Athletes Treating Athletes

This is part twelve in the Self Muscle Massage Series. In the introduction post to this series we introduced and demonstrated the three muscle release techniques that will be used in this post. If you would like to review them, click here. If you would like to see any other parts of the series, click here.

In this post, we’ll be finishing up our discussion of the spine by talking about the neck or cervical region. Unlike the low or mid back regions, the neck (aka cervical region) is not stabilized by the rib cage or hips and pelvis. Instead, it positions the head and contributes to proper functioning of the most unstable joint in the body- the shoulder. If the arm goes up, neck muscles are at work to help rotate the shoulder blade and vice versa. The muscles in this area can also assist with breathing during intense activities. All of the above are why the neck is so commonly injured with muscle sprains and strains.

Anatomy

Bony Landmarks

#1 Cervical Spine (C1-7). You may have heard of the spine being described by letters and numbers. Traditionally, the spinal column is broken down into four regions (the neck/cervical – C, thoracic/midback – T, lumbar/low back – L, and sacrum/tailbone- S) and then given a number based on it’s level. The number refers to each specific vertebrae (they are stacked up one on top of the other). The easiest way to visualize the the level is to count the little bumps down the middle of your back. These are the spinous processes ( the little circles in the middle of the picture above). There are seven vertebrae in the cervical spine, numbered one thru seven. The cervical spine is unique in that the first two vertebrae work to allow the skull to move on top of the spinal column itself. As such, C1 is deep and you will be unable to palpate it. Starting just beneath the skull, the first spinous process you will find is C2. From here you can work your way down the “bumps” in the middle of the spine until you reach C7.

#2 Upper Border (C2). The cervical spine begins at the base of the skull. Here there are a numbers of tiny muscles and ligaments that help maintain proper functioning between the levels of C1 and C2. Because C1 is deep to these structures, you will be unable to feel or see it. For this reason, C2 will be the first spinous process you will be able to find. When working on the muscles of the neck, consider this your upper border. For anything between the level of C2 and the skull itself, it is recommended that you see a healthcare professional.

#3 Lower Border (C7). To locate C7, you can start in one of two ways. You can follow the spinous processes down from C2 or you can work you way up from T1. The thoracic/middle spine are the easiest to identify because each level in this region has a rib coming off it’s side. To find the first level (aka T1), place both hands around your neck (thumbs in the front and fingers wrapping around to the back). Where your fingertips meet in the back, you will feel a big bony bump. This is the first thoracic vertebrae and marks the start of the rib cage. Move up one “bump” from here and you will be on C7, the last cervical vertebrae.

Muscles

Like the low and mid-back, the muscles in the cervical region are arranged in layers. To better identify where they begin and end, we’ve broken them down into these layers.

Layer One (innermost or deepest to the bone)

#1 Semispinalis. In the last two posts on the low and mid back, we’ve talked about the muscles that run parallel the spine (the erector spinae group). In the cervical or neck region, this muscle is called the seminspinalis. It begins where the the ES group stops and runs from T6 up along the spine to insert into the base of the skull. This muscle is responsible for pulling the head back to look towards the ceiling (extension of the cervical spine) and bending the ear towards the shoulder (side bending).

#2 Levator Scapulae. The levator muscle is a commonly injured muscle due to the fact that it moves the neck and the shoulder blade. It inserts on the upper corner of the shoulder blade closest to the spine and attaches to the transverse processes of C1-4. In addition to rotating the shoulder blade down, it also pulls the entire blade up alone the ribcage. To find this muscle, reach one hand over your shoulder so that your fingers are on the shoulder blade. Trace along the blade until you get to the innermost border. This will be easy to feel as the bone runs horizontally. From here, place the hand of the shoulder you are feeling at the small of you back and hike your shoulder up. This will relax the more superficial and larger upper trap muscle. While performing this motion you will be able to feel the levator move from it’s attachment on that inside corner of the shoulder blade.

#3 Scalenes. These muscles are small and found along the side of you neck. They attach to your upper two ribs and move up the spine to attach to the sides of C2-7. These muscles are responsible for side-bending and flexing the neck, as well as, rotating the head towards the opposite side. In addition, they also act as secondary respiratory muscles to help elevate the ribs during times of stress or fast breathing. **Please note- this area is home to the brachial plexus of nerves, as well as, arteries and lymphatic structures. It is VERY possible to hit these structures and cause further injury. If this area is symptomatic for you, it is strongly recommended that you see a licensed health care professional versus trying to massage out the area on your own. **

Layer Two (middle layer)

#1 Splenius capitus. This muscle runs upwards and diagonal  from the the spinous processes of C3-T4 to just behind the ear. It helps bend the neck back, to the side and also rotates to the head to the same side. Unlike the smaller muscles of the first layer, this muscle is larger and easier to find/palpate. To find this muscle, place your hand along the side of your neck. From here rotate your head to look over that shoulder and then try to look up towards the ceiling from that position. You will feel the muscle move beneath your fingertips.

Layer Three (outer layer)

#1 Upper Trapezius. On top of the previous two layers of muscles is the trapezius muscle. It is typically broken down into three parts- upper, middle and lower. Together this muscle works to rotate and move the shoulder blade to better accommodate the shoulder joint as it moves. The middle fibers pull the shoulder blades together and the lower portion rotates the scapula up while pulling the shoulder blade down. The muscle forms a big diamond on your back with the upper fibers inserting near the base of your skull, running out to the ends of your shoulder blades and then down to T12 (the end of your rib cage). In this section we will be focusing on the upper portion. This part of the muscle starts at the base of your skull and out to the tips of your shoulders blades. To isolate this muscle from the deeper splenius muscle, place your hand on one side of your neck and rotate your head to the opposite shoulder. From here try to look up towards the ceiling. You will feel the muscle move beneath your fingertips.

Soft Tissue Release

What you’ll need: stick/foam roller and tennis ball

The techniques: click here for an introduction to the techniques and a video demonstration

1) Lengthening/elongation with the foam roller or stick.
2) Cross friction with your hand or tennis ball.
3) Sustained pressure or trigger point release with the tennis ball.

Key Areas

The neck is easy to visualize as an area. All of the muscles run up the spine unlike some of the other areas we’ve talked about where muscles move in a variety of directions. For this reason, we’re going to break down the key areas by the three soft tissue release techniques themselves.

#1 Foam Roller. When working with the foam roller, start by working on the trapezius muscle as a whole. To better lengthen the muscle fibers, you will need to change the position of your arms as you do so. While on the lower fibers, you will want to keep your arms down by your sides. While on the middle fibers, cross your arms behind your head. And lastly, while on the upper fibers, straighten your arms up over your head. These arms positions will help move the shoulder blade. When trying to better isolate the deeper levator scapulae and splenius capitus, position the foam roller at the curve of your neck. From here, press your neck down into the roller and rotate your head slowly from side to side. This will help lengthen the muscles as they move from spine to shoulder blade and spine to skull/behind the ear. DO NOT roll on your side with the roller to try and work on the scalenes. This area is very sensitive with superficial nerves and arteries in between and beneath the muscles themselves.

#2 Tennis ball- Cross friction.

1) The levator scap origin at the shoulder blade. Find the origin and lay down on the tennis ball. This is a great area to use both the cross friction and trigger point release techniques as it’s a common area for tension and injury. See video for further details.

2) The seminspinalis all the way up the cervical region. In the 1-2 inches next to the spinous processes, cross friction can be used at each of the cervical levels. Start at the lower C7 level and work your way up. Remember, the muscle runs up and down (parallel to the spine). To perform the cross friction technique you will want to work perpendicular to it. As you work on each level you will then need to reposition the tennis ball to move up/down to the next level.

3) The base of the skull. In the little groove between C2 and the base of the skull, the upper trap and splenius capitus both insert. Start off GENTLY in this area as there are smaller deeper muscles below. The movement will be perpendicular to the spine.

#3 Trigger Point Release

1) The trick with trigger point release is to allow the tennis ball to sink into the knot or muscle spasm. With an acutely injured muscle, this may be difficult to keep the effort to tolerance. This should not be a how much pain can you take kind of attempt. Once it starts to get uncomfortable hold there. As the muscle releases, you will be able to sink in deeper. Above is picture of common trigger points in the cervical region.

Video

Here is a video demonstration for the neck/cervical region.

References

1) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

2) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

3) Moore, Keith and Dalley, Arthur. (1999). Clinically Oriented Anatomy, 4th edition. Lippincott Williams and Wilkins, Baltimore, MD.

4) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.