Osteopathic Cervical Treatment

by Sheldon C. Yao, DO

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    00:01 Suboccipital Release: So, what we want to do with the suboccipital release is try to decrease the tension right underneath the occipital bone to superior portion of the cervical spine. What we’re going to do is get our fingers into that suboccipital space. We’re going to slide down following the occiput.

    00:17 Then when we get there, we’re going to slowly provide some lateral traction and then some superior traction to try to release those muscles.

    00:25 I’m going to gently place my fingers underneath the patient's head. Find the occiput.

    00:29 Go ahead you can relax your head. Now, I’m going to let my fingers slide just underneath the occiput here into the suboccipital space.

    00:37 I’m going to feel for any tension in the area. Then I’m going to slowly provide some lateral traction by spreading my fingers apart.

    00:46 You could sometimes do that by bringing your wrist a little closer together and then slowly leaning my back, leaning my body back to provide a traction and then matching the tension underneath my fingers and waiting for the tension to decrease and relax. Once I feel like the muscles have relaxed, I could release the traction, come back, and then reassess the soft tissue underneath the suboccipital region.

    01:14 Cervical Myofascial Release: So, to perform cervical myofascial release, what we want to do is to first assess the cervical muscles to see if there’s any hypertonicity.

    01:25 We were going to stand on the opposite side from where we want to treat.

    01:29 So here, we're treating the left side here. What we want to do is to take our fingers and contact those cervical paraspinal muscles and then we’re going to apply an anterior traction.

    01:39 As I pull the muscles superiorly, it’s going to start to loosen up the muscles.

    01:45 If I don't stabilize the head when I pull, the whole head is going to turn.

    01:48 So, what I do with my other hand is to stabilize the head by the forehead and my other hand grasps the posterior musculature and just kind of leans back.

    01:56 You don’t want to lean back and pull too quickly. Myofascial should be done slowly.

    02:02 You can move up and down the cervical spine and even down into the trapezius muscles to try to get a good stretch. You hold the stretch until you feel a release and then you come back.

    02:12 Then afterwards, you could reassess to see if the muscles are a little bit more relaxed.

    02:17 Counterstrain for the Cervical Spine: We could utilize counterstrain for the cervical spine to treat any tender points that we may find, patients with headaches, patients with neck pain, may have these tender points throughout their neck.

    02:31 We have anterior counterstrain points that follow the sternocleidomastoid.

    02:35 Also, there's a point that is just posterior to the mandible, C1 mandible that is a good point to treat if patients are complaining of TMJ.

    02:44 Posteriorly, we have our tender points that are midline along the spinous processes and also along the articular pillars. So, as long as you understand the principles of counterstrain, you could treat any of these points.

    02:58 So if we’re here, our patient has a tender point at C4 on the right.

    03:05 Over here is that tender. So first, we want to find the point and we want to establish a pain scale. So, we tell the patient this pain we're going to rate on a scale of 0-10, a 10 out of 10 at this point.

    03:20 We want to try to get that point down to zero. What I’m going to do is to position.

    03:25 Now remember, posterior points, you'll tend to put into extension.

    03:29 Anterior point, you'll put more into flexion. So with this C4 posterior transverse process tender point, we’re going to extend. We’re going to side bend away from the point and we’re going to rotate away from the point. Once we position the patient into the mobile points, we want to double check to make sure the pain is gone.

    03:50 As I push here, is the pain still there? A bit.

    03:54 A little bit, so maybe a 2 or 3 out of 10? Good.

    03:59 Okay. So now, what we’re going to do is we’re going to reposition a little more extension, a little bit more rotation, and perhaps a little bit more side bending.

    04:08 How’s the pain now? Is it a zero? Yeah, it’s gone.

    04:11 Okay. So now that we reached our mobile point, we’re going to hold this for 90 seconds.

    04:15 As we’re holding this for 90 seconds, what’s happening is the muscle spindle is resetting.

    04:20 So, this will allow for the muscle to then return to a normal length and will return the segment.

    04:26 There should be less tenderness. While you're waiting for 90 seconds, you shall also be paying attention with your finger that’s palpating the point.

    04:34 You’re really not putting pressure on the point. You are sensing, getting a sense of possible change. So usually when I’m holding counterstrain point, I will get a sense of the tissue softening. Sometimes you may feel a pulsation when the muscles start to relax and the blood starts to flow a little bit better across the region.

    04:53 So now, I feel like it’s been a little bit softer here. I’m going to bring the patient back to neutral.

    04:59 It’s important you tell the patient not to help you because you don’t want them to activate the muscle that you’re treating here. So, don’t help me.

    05:05 I’m going to bring your head back. After bringing the patient back, keep your finger on the spot and reassess the point to see if there’s improvement.

    05:14 Is that better now? Less pain? Yes.

    05:16 Good. So, that’s how you could apply the principles of counterstrain to the cervical spine tender points.

    05:24 Muscle Energy for the Cervical Spine: We could utilize muscle energy to treat different dysfunctions in the cervical spine. So, you want to scan the cervical spine.

    05:35 Find a somatic dysfunction. Here we have a posterior articular pillar at the level of C4.

    05:41 On motion testing, it seems to get better with flexion and worse in extension.

    05:48 So, I have a C4 FRS right. To treat a C4 FRS right with muscle energy, we’re going to take our hand and monitor C4 on the right with my left hand.

    06:02 So usually I put my middle finger on that posterior articular pillar.

    06:07 My other hand is going to control the head. So remember with muscle energy, you want to put the segment into its barriers. So if we have a C4 FRS right, we’re going to extend into the barrier just so I feel motion, side bend left, and rotate left.

    06:23 Once we place the segment into the barrier, we’re going to engage one plane of freedom.

    06:28 So, we’re going to have the patient bring their right ear to the right shoulder.

    06:32 Go ahead and push. You push for one, two, three, and relax.

    06:37 You let the patient relax for three seconds. Then we’re going to reengage all three planes of the barriers. We’re going to do a little more extension, a little more side bending to the left and a little more rotation to the left.

    06:48 Go ahead and push again, one, two, three, and relax. Then one last time, we’re going to reengage the barriers and then have the patient push again, one, two, three, and relax. At the end, we’re going to do a little bit of a passive stretch.

    07:03 So, we reengage all three barriers and come back and then we reassess the segment and there should be improved joint motion after utilizing muscle energy.

    07:16 So with muscle energy, we could treat any cervical somatic dysfunction.

    07:20 You have to make the diagnosis. Place it into the barrier.

    07:23 Have the patient push to their freedom using isometric contraction three times.

    07:28 Do a passive stretch and go back and reassess your somatic dysfunction.

    07:32 Cervical Articulatory Technique: We could utilize the articulatory technique to treat the cervical spine. So, if we have restrictions in the cervical spine and we want to try to articulate a segment, what we wanted to do is to contact that cervical segment. So, I’m going to take my hand and hold onto the cervical segment that feels a little bit more restricted. Here it’s C3.

    07:55 Then with my other hand, I’m going to contact the head and add a little bit of a circulatory motion. At the same time, I’m translating that segment with my hand underneath. So here, we’re articulating the segment.

    08:09 Remember, articulatory technique is just to take the segment and try to mobilize it and move it. Here, it’s more moving this segment through its barrier.

    08:20 So I’m doing a little bit of a translatory pull as I’m moving each segment.

    08:25 You can move up and down the cervical spine trying to get increased range of motion in the cervical spine. So afterwards, you could come back, reassess the segments.

    08:34 Make sure there’s good motion and movement and to see if the technique was effective in treating the different restrictions.

    08:42 High-velocity, Low-amplitude for the Cervical Spine: So first, we make our diagnosis.

    08:49 Feel for a posterior articular pillar. That will tell us the rotation.

    08:54 So here we have a C4 posteriorly rotated on the right. To perform HVLA, I want to stand on the same side as the posterior articular pillar.

    09:03 I’m going to put my MCP joints on that segment and my thumb resting along the jaw.

    09:08 We’re going to slowly side bend down to that segment. You don’t want to over side bend.

    09:14 So, side bend just down to the segment. Encourage a little bit in extension.

    09:18 Pick up the head so that you feel like you have control of the head.

    09:22 We’re going to rotate that segment through its barrier. When we reach that point of barrier, we could do a little muscle energy by having the patient turn their cheek the other way.

    09:31 So turn this way, one, two three, and relax. One more time, one, two, three, and relax.

    09:37 One more time, one, two, three, and relax. So now we have the patient in the barrier.

    09:44 We’ve reached the restriction here. We did some soft tissue to make sure that the muscles around that segment is relaxed. Then we’re going to provide a quick high-velocity but low-amplitude thrust. So the thrust is going to be turning the head in a rotational thrust. I’m going to lock the patient now with a little extension, side bending.

    10:02 It should feel like the nose can’t rotate any further. Once we get to that point, it’s a quick turn. Then we bring the head back.

    10:09 We come back and reassess to make sure that that segment is moving better.

    About the Lecture

    The lecture Osteopathic Cervical Treatment by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Suboccipital Release
    • Cervical Myofascial Release
    • Counterstrain for Cervical Spine
    • Muscle Energy for Cervical Spine
    • Cervical Articulatory Technique
    • HVLA

    Author of lecture Osteopathic Cervical Treatment

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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