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Chapter 10 Balancing the Upper Pole 225
Energy
POSITION
r
The client is in side posture. A small pad is placed under the
side of the head; a bolster is positioned between the knees.
r The therapist is standing behind the table at the client’s
neck and head region.
POLARITY
The palm of one hand is placed lightly across the occipital
ridge. The palm of the other hand contacts the C7 vertebra.
Envision the neck lengthening as the cervical vertebrae decompress and the musculature of the neck relaxes. Maintain
contact for at least 1 minute.
SHIATSU
Place one hand on the client’s shoulder. Wrap your other hand
around the posterior neck, just below the occipital ridge, with
the thumb on one side of the trapezius and the fingers on the
other. Slowly squeeze the neck, and hold for a few seconds
(Fig. 10-8). Let go, slide your hand to the middle of the neck, and
repeat. Then, putting your hand at the base of the neck, squeeze
again. This move helps to stimulate the points on the portion
of the bladder channel that passes through the posterior neck.
Swedish/Cross Fiber
1.
Perform effleurage strokes from the acromion to the
occipital ridge.
2. Perform one-handed pétrissage:
r From the shoulder to the base of the neck
r From the base of the neck to the occiput
3.
Perform fingertip raking across the posterior neck, working
in horizontal strips, from the C7 vertebra to the occiput.
Connective Tissue
Reaching across the posterior neck, place the fingers of one
hand just posterior to the transverse processes of the cervical
spine on the opposite side from where you are standing. Allow
your fingers to sink into the tissues. As the tissues melt under
your touch, let your fingers glide toward you, to the sides of
the spinous processes of the cervical spine (Fig. 10-9).
Deep Tissue/Neuromuscular Therapy
SEQUENCE
1. Superficial layer—upper trapezius
2.
Intermediate layer—splenius capitis, splenius cervicis,
and levator scapula
3.
Deep layer—longissimus capitis and semispinalis capitis
a.
Transversospinal muscles—semispinalis, multifidus,
and rotatores
b.
Suboccipital muscles—obliquus capitis superior,
obliquus capitis inferior, rectus capitis posterior major,
and rectus capitis posterior minor
Superficial Layer
Upper Trapezius
Origin: Medial third of the superior nuchal line and EOP,
ligamentum nuchae and spinal processes of C1–C5
vertebrae.
Insertion: Lateral third of the clavicle.
Action: Elevation and upward rotation of the scapula, cap-
ital extension.
FIGURE 10-8 Shiatsu compression of the posterior neck.
DAR
FIGURE 10-9 Connective tissue release of the posterior neck.
226 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
Trigger points in this muscle frequently are responsible for tension headaches that may be felt
at the temple, behind the eye, and sometimes, at
the mastoid process and down the posterior neck. Trigger
points are located in the fibers slightly behind the border
of the muscle, near where it attaches on the lateral portion
of the clavicle. They are best palpated by squeezing the
edge of the muscle between the thumb and fingers.
Strokes
r Wrap your hand around the base of the neck, as in the
shiatsu procedure above, with the thumb pad at the border
of the trapezius. Using the thumb pad, stroke posteriorly,
from the border of the trapezius to the spinous process of
the C7 vertebra (Fig. 10-10).
r
Sliding your thumb a half-inch superior, repeat the stroke.
Continue, working in strips, to the occipital ridge.
r
Using the thumbs, apply up-and-down and side-to-side
strokes to the attachment of the upper trapezius on the
superior nuchal line on the occiput.
Intermediate Layer
Splenius Capitis
Origin: Ligamentum nuchae from the C3–C7 vertebrae,
spinous processes of the C7–T4 vertebrae.
Insertion: Mastoid process of the temporal bone, lateral
third of the superior nuchal line of the occiput.
Action: Extension of the head, lateral flexion of the head
to the same side.
A trigger point may be found in the upper portion of the muscle, on the occiput, in the space
between the trapezius and SCM. It refers pain
to the highest point on the head on the same side as the
trigger point.
Strokes
Using your thumb pad, stroke at an oblique angle from the
r
spinous processes of C3 and C4 to the mastoid process.
Repeat the stroke, beginning at the C5 vertebra. Continue,
working in strips, to T3 (Fig. 10-11).
r Roll your thumb across the fibers of the muscle, and feel
for taut bands. Check for trigger points.
Splenius Cervicis
Origin: Spinous processes of the T3–T6 vertebrae.
Insertion: Transverse processes of the C1–C3 vertebrae
(varies).
Action: Extension of the cervical spine, rotation of the cer-
vical spine to the same side, flexion of the cervical spine
to the same side.
FIGURE 10-10 Deep tissue stroking on the upper trapezius, from
C7 to the occiput.
A commonly experienced trigger point can be
palpated near the transverse process of C3.
It refers pain to the eye on the same side. In
some cases, treatment of this trigger point may relieve
blurred vision in that eye.
Strokes
r
With your fingertips, find the posterior aspects of the
transverse processes of the C2–C4 vertebrae. Perform
short, up-and-down strokes (Fig. 10-12).
r Pause at trigger points and hold.
Deep Layer
Three areas of trigger point activity form in the
line of the lamina groove:
t The first one is found at the level of C4 and C5. Pain
can be referred up to the suboccipital area and also
down to the upper vertebral border of the scapula.
t The second area of trigger point activity is located at
the level of C2. The pain referral zone is around the
occiput and upward toward the top of the head.
t The third location of trigger points is right below the
occipital ridge at the attachment point of semispinalis
capitis. The pain pattern forms a band around the
head, with the most severe sensation felt at the temple and forehead over the eye.
Chapter 10 Balancing the Upper Pole 227
Semispinalis Capitis
Origin: Transverse processes of the T1–T7 vertebrae (var-
ies), articular processes of the C4–C6 vertebrae.
Insertion: Occiput between the superior and inferior nu-
chal lines.
Action: Extension and lateral flexion of the head.
Strokes
With your thumb, perform combination stroking (up and
r
down and side to side), working in small sections in the
space between the spinous processes and the transverse
processes of the cervical vertebrae. Begin at the level of
the C7 vertebra, and continue to the occiput (Fig. 10-13).
Treat trigger points when you find them.
r Work on the attachments of the muscles on the occiput
using the combination strokes:
r
Longissimus capitis—posterior margin of the mastoid process.
r
Semispinalis capitis—the space between the superior and
inferior nuchal lines.
Transversospinal Muscles (Semispinalis, Multifidus, and
Rotatores)
Origin (Semispinalis cervicis, multifidi, and rotators):
Transverse processes of cervical vertebrae.
Insertion:
Semispinalis cervicis—spinous processes of the C2–C5
vertebrae.
Multifidi—spinous processes of two to four vertebrae
above the origin.
Rotatores—base of spinous process of the next highest
vertebra.
FIGURE 10-11 Deep tissue strokes on the splenius capitis.
C3
FIGURE 10-12 Working the attachments of the splenius cervicis
and levator scapula, from C2–C4.
Longissimus Capitis
Origin: Transverse processes of the T1–T5 vertebrae, artic-
ular processes of the C4–C7 vertebrae.
Insertion: Posterior margin of the mastoid process of the
temporal bone.
Action: Extension of the head, lateral flexion and rotation
of the head to the same side.
Strokes
r With your thumb, perform the combination stroke in the
lamina groove of the cervical spine, from C7 to the occiput
(Fig. 10-14). Working in small sections, pay attention to
soft tissue dysfunction at the deepest level, next to the
bone. Treat trigger points as you find them.
DAR
FIGURE 10-13 Deep tissue strokes on the longissimus capitis and
semispinalis capitis, from C7 to the occiput.
228 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
Rectus Capitis Posterior Major
Origin: Spinous process of the axis.
Insertion: Lateral part of the inferior nuchal line of the
occiput.
Action: Extension of the head, rotation of the head to the
same side, lateral flexion of the head to the same side.
Rectus Capitis Posterior Minor
Origin: Tubercle on posterior arch of atlas.
Insertion: Medial part of inferior nuchal line of occiput.
Action: Extension of head, lateral flexion of head to same
side.
DAR
Strokes
Standing at the head of the table, cup your palm over
r
the back of the cranium, hooking your fingers under the
occipital ridge. Allow them to sink in as far as the client’s
FIGURE 10-14 Deep tissue strokes on the transversospinalis
muscles.
Suboccipital Muscles (Obliquus Capitis Superior,
Obliquus Capitis Inferior, Rectus Capitis Posterior
Major, and Rectus Capitis Posterior Minor)
Obliquus Capitis Superior
tissues will allow without discomfort (Fig. 10-15A). Do
slow, up-and-down and side-to-side strokes.
r
Standing at the side of the table and facing the client’s
head, place the thumbs on the occipital ridge, next to the
EOP. The thumbs should be in a horizontal position, one
above the other (Fig. 10-15B). Roll the thumbs alternately
upward along the base of the cranium and slightly below,
on the neck, at the level of C1 and C2.
Origin: Transverse process and superior surface of the
atlas.
Insertion: Occiput between the superior and inferior nu-
chal lines (lateral to semispinalis capitis).
Action: Extension of the head of the atlas, lateral flexion to
the same side.
Obliquus Capitis Inferior
Origin: Apex of the spinous process of the atlas.
Insertion: Inferior and dorsal part of the transverse process
of the atlas.
Action: Extension of the head, lateral flexion to the same
side.
STRETCH
The client sits upright, on the edge of the table. Sitting or
standing behind the client, place one palm on the shoulder
and the other palm on the same side of the head, above the
ear. Laterally flex the head while stabilizing the shoulder
(Fig. 10-16). Have the client slowly rotate the head to bring
the chin toward the chest. Pause, and maintain the stretch
where tightness and/or tenderness are experienced. Be careful
not to overstretch the neck in this position. Direct the client
to imagine breathing into the muscles being stretched as they
relax and lengthen.
AB
FIGURE 10-15 A. Using the fingertips to release the suboccipital muscles. B. Deep tissue thumb strokes to release the suboccipital
muscles.
Chapter 10 Balancing the Upper Pole 229
ACCESSORY WORK
1. Work on neck and head extensors in conjunction with
the neck and head flexors to balance the musculature
of the cervical region.
2. Jaw work should accompany the neck session, because
imbalance is almost always reflected in both segments
simultaneously.
3.
Work on the feet synchronizes the upper and lower
poles of the body and grounds the client after neck and
head massage.
CLOSING
Sitting at the foot of the table, lightly hold the heels of the
client’s feet in your hands for 30 to 60 seconds. Remove your
hands slowly to complete the session.
◗ NECK AND HEAD FLEXORS
ROUTINE
Objectives
FIGURE 10-16 Stretch for posterior neck
muscles.
To continue the process of balancing the head on the
r
cervical spine
r To relieve painful conditions caused by shortened flexor
muscles
r To reduce uneven pulls on the hyoid bone
Energy
POSITION
r The client is lying supine on the table.
r The therapist is sitting at the head of the table.
POLARITY
The therapist holds the client’s head by placing his or her
right palm (positive pole) across the client’s occipital ridge
(negative pole) and the left palm (negative pole) across the
forehead (positive pole) (Fig. 10-17). This head hold is very
relaxing. It is sometimes referred to as the “brain drain” because of its effectiveness in easing excessive mental activity.
The position is held for at least 1 minute.
r To elongate the muscles of the anterior neck
r To balance the anterior neck muscles with the posterior
neck muscles
SHIATSU
Press the conception vessel 22 point, which is located in
the notch at the base of the throat, just above the sternum
230 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
FIGURE 10-17 Polarity balancing head hold.
(Fig. 10-18). This point is intended to open the throat passage
and to relieve sore throat and other inflammatory conditions
of the throat and chest.
Keep your finger on the superior edge of the manubrium. Do not press into the soft tissues above
it, because nerves and blood vessels are close to
the surface here.
DAR
Swedish/Cross Fiber
1. Perform effleurage strokes down the sides of the neck.
2.
Apply circular fingertip friction along both sides of the neck.
3.
Perform thumb sweeping on the side of the neck, stroking
each side individually.
Connective Tissue
Holding the client’s head in one hand, rotate it slightly to the
side. Place the fingers of your other hand along the anterior
border of the SCM. Allow your finger pads to sink into the
muscle. As the tissues yield, let your fingers slowly glide in
a posterior direction. Repeat along the length of the neck.
Deep Tissue/Neuromuscular Therapy
SEQUENCE
1. Platysma
2. SCM
3. Scalenes
4.
Suprahyoid muscles—digastric, stylohyoid, and mylohyoid
5.
Infrahyoid muscles—omohyoid, sternohyoid, and
sternothyroid
6.
Prevertebral muscles—longus capitis and longus colli
Platysma
FIGURE 10-18 Contacting conception vessel 22 point.
Origin: Fascia covering the upper portion of the chest.
Chapter 10 Balancing the Upper Pole 231
Insertion: Mandible, subcutaneous fascia, and muscles of
the chin and jaw.
Action: Depresses lower lip and draws it backward, lifts
skin of the chest.
Active trigger points in this muscle are usually
found where it covers the SCM. These trigger
points may be palpated best by sifting the platysma between the thumb and fingers. The trigger points
refer to the area of the mandible. The sensation of pain is
superficial, as if originating in the skin over the jaw.
Strokes
r
Place the fingers of one hand on the mandible, just below
the corner of the mouth. Perform a slow elongation stroke,
following the fibers of the muscle, down the neck, over the
clavicle, and onto the upper chest (Fig. 10-19).
Sternocleidomastoid
Origin:
Sternal head—sternum, ventral surface of the
manubrium.
Clavicular head—superior and anterior surface of the
medial third of the clavicle.
Insertion: Mastoid process of the temporal bone, lateral
half of the superior nuchal line of the occiput.
Action: Flexion of the cervical spine (both muscles), lateral
flexion of the cervical spine to the same side, rotation of
the head to the opposite side, capital extension (posterior
fibers); lifts the sternum in forced inhalation.
Trigger points may be found almost anywhere
along the length of the sternal and clavicular
branches of the muscle.
Sternal Division
Clavicular Division
Trigger points in the middle section refer pain
to the forehead.
Dizziness can be an associated autonomic
response to trigger points in the clavicular division, particularly after the SCM muscle has been stretched.
Strokes
Holding the client’s head in one hand, rotate the head
r
slightly. Place your thumb pad on the mastoid process.
Using the broad side of the thumb, perform an elongation
stroke along the fibers of the SCM, ending at the sternum.
r With the thumb or index finger, apply cross-fiber strokes
to the SCM attachment on the sternum. Glide your
thumb along the top edge of the clavicle to the clavicular
attachment of the SCM, and apply cross-fiber strokes to it.
r
Grasp the SCM muscle between your fingers and thumbs,
and sift the muscle fibers thoroughly, searching for trigger
point activity (Fig. 10-20). Begin near the insertion on the
mastoid process, and continue down to the origins on the
sternum and clavicle.
Scalenes
Scalenus Anterior
Origin: Transverse processes of the C3–C6 vertebrae.
Insertion: Scalene tubercle on the inner border of the first rib.
Action: Flexion of cervical spine, elevation of the first rib on
inhalation, rotation of the cervical spine to the opposite
side, lateral flexion of the cervical spine to the same side.
Scalenus Medius
Origin: Transverse processes of the C2–C7 vertebrae.
Insertion: Superior surface of the first rib.
Action: Flexion of the cervical spine (weak), elevation of the
first rib on inhalation, lateral flexion of the cervical spine to
the same side, cervical spine rotation to the opposite side.
A trigger point in the lower portion of the muscle refers pain downward, over the upper part
of the sternum.
Trigger points in the middle section tend to shoot pain across
the cheek area, around the eye orbit, into the eye, and sometimes, into the external part of the ear canal. Trigger points
along the medial border of the middle SCM refer pain into
the throat and the back of the tongue, creating the sensation
of a sore throat. Trigger points in the upper section refer pain
to the occipital ridge and the top of the head.
Eye problems, such as blurred vision and an inability to
control eye muscles fully, can be an associated autonomic
response to trigger points in the sternal division of the SCM.
DAR
FIGURE 10-19 Direction of deep tissue stroking on the platysma.
232 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
Do not apply deep pressure in the posterior trian-
gle area, because the subclavian artery and vein
are located here. Light, cross-fiber strokes are sufficient to
relax the scalene muscles.
r With your index finger, reach under the superior edge of
the clavicle, toward the scalene attachments on the first
DAR
and second ribs (Fig. 10-22C). Apply cross-fiber strokes
to the attachments. Keep your finger against the inside
surface of the clavicle to avoid pressing on nerves.
Suprahyoid Muscles (Digastric, Mylohyoid, and
Stylohyoid)
Digastric
Origin:
Posterior belly—mastoid notch on the temporal bone.
FIGURE 10-20 Sifting the sternocleidomastoid.
Scalenus Posterior
Origin: Transverse processes of the C4–C6 vertebrae
(variable).
Insertion: Outer surface of the second rib.
Action: Cervical flexion (weak), elevation of the second rib
on inhalation, lateral flexion of the cervical spine (assists), cervical spine rotation to the opposite side.
The order of frequency of trigger point activity in the scalene muscles is from anterior to
medial to posterior. Trigger points in the three
scalenes may refer pain to the chest, the upper arm and
shoulder, and in the back of the body, to the medial border of the scapula. Trigger points in these muscles often
form secondarily to trigger points in the SCM, so it is
important to check both muscles together.
Strokes
r With your fingers, find the posterior border of the SCM.
Moving it slightly anterior and avoiding the jugular vein,
gently press your fingers down on the front portion of the
transverse processes of the cervical vertebrae (Fig. 10-21).
Hold tender points.
r
Using the broad side of your thumb, perform an elongation
stroke in the triangle formed by the posterior border of
the SCM and the anterior border of the upper trapezius
(Fig. 10-22). Move, in an inferior direction, to the clavicle (Fig. 10-22A). Then, with your fingers, stroke across
the direction of the muscle fibers of the medial scalene,
seeking taut bands of tissue (Fig. 10-22B). Pause to treat
trigger points.
FIGURE 10-21 Contacting the scalene attachments on the
transverse processes of C3–C6.
B
DAR
C
FIGURE 10-22 Sequence of deep tissue strokes on the scalenes.
A
Anterior belly—inner side of the inferior border of the
mandible near the symphysis.
Insertion: Intermediate tendon and to hyoid bone via a
fibrous sling.
Action: Mandibular depression, elevation of the hyoid
bone during swallowing, anterior belly draws the hyoid
forward, posterior belly draws the hyoid backward.
Take great care in this area of the neck as several
structures are vulnerable to damage, and intrusive
pressure may feel unsafe.
A trigger point may be found in the digastric
muscle near its attachment on the mandible,
just under the chin. It refers to the lower front
teeth and the alveolar ridge below them.
Strokes
Chapter 10 Balancing the Upper Pole 233
A
B
FIGURE 10-24 Direction of deep tissue strokes on the bellies of
the digastric (A) and mylohyoid and stylohyoid (B).
B
DAR
r Digastric and Mylohyoid Attachments on the Mandible.
Place the pad of your index finger on the underside of the
mandible near the center, at the digastric fossa. Slowly
stroke across the inside border of the bone, to the angle
of the mandible (Fig. 10-23).
r
Belly of Digastric. Beginning with your index finger at the
digastric fossa of the mandible, stroke along the fibers of
the muscle on the underside of the chin, to the fibrous
loop on the superior border of the hyoid (Fig. 10-24).
Mylohyoid
Origin: Mylohyoid line (from symphysis to molars) on the
inside surface of the mandible.
Insertion: Hyoid bone.
Action: Raises the hyoid bone and the tongue for swallowing.
DAR
FIGURE 10-23 Working the digastric and mylohyoid attachments
on the inside border of the mandible.
Stylohyoid
Origin: Styloid process of the temporal bone.
Insertion: Hyoid bone.
Action: Hyoid bone drawn upward and backward; assists in
opening the mouth; possible participation in mastication and speech.
Strokes
r
Belly of Mylohyoid and Stylohyoid. Place your fingers at the
inferior border of the mandible. Stroke in an inferior direction from the mandible to the hyoid bone (see Fig. 10-24).
Repeat the stroke, starting more laterally on the mandible
and covering the entire surface area of the muscles. Feel
for taut bands, and hold at trigger points. This stroke moves
across the fibers of the muscles rather than parallel to them.
Note: The mylohyoid muscle forms the floor of the mouth.
Be careful to avoid moving off the mylohyoid muscle fibers on the lateral side, because the subman-
dibular lymph nodes are located here.
r
Attachments on the Hyoid Bone. To locate the hyoid bone, slide
the fingers of one hand downward from the inferior border of
the mandible until they touch the superior border of the hyoid
bone (Fig. 10-25). To stabilize the hyoid, keep the index finger
on the superior border of the bone while placing your thumb
on the tip of the greater horn of the hyoid on one side and
your middle finger on the tip of the greater horn on the other.
To relax the muscles that attach to the hyoid bone, remove
your index finger from the superior border. Maintaining the
hold on the ends of the bone, slowly shift the hyoid from side
to side. To work the suprahyoid muscle attachments, place
the index finger of your other hand on the superior border
of the hyoid while you continue to hold on to the ends of the
bone (Fig. 10-26). Move your finger across the edge of the
bone, getting client feedback about tenderness. Pay special
234 Scheumann’s The Balanced Body: A Guide to the Integrated Deep Tissue Therapy System
Inferior Oblique Part
Origin: Anterior bodies of the T1–T3 vertebrae (variable).
Insertion: Transverse processes of the C5–C6 vertebrae.
Vertical Portion
Origin: Anterior bodies of the C5–C7 and T1–T3 vertebrae.
Insertion: Anterior bodies of the C2–C4 vertebrae.
Action of all three parts: Cervical flexion (weak), cervical
rotation to opposite side (inferior oblique), lateral flexion (superior and inferior oblique).
Strokes
Place the fingers of both hands lengthwise along the
r
borders of the trachea. Slowly and lightly slide the fingers
medial, under the trachea, toward the anterior bodies of
the cervical vertebrae (Fig. 10-27).
Do not press on the top of the trachea so that the
thyroid gland can be avoided. Move slowly and
sensitively in this area, because the vertebral artery runs
parallel to the trachea. If you feel a pulse as you slide under the trachea, lift your fingers slightly, and move them
more medial to take pressure off the artery.
FIGURE 10-25 Palpating the superior border of the hyoid bone.
attention to the fibrous loop on the lesser horn of the hyoid
that connects the digastric muscle to the bone.
The hyoid bone is fragile. Do not squeeze it tightly
or apply strong pressure.
Infrahyoid Muscles
Strokes
r Still stabilizing the hyoid with one hand, place the index
finger of your other hand on the body of the hyoid, and
slowly stroke side to side. Hold sensitive points.
r Slide your finger down slightly, and stroke side to side on
the inferior border of the hyoid.
r Slide the pad of your index finger onto the inner surface
of the clavicle, and stroke side to side on the medial end
to contact the attachment of the sternohyoid.
Prevertebral Muscles (Longus Capitis and Longus
Colli)
Longus Capitis
Origin: Transverse processes of the C3–C6 vertebrae.
Insertion: Inferior basilar part of the occiput (anterior to
the foramen magnum).
Action: Capital flexion, rotation of the head to the same side.
Longus Colli
Superior Oblique Part
Origin: Transverse processes of the C3–C5 vertebrae.
Insertion: Tubercle of the anterior arch of the atlas.
FIGURE 10-26 Hand position for contacting muscle attachments
on the hyoid bone.