Tuesday, 26 July 2011

Head and Neck Pain (Part Two)

Gosh, you must have thought I had fallen off the face of the earth as it's been 3 weeks since I last updated the blog. I am so sorry for leaving you hanging around waiting for this next episode in the series of 'Head and Neck Pain'.

I haven't forgotten to write; it's just been a manic time for my Level 6 Diploma in Advanced Clinical and Sports Massage. I have to submit a bunch of paper work on Friday this week to ensure that I get ethical approval for my research project so I have been busy working that all out. 

But now I can sit back and enjoy writing about the Trapezius Muscle and it's radiating pain patterns; it's a lot more fun than ethics and I love getting my books out! 

As always, if you have just joined me with this blog I would encourage you to read the posting entitled: Pain Patterns Explained as it will make the following easier to navigate through. Also, this blog is written for my clients and anyone who is interested in my work with muscular-skeletal pain, not anatomists! This means a lot of the anatomical language has been broken down into descriptions to make it easier to understand.

The Trapezius Muscle is a very thin (the width of a piece of paper) expanse of muscle across the top of your back. The lovely thing about muscles is that the name of them usually gives them away and it is true in this case as it is kite shaped. You have one on both sides of the back, however it's fascially attached so well that for this blog I am going to look upon it as one muscle with a left and right side. It starts just above the base of the head, crosses both shoulders to join on to the tip of your shoulder and onto the outer portion of your collar bone. It travels down your back and points down to attach on to the middle of the spine at T12.

We should, however, look on it in 3 different sections; the upper, middle and lower portion. The middle and lower portions can produce a pain pattern through out the shoulders, giving pain at the tip of the shoulder where your arm hangs, as well as right next to the edge of your shoulder blade near the spine. Today I am just going to take you through the movements and pain referred to the upper and middle portions of the Trapezius as that is where we find problems with the head and neck.

The upper fibres of the Trapezius are found running down from just above the base of the head and merge into the middle fibres where your neck vertebrae stops and where your thoracic vertebrae begin. The middle fibres run from this upper most merging point and then incorporate the lower fibres at around T5.

As you can see from this photo of Andrew Beil's fantastic anatomy book 'Trail Guide To The Body', it is quite a big muscle and does a lot of work. The upper and middle fibres allow you to bring your head down to your chest, flex your neck to the same side and turn your head to the other side as well as enabling you to bring your shoulders to your ears. The middle fibres make sure that your shoulder blade is stable and they can also bring your shoulder blade nearer to your spine. Pretty cool hey?!

These photos from 'Travell and Simons' Trigger Point Flip Charts' show the radiating pain that you can experience if your Trapezius is filled with Trigger Points. The pain travels up the back of the neck and then over the ear culminating behind the eye and sometimes you may feel pain in the back of the jaw, (near the angle). Unlike the Sternoclydomastiod that we looked at in the last blog, Tapezius doesn't tend to jump over to the other side of the body. This means if you come to see me with a head ache on the left side produced by 'knotts' in the left side of your Trapezius, I would treat the left side.

It's a big muscle, which is why I wanted to dedicate the blog to it this week.

Next time I want to start looking at how I would try to help muscle based pain in the head and neck in the treatment room; that's where the fun really begins!

I look forward to seeing you in the treatment room soon.

Take care

Restart! : I went for a blood test to see what my body is up to and I was really pleased to find out that I have great cholesterol levels and that I am not anaemic. It was a great spur to keep going with eating whole foods and a little exercise every day. I would encourage you to go to your doctor and get a well-being health check; it's really worth it as you can get a full picture to tell you how you are.

What I'm loving in the Treatment Room today: If you have Google Chrome and want to look at a really great new piece of kit, look up Google Body and it will take you through the whole body, so you can dissect down to the muscles of the body and search for Trapezius and it will show you in full 3D glory! I'm in love with it! Also, Apple has an app called Visual Body, which I think is better, but a bit pricey unless you are studying for anatomy/massage/bodywork etc. Have a play and let me know what you think. I am trying to work out how to get screen shots as JPEGs so I can up loads them for you to see ….. I'll keep pestering David to help me :) .

Music of the day: It's dissertation time; Florence and the Machine is keeping me going on that one.

Friday, 8 July 2011

Head and Neck Pain (Part One)

I hope that this finds you well and that you are ready to get nerdy with me. Last week I promised that I would write a few blogs on head, face and neck pain, so lets start today!

(If you have just joined me with the blog, please do read the posting entitled: Pain Patterns Explained as it will make the following easier to understand).

Firstly I would like to introduce my study partner; Gilbert. He stands behind me every day as I sit at my desk and provides me with a very willing volunteer when I am revising my anatomy. I have decided to use Gilbert as a visual aid for a few key muscles that effect people with head and neck pain. I would like to caveat that the photos below are simply an aid and not anatomically accurate (any Anatomist would have a lot to say about the bulky attachments and the width of the ribbons). However, I hope that over these blogs Gilbert and I can try and show you just how important knowing your anatomy is if we want to look at pain in any depth.

The first thing that we need to do is take a look around the head, face and upper portion of the chest. The head is made up of 8 cranial bones, but the ones that we will be looking at are the Temporal, which is on the side of the head and the Zygomatic, which is your cheek bone. We also need to be aware of some facial bones; your Mandible, which is your jaw bone, the sternum; your breast bone, and your clavicle, which is your collar bone. These bones form the attachments to the muscles that we will cover today.

There are 11 main muscles that when I am carrying out a treatment for a client I will make sure I treat if they suffer from any form of head and eye ache that may go into migraine attacks, neck pain, toothache, earache, as well as general discomfort and tension. Today I would like to share with you some knowledge about 3 of them that I think are easy for you to treat at home when you have had a Clinical Massage Therapist show you how, so you can start to help yourself in between treatments. They are:

The Sternoclydiomastoid (SCM)
The Masseter
The Temporalis

The Sternoclydomastiod (SCM) is a wonderful muscle; SCM is thick and strong, it allows us to move our neck and head laterally to the same side that it is on, it helps us rotate the head to the opposite side from where it is and it helps us to breath in. We have one SCM on each side of our necks and it attaches just behind the ear on the temporal bone (at the Mastoid Process) and then it splits in to two, allowing for two attachments, one on the sternum and the other on the third of the clavical that is nearest the sternum.

However, when it gets grumpy and filled with trigger points we need to watch out as the referral pain is wide ranging. The end that attaches into the sternum refers from the sternum, up to the back of the head, into the top of the head and then down around the top of the eye. It can also be felt in the chin. The other end that attaches onto the clavical refers into and around the back of the ear as well as into the forehead and can jump; so if your left SCM is referring pain you may feel it on the right side of your forehead.

The Masseter is a powerful muscle and I call it the 'Jack Bauer Muscle'. If any of you have seen the series '24' you may have seen the bit where the lead character, Jack Bauer, killed a man by biting his neck. Horrid. However, to do that the character would have had to use his Masseter muscle to full effect as its job is to close your teeth together and one muscle can exert 140 pounds worth of force. It's a very cool muscle and you can find it going from the zygomatic arch (your cheek bone) and going down to the Angle Ramus of the Mandible, which is a fancy way of saying the angle of your jaw. You have two layers to is, the Superficial is near the skin side of the cheek and the Deep layer is nearer the inside of the mouth.

The Masseter is a personal challenge for me as I have trigger points in it on my right side. The pain that the superficial belly produces is into the back molers, so it can feel like tooth ache in your back teeth, (which is how it manifests in me). You may also feel it in the mandible, just below the teeth, or just above it in your cheek bone, radiating above the eye. The Deep belly causes ear pain and some eminent therapists have suggested that it can make tinnitus worse.

Temporalis is the last muscle of the day and that is a fan shaped muscle on the side of your head. It has a fascial connection with the head and also attaches to the temporal fossa, then it reaches down to the cocnoid process of the mandible. If you put your finger half way along your cheek bone and then open and close your mouth you may feel this part of the mandible come down as you open and then go back up when you close.

The reason why it is vital to cover is that the pain can be felt over the entire muscle, going up the side of the head. Or it may come down the side of the face in to the top back teeth. It's a far reaching pain pattern and one that can be over looked.

So there you have it; 3 muscles that are easily reached and easy to massage yourself. Just using gentle stroking moves with little or no oil around these areas can really help lower your pain patterns if you suffer a lot from them.

In the next blog we will be looking at one final, but very large muscle, the Trapezius! We will then go on to see how Clinical Massage Therapy can help with Pain Patterns and Trigger Points.

I hope you have enjoyed the read and that you are able to join me next time!

Disclaimer: This blog is not a diagnostic tool and I would advise anyone suffering from pain to seek medical help. I am a Soft Tissue Massage Therapist and not a clinician and am simply writing about pain from a soft tissue point of view.

Wednesday, 6 July 2011

Pain Patterns Explained

You will be glad to know that I have not been slacking off; in fact I have had my head (ha ha) stuck in my anatomy books to make sure I can explain Pain Patterns, Trigger Points and Referred Pain to you in a coherent manner before we move on to some great Body-Work!

I am posting a few blogs on Head and Neck Pain over the next week or so and as I started writing the series at the beginning of the week I realised that before we get cracking you need to have a very clear idea of what I mean when I talk about pain.

Pain can be caused by all manner of things. Trauma (when you fall over, have a car crash etc), illness, disease, as well as emotional and mental problems can all cause us to feel pain. We feel pain through our Central Nervous System when our brain picks up the fact that something is not right within our bodies through nerve impulses. This is why it is so important to make sure that we get pain investigated by a medical practitioner. I cannot tell you how many times I have advised my clients to go and 'get a picture', either by asking the General Medical Practitioner to take a blood test, x ray or MRI scan. If your are suffering from pain, your doctor needs to know as it could be something that needs medical intervention and help. I am really great at massage therapy, but I cannot diagnose pain or cure you, nor can any other holistic therapist. However what I can do is help with soft tissue based Pain Patterns!

Pain Patterns are a very specific way of talking about the pain that muscles can create through out the body. We can thank the work of Dr Janet Travell and Dr David Simons who worked whole heartedly and thoroughly to scientifically research Trigger Points and their associated Pain Patterns. Their book is the basis of many texts written on the subject and all the knowledge I have concerning the material is based on their work.

Dr Janet Travell described a Trigger Point as “a hyperirritable locus within a taut band of muscular tissue and/or it's associated fascia”.

When you get a 'knot' in a muscle, or in your connective tissue (fascia), you can often feel it. Most people can run their hands over the top of their shoulders and feel a bump in the muscle that causes pain when they press down on it. Sometimes that 'locus', or bump, sends pain shooting up towards the head or down to the hand. Well, the bump is a Trigger Point and the pain you feel when you press on it is a Pain Pattern.

The Pain Patterns were mapped by Travell and Simons by injecting a saline solution into the trigger points of willing candidates. They then scanned them and found that common trigger points could be found in many people and that these Trigger Points send pain in the same 'pattern' though out the body. They painstakingly went through every muscle and mapped the common trigger points and the radiating pain, so we know have maps and illustrations to show us where to start looking for likely culprits!

As a Clinical and Sports Massage Therapist it is my job to find the trigger points that are causing you soft tissue based pain and treat them. I do this with a manner of different techniques including; hot or cold heat, fascia stretching, massage, compression onto the the trigger points, as well as muscular based stretching. Used in the correct manner and in the right way these trigger points can be treated very effectively and then the pain dissipates.

This type of treatment can be very quick in it's results and adequate home care can keep on top of any recurring issue. However I do have some clients who need to take a long time getting over the soft tissue trauma that they have received and it can take months to get on top of the pain.

Either way, I think massage is a very over looked tool in the treatment of pain in the U.K in both preventative and after care situations. I personally long for the day when the vast amount of scientific based research in soft tissue pain is taken seriously, but at the moment I will have to be patient!

To read more, do click on the following links for some great insight to fascia release, trigger point research and pain patterns.

                                                      Trigger Point information in depth 

If you have any questions, please don't hesitate to leave a comment and I will do my up most to answer you.

I look forward to publishing my posts on Head and Neck Pain and hope you will join with me on a great journey of nerd based body work. How cool!!

Disclaimer: This blog is not a diagnostic tool and I would advise anyone suffering from pain to seek medical help. I am a Soft Tissue Massage Therapist and not a clinician and am simply writing about pain from a soft tissue point of view.

Restart! : I'm doing well at looking after myself this week after two really bad junk food filled days last Thursday and Friday. I am eating more whole foods and drinking 2lts of water a day and have made sure that I walk into Godalming at least every other day. I will keep reading for tips on how to up the diet and keep you posted.

What I'm loving in the Treatment Room today: I have had a great week treating lower back pain and have really enjoyed working into the hips, buttocks and lumber regions. It's allowed my clients to really relax and move with more ease. Wonderful stuff!

Music of the day: Currently listening to my Study Classic; 'Sting – Mercury Falling' 

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