The cervical spine poses several problems for the manipulative practitioner. Patients are often nervous of having their neck handled. This is either through natural fear of damage to the area from its apparent fragility, or due to having had a previous bad experience. Some operators are also afraid of harming the patient with techniques in the neck and unconsciously transmit this to the patient. The patient then finds relaxation impossible, thus perpetuating the vicious circle.
There are clearly particular reasons for extreme caution in the neck, and it is wise to use as gentle technique as is possible consistent with a good result. Particular care should be taken in cases of hypertension, postural hypotension and vestibular origin dizziness. Each of these conditions can be irritated by excessive force or rapid movement. If a particular position irritates a brachial syndrome, it should also be stopped immediately. Nowhere is it more important to make tech nique slow, deliberate, and non-threatening than in the neck.
Discomfort and pain will often occur if not enough care is taken to keep the head substantially in the midline. Most of the thrust techniques require the vertex to remain almost central and the neck to be pushed or buckled into sidebending and sideshifting to achieve locking and localization. It may apparently be easier to produce an effective barrier if the head is taken out of the midline, but pain, distress and overstretch are the common undesirable results.
Some patients feel threatened if they cannot see the practitioner, and in these cases techniques should be performed from the side or front of the patient. Some patients intensely dislike chin hold techniques, and in these cases cradle hold methods are preferable. The use of rhythm is essential to produce a dynamic state of relaxation, and it is also easier to accelerate in thrust technique from a slightly moving pathway.
21.1 • Kneading of soft tissues supine Stand at the side of the patient and stabilize the head with the upper hand. Pull up on the posterior and lateral tissues with the pads and fingertips of the active hand. Depending which fingers are used, the lower, mid or upper parts of the neck muscles are kneaded.
Tips: Try adding a sidebending movement with the head hand to emphasize the effect. Try not to slide over the skin excessively as this can be uncomfortable.
21.2 • Kneading of soft tissues supine This operator viewpoint photograph shows the hold illustrated in photograph 21.1. Note that even though the head has been sidebent, the vertex remains in the midline. This avoids excessive facet compression on one side, and overstretch on the other.
21.3 • Kneading of soft tissues supine This photograph is of a similar procedure to that shown in photograph 21.1. However, it can be seen that by changing the hand hold slightly, you can pull into a combined extension and rotation at the same time as the kneading. This will have the effect of making the technique much stronger.
Tips: Try extending the neck with the kneading hand or fixing with this hand and extending with the other. Try using both hands together.
21.4 • Kneading of soft tissues supine Fix the head into the pillow with one hand applied to the forehead. Apply the fingertips of the kneading hand parallel to the spinous processes. Push the fingers upwards into the neck and pull laterally while maintaining this upward push. The effect of this is to stretch the muscle tissue away from the spine while the neck remains static.
Tips: Use the back of the hand on the pillow as a fulcrum. Extra considerations: Try rolling the head slightly to enhance the effect of the kneading force.
21.5 • Kneading of soft tissues supine Fix the head into the pillow with the stabilizing hand. Use the fingers and thumb of the kneading hand to work on the posterior tissues of the neck on both sides at once.
Tips: With both fingers and thumb applied underneath it is easier to combine an articulation force at the same time rather than when just using the fingers. Extra considerations: Try adding a traction force.
21.6 • Kneading of soft tissues prone Stand to the side of the table and stabilize the head with the upper hand. Apply the kneading hand to the tissues on the other side of the neck and pull toward yourself.
Tips: This is not very comfortable for the patient unless a table with a breathing hole is used as excessive extension can result if insufficient care is taken.
21.7 • Kneading of lower soft tissues prone
Stand at the side of the table and stabilize the head with the upper hand. Use the heel of the kneading hand to push the trapezius and lower posterior cervical muscles toward the table.
Tips: This is not very comfortable for the patient unless a table with a breathing hole is used as excessive extension can result.
21.9 • Kneading of soft tissues sidelying Stand in front of the patient and stabilize the head with the upper hand. Use the heel of the kneading hand to work on the lateral and posterior tissues uppermost to push them toward the spine.
Tips: Most useful in subjects with very tight fascial states as working toward the spine is often easier than working away. Try reaching round to the lower side and pulling up with the fingertips to work on the tissues nearer the table.
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