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.
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.
I’m going to gently place my fingers underneath
the patient's head. Find the occiput.
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.
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.
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.
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.
We were going to stand on the opposite side
from where we want to treat.
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.
As I pull the muscles superiorly, it’s going to
start to loosen up the muscles.
If I don't stabilize the head when I pull,
the whole head is going to turn.
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.
You don’t want to lean back and pull too quickly.
Myofascial should be done slowly.
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.
Then afterwards, you could reassess to see
if the muscles are a little bit more relaxed.
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.
We have anterior counterstrain points
that follow the sternocleidomastoid.
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.
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.
So if we’re here, our patient has
a tender point at C4 on the right.
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.
We want to try to get that point down to zero.
What I’m going to do is to position.
Now remember, posterior points,
you'll tend to put into extension.
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.
As I push here,
is the pain still there?
A little bit, so maybe a
2 or 3 out of 10?
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.
How’s the pain now?
Is it a zero?
Okay. So now that we reached our mobile point,
we’re going to hold this for 90 seconds.
As we’re holding this for 90 seconds, what’s
happening is the muscle spindle is resetting.
So, this will allow for the muscle to then return
to a normal length and will return the segment.
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.
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.
So now, I feel like it’s been a little bit softer here.
I’m going to bring the patient back to neutral.
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.
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.
Is that better now?
Good. So, that’s how you could apply
the principles of counterstrain
to the cervical spine
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.
Find a somatic dysfunction. Here we have a
posterior articular pillar at the level of C4.
On motion testing, it seems to get better
with flexion and worse in extension.
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.
So usually I put my middle finger
on that posterior articular pillar.
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.
Once we place the segment into the barrier,
we’re going to engage one plane of freedom.
So, we’re going to have the patient bring
their right ear to the right shoulder.
Go ahead and push. You push for
one, two, three, and relax.
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.
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.
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.
So with muscle energy, we could treat
any cervical somatic dysfunction.
You have to make the diagnosis.
Place it into the barrier.
Have the patient push to their freedom
using isometric contraction three times.
Do a passive stretch and go back and
reassess your somatic dysfunction.
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.
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.
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.
So I’m doing a little bit of a translatory
pull as I’m moving each segment.
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.
Make sure there’s good motion
and movement and to see
if the technique was effective in
treating the different restrictions.
High-velocity, Low-amplitude for the Cervical
Spine: So first, we make our diagnosis.
Feel for a posterior articular pillar.
That will tell us the rotation.
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.
I’m going to put my MCP joints on that segment
and my thumb resting along the jaw.
We’re going to slowly side bend down to that
segment. You don’t want to over side bend.
So, side bend just down to the segment.
Encourage a little bit in extension.
Pick up the head so that you feel like
you have control of the head.
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.
So turn this way, one, two three, and relax.
One more time, one, two, three, and relax.
One more time, one, two, three, and relax.
So now we have the patient in the barrier.
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.
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.
We come back and reassess to make sure
that that segment is moving better.