Download Cervical 360º Concise

Cervical Anatomy 360º + Massage
Taught by Christopher SovereignLMT, CNMT, CBAT, COSM
[email protected]
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Cervical Anatomy 360º + Massage
Taught by Christopher Sovereign- LMT, CNMT, CBAT, COSM
In this class & manual we shall delve layer by layer through the neck, examining the individual
tissues.
Goal 1. Show the muscles individually.
Goal 2. Increase your understanding of location and jobs of the cervical muscles.
Goal 3. Show basic massage techniques for each tissue.
The posterior neck is classically divided into 4 layers of muscles- AVIIA
Upper trap ^
Spleni V
Semispinalis II
Multifidi & rotatores ^
Landmarks
Trapezius
Spleni V
Semispinalis capitis II
Semispinalis cervicis II
Multifidi & Rotators ^
Erector Spinae group
Spinalis
Longissimus cervicis
Longissimus capitis
Suboccipitals
Lateral neck
Scalenes
Levator scapulae
Sternocleidomastoid
Anterior neck
Hyoid muscles
A. supra-hyoids B. Infra-hyoids
Longus coli
Longus capitis
Various
Interspinous
Rhomboid minor
Serratus Posterior Superior
Sovereignisms
1
Bump AKA: External
Occipital protruberence
SNL
Superior Nuchal
Line (SNL)
Inferior Nuchal Line
1
1
C1; note- Does not have a spinous
process. It has a small bump called a
tubercle
C2 ; note- large spinous, the largest
in the upper cervical. Smaller than
C7 spinous process.
C7; note- this is the largest
spinous process of the upper
body
T1; note- large, but smaller than C7.
May stick out farther but less
massive
Note the space between the
‘transverse processes’ and the
articular pillars
Lateral mass. The
group of these are
known as an articular
pillar
3
Trapezius
Upper Trapezius
Cranial attachment: External
occipital protuberance (EOP),
medial portion of superior nuchal
line, nuchal ligament, possibly to
spinous processes of C2-5.
Laterally connects to: Lateral 1/3
of posterior clavicle. [middle
trapezius attaches to scapula @
acromium & spine of scapula]
Jobs: Elevation of scapula, lateral
flexion of head & neck, helps resist
weight carried on shoulder, upward
rotation of scapula. Stabilization &
checkrein of head.
Of note: One of the most common
muscles to have trigger points,
commonly referring to temple &
mastoid process (& inferior of it).
Massage: Glide with skin @ EOP
& superior nuchal line, midline &
nuchal ligament, glides from
midline out to posterior clavicle
( lateral 1/3 to acromium ). Thumbs
are perfect for clavicle work when
client is supine.
clavicle
Spleni
Splenius capitis & cervicis V 13/36
Upper trap: lateral attachment:
> Lateral 1/3 of the posterior aspect of
the clavicle.
Note: the upper trap does
NOT attach to the scapula.
Normally, this structure would be thought of as two structures- one going to the cranium & one to the upper cervicals. In my
mind, this is more like a biceps muscle- a muscle with one base and 3 additional insertions. A cervical triceps if you will.
Capitis: to the mastoid process and
medially to the occiput between
superior & inferior nuchal lines. This
attachment is deep to ( underneath )
the SCM mastoid attachment.
From the midlineFrom C3 lateral
spinous process to T6
lateral spinous
process.
Cervicis section looking
medially- Curls around to the
lateral neck inserting into the
posterior tubercles & posterior
transverse processes of C1 &
C2 & maybe C3.
Jobs: Stabilization of head & neck,
rotation of head to same side. Bilaterally:
Stabilization & extension of head &
neck.
Massage: Glides from C3-T6 spinous
processes upward & laterally towards
mastoid process. Also treat mastoid
process & lateral attachments @ C1-3
Of note: Remember this one by V
13/36: Bilaterally this is in a V
shape and attaches above to C1-3
& below to C3-T6
Cervicis section- posterior view- note it’s
curling about to the lateral.
Anatomical landmarks: Spinous processes; mastoid process;
C1 TP; C2 & 3 posterior tubercles
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Semispinalis Cervicis and Capitis
Mainly straight up the spine
Semispinalis Capitis: ˆC46-T17
From above:to occiput in between
the superior and inferior nuchal lines.
From below: C4-C6 articular
processes, Transverse processes of
T1-6 or 7
Actions: Stabilizing of Head in
flexion, extension of head
It lays in the lamina groove but does not attach
to the spinous processes.
Semispinalis cervicis: ˆ25/16
SP 25, TP 16
Above: spinous processes of C2-5
Below: Transverse P. of T1-5 or 6
Actions: stabilization of neck in
cerv. flexion, extension of cspine, rotation to opposite side.
Multifidi & Rotatores
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These muscles work
together typically. Of
note: Each one of these
is a mini-biceps
( rotatores ) or miniquadriceps ( multifidi ) as
from one location on a
transverse process these
‘reach up’ to multiple vertebrae above.
Multifidi
Above- Mid- lateral spinous processes of C2-C5
Below- Articular processes of C4-C7 This
muscle spans 2, 3 or 4
vertebrae.
Rotatores
Above- Spinous
process starting at C2
This muscle spans
one to two vertebrae.
Below- Transverse
process starting at C3
and continuing on.
Overall- stabilization & specific positioning of
individual vertebrae
Bilaterally- Extension of vertebral column
Unilaterally- help rotate vertebral column
towards opposite side.AKA: these muscles tighten on right and the neck is turned to the left.
Massage:Gently sink into the lamina groove and perform small glides from a transverse process
to the spinous process up one, up two, up three & up four. Repeat at the next vertebrae, working
small and gently.
Questions? Contact us via- [email protected] or 505-363-9004
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Erector Spinae Group:
Spinalis, longissimus & iliocostalis
Spinalis cervicis- a rainbow m. part of the erector spinae group
tends to help control ROM.
This is what I call a rainbow muscle. If you looked at this muscle
while someone were on their side-it is sharped just like a rainbow.
Others think of it like suspension springs on a car.
The fibers that attach to the spinous process of C2 have the longest
fibers and go all the way back to the spinous process at T3, likewise C3
goes to T2 ( and is slightly shorter in length, C4 to T1, C5 to C7 ( and is
the shortest )
Functions: Bilaterally- 1. Stabilization of the vertebral column 2. assist in
extension of the vertebral column
Unilaterally- lateral flexion of vertebral column ( side bending ) minor
player
Massage: sink in and gently work into the lateral spinous processes.
Longissimus capitis & cervicis
Longissimus capitis:
a smaller strap of a muscle
Below- To the articular processes ( lamina groove ) of C4 or C5 & T1-T4
or T5 Transverse processes
Above-Mastoid process
Function- 1. Bilaterally-Extension of the head ( think of what this might
do in forward head posture ) 2. Unilaterally-Helps to laterally flex the
head 3. Rotate head towards same side
Longissimus cervicis
Below- Superior portions of transverse processes of T1-T4 or T5
Above- Posterior tubercles of C2-C6
Functions: 1. Bilaterally-Extension of the vertebral column 2.
Stabilization of cervical vertebrae Unilaterally- 3. lateral flexion towards
the same side.
Massage: Sink in using gentle glides in the lamina groove out to the
transverse processes & the inferior mastoid process.
Iliocostalis cervicis
The most lateral of the 3 groups comprising the erector spinae
muscles.
Connects long fibers from the sacrum to the posterior
tubercles of the lower cervical vertebrae. Note it is lateral of
the transverse processes.
Massage: Work between mid thorax and the lateral cervicals.
Part of this shall put you in the lateral rhomboid area, as well
as very near the posterior scalene.
SUBOCCIPITALS This group of 4 muscles on each side are small and important. In their actions they
act similar to the spinal ligaments and multifidi lower in the spine, tho acting on the head & first 2
vertebrae. They are frequently involved in headaches via trigger points
Major & minor
Rectus Capitis Posterior MajorConnects C2 spinous process to the
occiput @ inferior nuchal line starting
one thumb width lateral of the midline.
minor- Connects C1 tubercle to the
occiput @ inferior nuchal line starting
at midline, is one thumb width wide.
Their actions: Primary: stabilizing
head, micro adjustments to C1 & C2
vertebrae.
Assist in extension (Bilat) & rotation to
same side.
Massage: Sink into the C1 tubercle &
press into the occiput & glide
superiorly. Shift one thumb width
lateral and repeat from C2.
Superior & inferior
Obliquus Capitis Superior
Connects C1 transverse process &
occiput in between superior & inferior
nuchal lines. Lateral section is near
mastoid process.
Obliquus Capitis inferior
Connects C2 spinous process to C1
transverse process.
Their actions: Primary: stabilizing head,
micro adjustments to C1 & C2 vertebrae.
Assist in extension (Bilat) & rotation to
same side.
Massage: find C1TP-work the small area
slightly posterior & above for superior.
For inferior- work between the large C2
spinous process and C1TP using small
partial glides & static pressure holds. Its
longer than you might think.
9
Scaleni- anterior, middle & posterior.
Of note: The subclavian artery, brachial plexus &
auxiliary artery run between the anterior & middle
scaleni. These have the ability to compress these
arteries directly and the ability to raise up the first rib,
compressing this neurovascular bundle indirectly.
None attach to C1.
The scaleni do not attach in the lamina groove, rather
the tubercles of the transverse processes.
Scalenus minimus: 7 [exists in at least
half/3/4 of people on a minimum of one
side] Connects the plural dome with the
neck, allowing increased lung expansion.
Scalenus anterior: 36/1 middle vertebrae
connects the anterior tubercles of C3-6 to
the anterior border of the first rib.
Scalenus Medius: 27/1 connects the
posterior tubercles of C2-7 diagonally
with the superior surface of the first rib.
Scalenus posterior: 57/2 lower neck:
Connects the lowest 3 vertebrae via
almost horizontal fibers to rib #2.
Jobs: From above: Inspiration. From
below: Lateral flexion of the cervical
spine ( almost and extension of the lev.
scap.), neck flexion, neck stabilization.
Working the posterior scalene
Glide from 2nd rib to C5 (where line is)
My favorite is w/ client in sidelying and using
my thumb
Massage: Minimus we can’t get to.
Anterior is difficult. We won’t be treating
in this class.
Medius is easily found- it’s just strait
lateral and meaty.
Posterior is best found in side lying
position. From the side it is an easy and
short stroke in the lower cervicals.
Levator Scapulae
Think Bi-14
From above: Transverse
process of C1-4 (Posterior
tubercles of C2-4)
Note the 90º
twist from
scapula to
vertebrae
From below: Posterior
edge of the superior
angle of the scapula
Jobs: Elevates shoulder,
side bends neck,
stabilizes/
counterbalances neck in
FHP, May insist in same
side ROT, Bilat. cerv.
ext. Assists in rotation to
same side.
C1 (Atlas) @TP
C2 (AXIS) @ Post Tub
C3 @ Post Tub
C4 @ Post Tub
Notes: Lev. Scap does elevate
the shoulder ( duh ! ) when the
neck is fixed. It also can pull
the neck laterally
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Levator Scapulae
Superior attachment work:
Find C1 TP just inferior to
mastoid process. It might be
slightly anterior.
High attachments: C2-4 Transverse
processes (C2-4 posterior tubercles)
Find the lateral articular pillars
Sink fingertips to bone level
Stay at bone level and shift
slightly anterior to slight boney
prominences ( post. tubercles) .
Scapular attachment: Posterior
superior angle of the scapula.
Find the spine of the scapula at
its medial end
Glide slightly superior.
Massage the posterior edge.
Note: At the superior angle is
a sandwich- levator scap then
serratus anterior.
Sternocleidomastoid:
The greatest name in
muscles
Superior attachment is at
mastoid process and posterior to
lateral half of the superior nuchal
line
The two lower heads of the SCM:
1.Sternal @ the manubrium
2. Clavicular
From above: Lateral surface of the mastoid process, lateral half of the superior
nuchal line of the occiput
From below: Sternal Head: Anterior superior surface of the manubrium
Clavicular Head: Medial 1/3-1/4 superior and posterior surfaces of the clavicle
Actions:
Bilaterally: Neck flexion, pulls head forward,
brings chin to chest,
checkrein against hyperextension,
stabilizes (with trapezius) head during talking and chewing
Unilaterally: Rotates the face towards the opposite side,
w/traps- side bends neck.
Basically, almost every movement of the neck involves help from the SCM
Note: the SCM does not attach to the neck !
13
Keys to success with the SCM:
working the
deep SCM.
on left- sidelying
>
Forget working the inferior
attachments. They are almost always tender
and do not improve much. Plus, clients hate it
and get little improvement, a lose/lose.
>
Do work the mastoid attachment as it
can improve and can be involved with
headaches.
>
Many MTs mistake with the SCM is
not working the deep portion. they work the
superficial section only. The deepest part
needs the most work and is also the hardest to
get to.
>
A pincher grip works best to go around
the superficial tissues. Once you grasp the
tissue, you can hold and release or work your
fingers back and forth gently.
In the supine position, the fingers are
recommended to treat the cranial
attachments at the mastoid process and
lateral superior nuchal line. Sink in, then
determine pressure. Moving with the skin in
a line back and forth or circles is excellent
In prone, thumbs are recommended.
Working the mastoid attachment
!
!
!
!
SCM
!
Carotid Artery
Internal Jugular Vein
You can see from this graphic that
the SCM is quite thick and wide.
Also note: the neurovascular bundle
resides on the posterior aspect of the
SCM. Don’t pinch 360º and you’ll be
fine.
Hyoid muscles
Two different functions of these tissues attaching to the
hyoid bone ( located where the jaw/mandible meets the
neck ) :
Supra hyoids- meaning above the hyoid.
These are the ones you use when you do a hard gulp.
Massage: these we gently work the ‘floor’ of
the mouth. Follow the midline and also along the line
of the medical jaw, always using easy pressure and
slow speeds.
Infra hyoids- meaning below the hyoid
bone. They depress/pull down on the hyoid.
Very important in swallowing.
Massage: these we will use extra gentle
pressure & use light finger circles onto the
thyroid cartilage, then following the
muscles down to the sternum.
15
Deep anterior throat muscles. Similar is design & function as the erector spinae, but for
the cervical spine.
Caution: We shall not be massaging them in this class. They can be worked, but this is not
recommended unless you have had very specific instruction.
Longus coli
This powerful cervical
flexor is deep and
directly attaches to the
anterior of vertebrae.
Longus Capitis
Connects the occiput to the transverse
processes of C3-6 via a ^ shape.
Jobs: Flexion of head, side flexion of
head.
Longus coli & capitis along with the
more lateral Rectus Capitis Anterior
& Lateralis.
Longus coli connects
C1-C6 superiorly
attaching closer to the
midline and as it is
inferiorly- moving
laterally into the
transverse processes of
C5 & 6.
Jobs: Powerful cervical
flexor working
bilaterally, assists in
lateral flexion.
Rectus Capitis Anterior & Lateralis
These are two small anterior &
anterior-lateral sub occipitals mirror
their posterior compadres.
They connect the anterior occiput &
mastoid process with the transverse
process of C1.
Jobs: Micro movements of C1,
flexion of the head, side flexion /tilting
of head.
Interspinous
This is a series of tiny muscles that
connect the inferior border of one
spinous process with the superior
border of the next one.
Jobs: It’s main action is micro
movements of the spinous
processes.
Massage: Tiny and hard to reach.
May be worked gently with a t-bar or
an add-on pencil eraser
Serratus Posterior Superior
This muscles hides deep to the
rhomboids and under the scapula. It
does connect the C7 spinous
process (& T1-3) with ribs 2-5.
Jobs: Assists with inspiration
Massage: move scapula as much
out of the way as possible. Detailed
work @ spinous processes followed
by glides laterally & inferiorly.
Rhomboid minor
Rhomboid minor does cross from the
thorax into the realm of the cervicals.
Connects spinous processes of C7
& T1 to the upper medical border of
the scapula.
Jobs: Elevate, downwardly rotate &
adduct the scapula.
Massage: Glides between C7
spinous process & the angle just
inferior of the superior angle.
17
1. Start Gentle
2. Work without lubrication for a while
3. Soft & slow improves the flow
4. Trust your intuition.
5. Trust your hands. They will take you far. And, the more you
trust them, the better you will be.
6. Let tissue rest before you work it more
7. Tell tissue what you are going to do, do it, then remind tissue
what you did. AKA general, specific, general
8. Biathlon thinking: Fast works great for flow and for general
strokes; slow is important for detail. Sitting down helps you
shift gears, give the time you need
9. Full body w/equal time everywhere is over-rated. Feel free to
skip full areas or just say hello to allow more time for more
important areas. AKA: where they asked for it !!
10. Talk less, Communicate more
11. Ask
12.Practice. Practice. Practice.
13.Finish Big !