So, a client comes in complaining about upper back and neck pain. She says she was so concentrated on the work she was doing a few days before that she was in a head forward position for almost 6 hours. Now, not only does she have neck and upper back pain, but she feels like she has a migraine coming on. This client tends toward forward head syndrome, and after being in a head forward, concentrated position for a long period of time has tension throughout her back, neck, and head. When I began to work on her, there was swelling under her scalp, hot spots at the sutures, and a generally immobility of all her cranial bones. The atlantooccipital joint between her head and neck was tight enough that all but superficial palpation of the suboccipital muscles was impossible.
Forward head syndrome leads to an accentuated lordotic curve in the cervical vertebrae. She has the latter, but with extreme tension on the anterior aspect of her neck. Anterior neck tension can lead to or exacerbate tension in the suboccipital muscles, which for this client are already fairly tense from the immobility and position of her occiput. The accentuated lordotic curve in her cervical vertebrae coupled with the forward position of her head and her arms in her job have led to kyphosis in her thoracic spine, which, of course, adds to the tension of the posterior neck muscles.
Many of the posterior neck muscles originate from the upper back. The position of her thoracic vertebrae and ribcage heighten the already existing tension in muscles like splenius capitis, splenius cervicis, and iliocostalis cervicis. But her kyphosis does not only cause tension in a superior direction. It also tightens the muscles going down to or coming up from the lumbar spine, and the kyphosis has contributed to lordosis of the lumbar spine.
Lumbar lordosis generally leads to a heightened sacral curve and an anterior pelvic tilt in the one or both hips. If this anterior pelvic tilt is only in one hip, pain will most likely be felt in the contralateral hip and the ipsilateral knee. However, if this anterior pelvic tilt is in both hips, it is likely that pain will be felt in both knees. The reasons for this is that an anterior pelvic tilt moves the pubic bones inferior causing tension in the adductors and it moves the anterior inferior iliac spine inferior causing direct tension in rectus femoris.
Knee pain is another complain for this particular client. I was extremely grateful that I had 2 hours to work on her. Using SMRT, which allows me to work quickly and deep without much effort or pain to the client, I began by mobilizing her head and removing the swelling. I then worked to take down the tension in the anterior neck. At this point, the suboccipital muscles were quite a bit looser. I could palpate fairly deep and do a little work on those muscles directly. Next, in a prone position, I worked to clear the laminae groove of the thoracic and lumbar spine. And finally I released the thoracolumbar fascia and did some mild positioning on the sacrum.
She came out after the session and said she had no idea how she felt. That although I had only worked her spine, her entire body felt different. Opening up the spine, I explained, would have given more room to her peripheral nerve roots and could have affected her entire body. In effect, by focusing on the complications caused from her forward head syndrome, I had done a full body massage without touching 2/3 of her body.
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