Case Report: Can Myofascial Release increase Cervical Flexion

The subject of my most recent case report is: Can myofascial release increase cervical forward flexion?
This client was in an accident several years ago. She suffered a head injury and still has headaches (mostly on the top of her head) and difficulty flexing her chin toward her chest.

Goniometers are tools used to measure range-of-motion.

The plan is for the subject to rate her pain on a scale of 1-10. I will then measure the ROM pre-treatment, apply myofascial release to the appropriate muscles, then re-measure to see if any change has been made.

All measurments and procedures used, and for what duration will be recorded in the first and subsequent sessions. The client will refrain from other treatments such as PT and chiropractic during this time. The duration for this study will be 1 30-minute session, 1x/week for 4 weeks.

Photo courtesy of ABMP

Different Strokes

As a massage therapist working in Washburn, WI, I have to say how wonderful it is to be surrounded by amazing colleagues. If you have ever been to the Chequamegon Bay or the Apostle Islands region of Lake Superior, you probably noticed the dense concentration of artists, musicians, and...massage therapists.

If you are looking for a damn good massage or bodywork session after your adventure at sea or on the trails, you’ve come to the right place. I’ve seen all kinds of massage from Accupressure to Zen Shiatsu offered between Ashland, Washburn and Bayfield, WI. They all have some similarities, but they are different, too. The method I use most is called Precision Neuromuscular Therapy, or PNMT.

That reminds me of something that happened to me a few weeks ago. I was giving massages to cyclists after the Superior Vistas Bike Tour.

Gina McCafferty giving a chair massage to a cyclist at Superior Vistas Bike Tour in Washburn, WI

A female cyclist approached me and told me about the neck pain, headaches and vertigo she had been experiencing as well as occasional pain and tingling down her arm. I noticed that she, like so many other cyclists, had some head forward position happening. She sat down and I immediately started to work on her sternocleidomastoid muscle, the SCM for short. For those of you who are curious about anatomy, that's a muscle that runs from the mastoid bone behind the ear diagonally to the clavicle and sternum. Clinicians sometimes use the angle of the SCM to determine head forward position. The shorter the angle of the SCM, the more forward the head position.

As I continued to work on her SCM, she suddenly exclaimed “That’s it!” “That causes the headache!” I had to clarify so I asked “When I compress this muscle in your neck, you feel the pain in your head?” “YES.” I told her that we were working with a common trigger point in the SCM that is capable of producing a headache. I continued to work on it until the “headache” dissipated.

Trigger points in the SCM can cause tension headaches and dizziness.

Then I worked on some other muscles in the front of her neck. I worked on her anterior and middle scalenes (after checking for arterial contraindications) and found a spot that seemed to refer the nerve-y tingling down her arm. Once that had been relieved, I finished up with a little myofascial streching over her platysma, another anterior neck muscle. Her platysma didn’t hurt. It was an effort to help restore her neck muscles and posture to a more normal resting length.

When her time was up, she told me that what I did was remarkable. In just 15 minutes, I found out what was causing her pain, thoroughly treated  it, and still had time to address her posture, her head forward position. She went on to say that she does get regular massage from a very good practitioner back home. She always leaves his office feeling wonderful, but said he has never touched the front of her neck. “Well”, I said, “the anterior musculature of the neck is often overlooked in traditional massage therapy because it’s not very relaxing.”  I also told her that he’s doing a great job of keeping her healthy and his gift is probably that he can really reduce stress. He's probably an expert in relaxation and stress management. Everyone needs that and more people should seek it for themselves.  She leaves (both of us) feeling wonderful and if her neck pain, headaches, vertigo, and arm tingling go away, that’s great news for her.

I guess my gift is pain relief.  I like to be challenged, solve the postural puzzles, and improve the quality of life for people with pain. Everything I do during a massage has to do with improving the condition of my patient. Everything. There’s really nothing “relaxing” about it. Sometimes it hurts.

I think its important for we massage therapists to remember that we all offer something different and unique to our clients. We’re offering a part of ourselves and different people will need our different types of touch at different times. 

Pain Relief for racers at Bayfield Race Week!

My colleague, BeckySue, and I are providing massage for the racers during Bayfield Race Week 2012 in Bayfield, WI. As a pain relief specialist I want to know how I can best help them. To answer my own questions, I thought about what kinds of pain people who sail might have. I thought more and I tried to mimic some of the repetitive actions used in sailing to get more ideas. I researched pain associated with sailing. I even interviewed someone from the Wayzata Yacht Club.

What I found out was that most people have pain between their shoulder and their neck. Many have forearm pain in an area that we massage therapists call the "wad of three," (For more information about forearm pain, please read my blog post entitled Tour De Cycling Anatomy). Still others have low back pain and knee pain.
There is a famous quote by Ida Rolf, a founder of the structural integration types of bodywork. It goes: "Where you think it is, it ain't." I want to relieve pain by correcting postural malalignment, breaking up adhesions, restoring muscles to a more normal resting length and freeing nerves that may be entraped by soft-tissue.

When Bayfield Race Week racers come to me for their massage, I will provide a brief but solid assessment: Is one shoulder higher or lower? More anterior? Do they stand with a forward bend?When they stand, do I see the back of the hands? These types of observations give me clues about the kind of pain they may be experiencing.  For example, if I see a high shoulder on the right, I can lengthen the muscles that elevate the shoulder. On the low side, I can restore the shoulder depressors to a more normal resting length. Similarily if I see a lot of the back of their hands, I know that the "medial rotators of the humerus" will need some TLC. If they bend forward when standing, I can lengthen the muscles that flex the hips, thereby taking some strain off the muscles that are stuck check reining the spinal flexion.

So... you might be wondering what does all of this mean to the Bayfield Race Week racers, in English?  It means that I use Precision Neuromuscular Therapy techniques to address structural shifts, restore muscles to a more normal resting length, relieve trigger points that can refer pain, and free nerve entrapments. People LOVE the way they feel when they are closer to neutral balance alignment and the work feels GREATwhile it is being performed!

Thanks for reading and have a remarkable, pain-free Bayfield Race Week!

Gina McCafferty, LMT
Pain Relief Specialist