Neck injuries and massage: Whiplash Associated Disorder

By: Genevieve Ward
Genevieve is a registered massage therapist at Body Poets; she loves seeing people’s comfort and movement improve with proper treatment after a whiplash injury

Whiplash injuries are very common, but maybe not well understood. They are also very treatable by massage therapy, but since people don’t know massage can help, they don’t always get appropriate care for their neck and shoulder injuries.

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Holding your head high

Muscle of the Month: Suboccipitals

There are eight tiny muscles that have the huge job of keeping your head up, but they can cause a huge headache too! These are your suboccipital muscles. Resting in the nook at the base of the skull, these muscles are essential to fine head movements and in relaying proprioception of your head (where your head is in space and time) to your brain. When out of balance or strained, these muscles can cause temporal headaches and pain with neck movements.

Suboccipital - ottawa massage blog

Rectus Capitis Posterior Minor

Suboccipital - ottawa massage blog

Rectus Capitis Posterior Major

Actions – 

Rectus Capitis Posterior Major: Rock and tilt head back into extension, rotate head to same side

Rectus Capitis Posterior Minor: Rock and tilt head back into extension

Suboccipital - ottawa massage blog

Oblique Capitis Superios

Suboccipital - ottawa massage blog

Oblique Capitis Inferior

Oblique Capitis Superior: Rock and tilt head back into extension

Oblique Capitis Inferior: Rotate head to same side

Common pain culprit – Eye strain and extended head tilting.

When our eyes are strained, we adjust our head with fine movements to focus better. This puts a strain on the suboccipitals. Also, keeping our head in even a slight tilt for extended periods of time can cause increased strain resulting in pain in the suboccipitals. Having to tilt your head back while driving to avoid the sun streaming into your eyes under your visor, or having a computer screen slightly too low or too high, can keep the head in a tilted position all day. This isn’t an overly strenuous task for the body, but it is for the suboccipitals. Over time they will become strained and headaches can develop.

ottawa massage blog suboccipital-group trpThe fix: Postural adjustments, eye exams, deep trigger point work.

Adjusting your position while at your computer, while driving, even while walking, can help with suboccipital pain. Any time your head is overly tilted (up or down) for an extended period of time, your posture needs to be adjusted.

An eye exam might show the need for a new prescription. Having the proper glasses puts less stress on the eyes and on the suboccipitals! Progressive lenses can contribute to suboccipital strain if you have to tilt your head back for computer work, for example. Ask your optometrist to help you fix this.

Deep trigger point work can target these deep muscles. Remember, “deep” means into deeper layers of tissue; it doesn’t mean the treatment will hurt. Deep work will always be done within your comfort level. As superficial muscles relax, the deeper ones can be more readily accessed, and when we get access to the suboccipitals, we can relieve the trigger points causing headaches.

Strengthening your deep neck flexors, as we saw in this recent post on chin tucks, will help balance the musculature of the front and back of the neck and decrease any tendency you have to tilt your head back.

Ask your RMT for treatment and a self-care program to address any headaches you may be experiencing.

A Deep Burn

Muscle of the Month: Levator Scapulae

The levator scapulae muscles lie on either side of your neck and attach to the upper Levator Scapula - Ottawa massage blogportion of your shoulder blade. The levator scapula (lev scap) is cleverly named after its main action: elevating the scapula (your shoulder blade). It is commonly tight, though it often goes unnoticed since the lev scap is deep to the upper trapezius. (Remember the trapezius?! Refresh your memory here.) Trigger points in the lev scap have different referral patterns than those of the upper traps (see below) and can be the true indicator as to which muscle is the problematic one.

Actions – Elevates scapula and rotates scapula clockwise (when neck is in a fixed position). Laterally rotates and flexes head (when shoulder is fixed).

Common Pain Culprit – Head-forward posture (e.g. at a computer); holding heavy purses or bags.

When the levator scapula is in a lengthened position, as with either of the above pain culprits, and then we engage it, it will need to do excess work, resulting in strain. For example, when we carry something heavy in our arms and then try to lift our shoulders, commonly the lev scap can strain. Think about the times you’ve taken an extra bag of groceries instead of making two trips. That burn in your neck is the lev scap working too hard! When you then try to muscle all those groceries up onto the counter, that’s when strain can happen. Look at the trigger point referral pattern below and you will probably remember a time you’ve felt that exact same pain.

Lev Scap TrP - Ottawa Massage Blog

The fix: Stretch and strengthen, and adjust your posture. Stretching the lev scap when you have pain will help the muscle loosen and return to a proper resting state. Strengthening the lev scap is a good preventative measure to allow the muscles to work longer and more effectively, without the strain.

Stretch – A very basic levator scapula stretch, the “sniff your arm pit” stretch, looks like this: http://www.youtube.com/watch?v=o6umvnWaRm8

Strength – Basic lev scap strengthening can be done wtih dumbell shrugs.

Dumbell shrugs: hold a small weight in each hand and shrug your shoulders as high as possible. Hold for one count and release slowly. Start with three sets of five, and build up to three sets of 12-15 before moving to a heavier weight.

Adjust your posture – At your desk, think of a string with a balloon on top lifting the top of your head toward the ceiling. Keep your ears centred over your shoulders.

Ask your RMT for assistance assessing your posture and the length and strength of your lev scap, and with any of these exercises.

The Trapezius, part 2 – Super posture!

Monthly Muscle: Trapezius

Trapezius sections - Ottawa massage blogThe middle and inferior traps fill the space from just below the top of the shoulder blades in a V down to the lower third of the back (the red and pink sections in the diagram to the right). Along with the upper traps, which we saw last week, these two muscles help move and support your shoulder blades and spine.

Middle Trapezius: The posture corrector

Actions – Pulls shoulder blades towards spine

Common pain culprit – Slouching; Internally rotated shoulders

If you work at a computer, wear a back pack or workout your pecs too much, you probably have internally rotated shoulders. With internally rotated shoulders, comes weakness in the middle trapezius. This happens because the internal rotation is drawing the shoulder blades farther from the spine, keeping the middle trapezius in a constant stretch position. Pain arises because the muscle no longer has the strength to fully contract back to its original length.

Middle Traps - Ottawa massage blogThe fix? Stretch pecs, strengthen mid traps/rhomboids, correct posture.

Keep checking our blog for great postural exercises. Or, ask your RMT to demonstrate proper strengthening exercises at your next visit.

Lower Trapezius:  Superman muscle

Actions – Depresses and upwardly rotates shoulder blade

Common pain culprit – Holding arms out unsupported (e.g.: driving with hands high on wheel, typing without support of table underneath forearms)

The lower traps are engaged when you hold your arms out in front of you, similar to Superman flying through the air. Holding this position for an extended period of time will result in overuse and strain of the lower traps.

Lower traps - Ottawa massage blog

Even though this muscle is much lower on the back, its pain referral pattern can extend into the neck. This is why it is important to include a back massage when you are coming in for treatment of neck pain. Clearing out the trigger points in the lower traps will help reduce your neck pain and improve postural control.

The fix? Ergonomic assessment of work station, stretch abdominals, strengthen lower traps

The ‘Superman’ position above is one lower trapezius strength exercise. There are many more, from isometric (without movement) to dynamic exercises. Your RMT can suggest options to suit your body and needs.