered a scalp tensor

Trigger points:
• Refer pain in forehead
• Activated by SCM and constant facial expression
• Could create entrapment of supraorbital nerve
Epicranius Trigger Point Map

Trigger points and referral Trigger points and referral

zones for the occipitalis zones for the frontalis
Corrugator Supercilii
• Tiny facial muscle associate with eye headaches

Trigger Points:
• Refer behind the eyes
• Activated by facial expressions of anger and surprise
• Use the pincer grasp
Attachment sites for corrugator supercilii
Temporalis
• Key player in TMJ

Trigger Points:
• Refer to teeth, maxilla, eyebrows
• Causes hypersensitivity in teeth
• Activated and stressed by bruxism and gum chewing
Temporalis Trigger Point Map
Trigger points and referral zones
for the temporalis
Masseter
• Strongest muscle of the body (for its size)

Trigger Points:
• Refer to teeth, inner ear and eyebrow
• Significantly restrict jaw opening
• Associated with unilateral tinnitus
• Activated by teeth clenching, nail biting, an uneven bite
Masseter Trigger Point Map

Trigger points and referral zones

for the masseter
Medial Pterygoid
• Only small portion of muscle can be palpated

Trigger points:
• Refer to TM joint area, ears, throat, cheek
• Activated by forward head posture
• Stressed by thumb sucking and anxiety
• Work very gently as muscle is extremely tender
Medial Pterygoid Trigger Point Map

Attachement sites for the Trigger points and referral zones

medial pterygoid for the medial pterygoid
Lateral Pterygoid
• The key muscle in managing TMJD

Trigger Points:
• Refer to the TM joint and maxilla
• Activated as satellite trigger points of SCM
• Stressed by bruxism, playing a wind instrument or violin
• Work very gently as muscle is extremely tender
Lateral Pterygoid Trigger Point Map

Attachment sites for the Trigger points and referral

lateral pterygoid zones for the lateral pterygoid
Review
The galea aponeurotica is associated with which of the
following muscles?

• A. SCM
• B. Epicranius
• C. Lateral pterygoid
• D. Scalenes
Answer

• B. Epicranius