History of the head and neck
The area of the head and neck have always been of importance to the practitioner due to the volume of clients that come in complaining of a range of issues including neck pain and stiffness, to headaches in various areas of the skull. We have many strings to our therapeutic bow in treatment methods including Deep Tissue Massage, Neuromuscular Techniques, muscle energy and they all work wonders. I want to add yet another string to your treatment bow and this includes activation of the muscles of the eyes, along with stretching manoeuvres. Tom Myers sums it up well with his quote “The deepest layers of muscles (the suboccipital “star”) are crucial to opening up and obtaining the most integrated function in the entire SBL. The high number of stretch receptors in these tissues, and their connection from the eye movements to coordination of the rest of the back musculature ensure their central role. These muscles have been shown to have 36 muscle spindles/ gram of muscle tissue. The gluteus maximus, by comparison, has.7 spindles/gram.1 That is a 50-fold difference.”
Now I am not discussing the Superficial Back Line (SBL) in this article though it has oodles to do with how we now start to perceive our clients. What is important in this reference is that the eyes have direct effect to the suboccipital muscles. These muscles include the Rectus Capitis Posterior Major and Minor, Oblique Capitis Superior and Inferior; along with relevant attachments at the skull.
What options do we have at hand?
The attachments of the Superficial Back Line of Myers start at the Plantar Fascia and short toe flexors and finish up via the suboccipital region and along the Occipitalis and Frontalis muscles and fascia to attach at the brows just above the eye sockets. This is why there is a connection directly between the eye movements and the contractions of the Suboccipital muscles. If you place your fingers at the back of the neck and work deeper past the superficial muscles you can test this out; close your eyes and move them left and right then up and down. Can you feel those deep Suboccipitals contracting subtly or changing tonus? If these muscles are altered in length then they directly affect the rest of the soft tissues of the neck. They must always be treated when someone complains of pain or decreased ROM in the area, or if they complain of symptoms that would appear in an imbalance of the SBL.(more of that later)
Palpation of the region is paramount to effective treatment. Have your client supine with their head on the table, you take their head into the palms of your hands with your finger pads from the index to the last finger cupping into the base of the skull. This requires quiet palpatory patience, but one that with practice becomes easy. Once you are able to work deeper than the Trapezius and SCM you will feel the next layer including the Semispinalis, Splenius and down to the 4 deepest muscles. If the eyes are controlled in a fashion by these muscles then it is more than possible to use movement to correct firing and length. When we look up – two of the Suboccipitals must contract and by reciprocal inhibition the other two must relax, if we look down then the reverse occurs.
Treating the headaches is easy
We can then apply a stretch to these groups between each muscle activation then stretch receptors will assist us in our procedure. 1. set yourself and your client in the position as shown above. 2. make sure the clients eyes are open and looking up at the ceiling which is a neutral position. 3. take up the tension of the tissues of the posterior neck region, this should be moderately firm. You can ask your client for feedback as to how much is too much. Mostly they simply moan in pleasure with the traction. 4. ask them to look to their toes without any head movement at all. This is imperative that all movement is generated by the eyes alone. They hold the downward gaze for 6 – 10 seconds. 5. ask them to look to the crown of their head in the same fashion, i.e. no head movement. Hold for 6 – 10 seconds also. 6. they then return their gaze to the ceiling.Note that there will be some eye strain which is common and stronger then more dysfunction in the region. 7. you then take up any slack that they posterior muscles have afforded and find a new stretch position. Follow these steps twice more so that they have been taken through the cycle 3 times. If you had previously checked cervical ROM for both upper and lower cervical movements you will find a significant difference. OUTCOMES include reduction or dissipation of headaches, increased ROM in all ranges, release of neck and shoulder tension and eye strain with possible improvement of vision.