fdm-textbook_section3.pdf

S ECTION T HREE

FDM T REATMENT OF M USCULOSKELETAL I NJURIES

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Chapter 12

FDM T REATMENT OF

N ECK AND B ACK P AIN

C ERVICAL S TRAINS

The most common neck complaints with their associated fascial distortions include:

Complaint

Distortion

Pulling pain from mid-upper back to neck

—

Star triggerband

Pulling pain from shoulder to neck

—

Upper trapezius triggerband

Deep ache in supraclavicular fossa

—

SCHTP

Spot(s) of pain

—

Continuum distortion

Ache deep in spine

—

Folding distortion

Spasm or generalized discomfort

—

Cylinder distortion

Stiffness and tightness of joints

—

Facet tectonic fixation

Triggerband Cervical Strains

“Pulling” or “burning” pain in the neck is a strong indication that a triggerband is present.

The two most frequently encountered neck triggerbands are the star and the upper

trapezius (also known as the shoulder to mastoid ) triggerbands.

The star triggerband is the most common triggerband found in the human body and

particularly in women, is frequently a culprit in neck aches, upper back pain, and sore

shoulders. Its symptoms of pain deep under the occiput with a burning or pulling pain

from the upper back to the neck is directly attributable to its pathway. It begins halfway

between the medial border of the scapula and the thoracic spine at the T 6 level and ends

at the ipsilateral mastoid.

Triggerband technique of the star can be performed with the patient either sitting or prone.

The treatment itself consists of using the physician’s thumb to iron out the wrinkled fascial

fibers along the entire triggerband pathway from the starting point to the mastoid. The

vector of force from the thumb is initially deep into the tissue, but once the triggerband is

coaxed to move the force becomes both anterior and superior. Note that movement of the

triggerband means that the twist of the separated fibers is changing locations along the

pathway as the fibers are physically re-approximated (re-zipping the Ziploc ® bag).

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As the treatment continues, the distorted fascial band is palpably followed along its

pathway upward to the base of the neck to the ipsilateral mastoid. If you are uncertain if

you are on the pathway, ask the patient, “Am I still on it?” Most people will give a clear

and unambiguous answer that will help guide the treatment. At the base of the occiput,

the fascial fibers dive deep below the edge of the skull. To follow the triggerband through

this area, be sure that your thumb applies strong and deep pressure.

Figure 12-1. Treatment of Star Triggerband

The burning or pulling sensation that so many patients complain of from the tip of the

shoulder to the mastoid (on the same side) is caused by the upper trapezius triggerband.

It is treated with triggerband technique along its entire pathway with particularly strong

force applied along the margin of the superior lateral neck.

Figure 12-2. Treatment of Upper Trapezius (Shoulder to Mastoid) Triggerband

SCHTP Cervical Strains

Neck aches in which the head is tilted to the side of pain are often the result of the

supraclavicular herniated triggerpoint (SCHTP). Note that the SCHTP has two main

presentations:

1. In an SCHTP sore shoulder there is typically an associated loss of shoulder

internal rotation or abduction

2. In an SCHTP neck ache the clinical finding is altered cervical rotation

The treatment of the SCHTP is discussed in Chapter 4. Note that the goal of the technique

is to have the treating thumb apply sufficient pressure directly into the supraclavicular

fossa to push the protruding tissue below the fascial plane.

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Continuum Cervical Strains

Continuum distortions in the neck generally hurt at the origin and insertion of the cervical

ligaments. The most common cause of continuum cervical strain is an auto accident in

which there is a jolt to the neck and the ligaments connecting the transverse processes

become injured. Some accidents result in continuum distortions at each vertebral level,

which upon palpation seem to line up like a stack of coins .

Continuum technique in the neck is best done in the seated position. The doctor stands to

the side and palpates the cervical spine with one hand and uses the other hand for the

forehead to rest on. The palpating hand cradles the neck so that the thumb is on one side

and the fingers on the other. The cervical vertebrae are rocked back and forth between the

physician’s thumb and middle finger until the continuum distortion is isolated. Then the

thumb-tip is focused into the distortion and substantial pressure is held until the release

occurs (transition zone shifts).

Figure 12-3. Treatment of Two Cervical Continuum Distortions

In a whiplash injury, inverted distortions are more common than everted distortions, but

either are possible. As discussed in Chapter 5, treated inverted distortions may seem to

spontaneously regenerate hours later when the transition zone shifts again and the

symptoms redevelop. This reoccurrence can often be prevented by delivering thrusting

manipulation directly into the treated inverted continuum distortion. However, please

note that everted distortions are made worse by thrusting, so if you are unable to

distinguish between the two, initially treat only with continuum technique. If the next day

there is still pain, treat again with continuum technique followed by thrusting

manipulation. If instead the neck feels tight or the joints feel stiff (these symptoms signify

a concurrent facet tectonic fixation), treat only with neutral thrust.

Folding Cervical Strains

Accidents that cause the cervical spine fascia to unfold and torque result in unfolding

distortions. The mechanism of injury is often a motor vehicle accident in which the head

is thrown forward when the car is struck from behind. The shoulder harness holds the

thorax with the trunk slightly flexed as the neck is propelled in the direction of the

windshield. The fascia unfolds (and rotates because the force is practically never perfectly

centered, nor is the head) and then snaps back into the refolded position contorted.

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