Question:
For some reason I have a mental block on PAs. Some days it's clear in my head, other days not so. Please help me! The areas where I get confused are assessing the sternocleidomastoid & levator scap eg. if there is more flexibility when turning the head to the right, does that mean the left is where the tension is? I have a case study who feels tension in the right upper fibres of the trapezius & insertion for the levator, there is more flexibility when turning the head to right, does this indicate that it is actually the left which is more flexible as the right neck muscles do not have full extension... does this make sense?
I also have case study who is right handed, but has more tension throughout the right side of the body. As a general rule if you are right handed shouldn't the right be more flexible?
Sorry to ramble... but I am chasing my own tail.
Hi, I will try and answer as best i can albeit my knowledge is only through yoga/posture work. if someone has limited movement on the left side, that is the side where the tension/problem lies. the further they can turn the more relaxed those muscles are. as for the case study who is right handed - it is hard to say but i would have thought that just because someone is right handed doesnt mean they would be more flexible that side, it would depend on posture, the way they stand, slump, poor posture, weight bearing more so on the left or right side and of course the more you use something the more tired it gets! if that makes sense so just because someone is left/right handed does not mean they would be more flexible that side it just means they use that side more often. a lot of people do get tension in neck and shoulders as i am sure you already know this can be due to poor sleeping positions, wrong pillows, lying down crouched up on the settee, but a great deal of neck and shoulder tension/pain is down to incorrect posture. a great way to ease tension is to shrug the shoulders and pinch the muscle/area of tension. you can use yoga postures also to ease stiffness and muscle pain/tension/spasm.but i am sure you already are familiar with this.i hope this helps sorry i cannot be more scientific in response!
tammyx
www.alternatively-endo.com
I think I'm looking more at extensors, which is why it gets a bit confusing for me. For example if you are doing side bends you are looking at tension in the quadratus lumborum, when you bend to the right you are actually looking at the flexibility of the muscle on the left. Most of my case studies are sports related injuries, so hopefully the cause of the imbalance is going to be fairly obvious.
Thanks for the help. :)
bit over my head that but good luck with finding out!!
Tammy
[8D]Angel fish please lok into Mel Cash Sport an Remedial massage therapy It deals wit hall the things you have mentioned i would think itf there is an inbalacance one side tight eg short tight muscles the other will be soft and loose
this would indicate more relaxed so more flexable try and get your head around this as when the exam comes you will need to be able to think about it love and light lionheart
Hi Angelfish
Only just joined on here and came across your thread on Postural Assessment. Are you still in need of an answer as I can probably offer some light on the matter....if so, let me know and I can was lyrical for your on contralateral and ipsolateral rotators/flexors/extensors and how you test for them being tight!
Take care
Hi Seymour,
Welcome, I'm new here too! :). Sorry to butt into this conversation but I've just started the ITEC Sports Massage Course and know I would gain value from your insight!
Looking forward to your posts and thanks in advance....
Hi Vik
Thanks for your message and interest.
The original thread asked about assessing flexibility of the neck muscles when the head is rotated to one side.
Before answering that, it's necessary to review a little muscle anatomy. Muscles of the neck that produce lateral rotation of the head and neck fall under two categories - Ipsolateral rotators and Contralateral rotators. Ipsolateral rotators rotate the head and neck to the same side (that is, an ipsolateral rotator on the right hand side of the neck will rotate the head to the right) whereas a contralateral rotator will rotate the head to the opposite side (that is, a contralateral rotator on the right hand side will rotate the head to the left).
Examples of ipsolateral rotators = levator scapula, splenius capitis/cervicis
Examples of contralateral rotators = trapezius, sternocleidomastoid, scalenes.
So when the head is rotated to the right (say), lev scapula and the splenius group on the right will be contracting and lev scapula and splenius on the left will then be in relaxation. During the same motion traps, SCM and scalenes on the left will be contracting and the corresponding muscles on the right will be in relaxation.
If there are flexibility issues with rotation of the head and neck to the right (say) it could be due to tightness in any of the muscles that are in relaxation during this action which is therefore lev scap and splenius on the left or traps, SCM or scalenes on the right.
Client feedback with regard which side the stretch is felt will help narrow down which muscle groups are restricted.
Of course, there could be other reasons for the restriction other than flexibility (for example, weakness in the agonists in this action) but that is probably a subject for another thread.
Does this help or muddy the waters???
Seymour
Brilliant and just the motivation I needed this morning to gear me into more revision!!
Thanks Seymour
[sm=hug.gif]
Hi seymour
I've just read your post, thanks it is a brilliant explanation. I gradually figured out what muscles were in play and I think as it was early days in my studies our tutor was trying to keep things simple.
Hope you find the time to share some more of your great wisdom.
Excellent!
Hi there, My name's Daniel, I'm a PT student at Queen's University. I'm presently doing my musculoskeletal placement and treating a Motor Vehicle Accident (MVA) patient. Although many modalities are useful in treating these patients (i.e. heat, cold packs, accupuncture, TENS, etc) I prefer to use manual therapy as my primary technique of choice.
In any case, I am presently performing cervical tractioning whereby i sit behind the patient's head and hold the patient lying in supine at the occipetal fossa and proceed to pull back with the palmar aspect of my hands to give the upper fibers of the traps a gentle stretch.
Following this I proceed to stretch the right levator scapulae by placing my left palm under the patient's neck, pulling it further to the left, rotating the head to the right, and using the thenar eminence of my right hand I push down on the superior border of the scapula, in particular at the superior medial angle of the scapula. Thus providing a right levator scapulae stretch.
Now my supervisor is grilling me on the question of which way should I rotate the head (to the left or to the right) in order to provide the most effective stretch of r. lev scap (even though she showed me, and confirmed this technique as effective before).
Seymour, your explanation was quite thorough, what do you think of my situation? Do you think it applies the same way to what I'm performing on the patient? That is, according to your explanation, in order to stretch the r. levator scap, because it is on the ipsilateral side, I would then have to turn the patient's head to the left and push down on the scapula to achieve the desired effect?
Thank you all in advance for your replies.
Daniel
hi daniel,
only just caught this thread. there does seem to be many different versions of the passive assisted levator stretch. here's what i've experienced in my remedial treatments. happy to be corrected, if only to realise that my intuition has been misplaced....
stabilising the scapula and taking the head into contralateral flexion (away from the side being stretched) is one way. but with this techinique you also seem to engage the upper traps as well, which can often be more shortened than the corresponding levator.
from this position, taking the head into cervival flexion increases the stretch but seems to still engage the upper traps and also the middle scalenes.
from this position, taking the head into ipsolateral rotation (towards the side being stretched) seems the engage the anterior scalenes and possibly the scm, especially if you choose the stabilise the clavicle rather than the scapula.
however from this position, taking the head into contralateral rotation seems to isolate the levator.
so in short, rotating the head to the left (in your example) isolates and increases the stretch on the right levator.
does this tie with anyone else's experiences?
warm regards
henry
Henry. sounds good to me.. I would add... what feels tighter, more restricted... you can learn all the corrrect protocols and muscle functions but if you dont feel what is going on, it wont help, do both sides and ask the patient which side they feel is tighter and also what you feel and go from there.
see you
I also have case study who is right handed, but has more tension throughout the right side of the body. As a general rule if you are right handed shouldn't the right be more flexible?
Sorry to ramble... but I am chasing my own tail.
Answers:
Hi, I will try and answer as best i can albeit my knowledge is only through yoga/posture work. if someone has limited movement on the left side, that is the side where the tension/problem lies. the further they can turn the more relaxed those muscles are. as for the case study who is right handed - it is hard to say but i would have thought that just because someone is right handed doesnt mean they would be more flexible that side, it would depend on posture, the way they stand, slump, poor posture, weight bearing more so on the left or right side and of course the more you use something the more tired it gets! if that makes sense so just because someone is left/right handed does not mean they would be more flexible that side it just means they use that side more often. a lot of people do get tension in neck and shoulders as i am sure you already know this can be due to poor sleeping positions, wrong pillows, lying down crouched up on the settee, but a great deal of neck and shoulder tension/pain is down to incorrect posture. a great way to ease tension is to shrug the shoulders and pinch the muscle/area of tension. you can use yoga postures also to ease stiffness and muscle pain/tension/spasm.but i am sure you already are familiar with this.i hope this helps sorry i cannot be more scientific in response!
tammyx
www.alternatively-endo.com
Answers:
I think I'm looking more at extensors, which is why it gets a bit confusing for me. For example if you are doing side bends you are looking at tension in the quadratus lumborum, when you bend to the right you are actually looking at the flexibility of the muscle on the left. Most of my case studies are sports related injuries, so hopefully the cause of the imbalance is going to be fairly obvious.
Thanks for the help. :)
Answers:
bit over my head that but good luck with finding out!!
Tammy
Answers:
[8D]Angel fish please lok into Mel Cash Sport an Remedial massage therapy It deals wit hall the things you have mentioned i would think itf there is an inbalacance one side tight eg short tight muscles the other will be soft and loose
this would indicate more relaxed so more flexable try and get your head around this as when the exam comes you will need to be able to think about it love and light lionheart
Answers:
Hi Angelfish
Only just joined on here and came across your thread on Postural Assessment. Are you still in need of an answer as I can probably offer some light on the matter....if so, let me know and I can was lyrical for your on contralateral and ipsolateral rotators/flexors/extensors and how you test for them being tight!
Take care
Answers:
Hi Seymour,
Welcome, I'm new here too! :). Sorry to butt into this conversation but I've just started the ITEC Sports Massage Course and know I would gain value from your insight!
Looking forward to your posts and thanks in advance....
Answers:
Hi Vik
Thanks for your message and interest.
The original thread asked about assessing flexibility of the neck muscles when the head is rotated to one side.
Before answering that, it's necessary to review a little muscle anatomy. Muscles of the neck that produce lateral rotation of the head and neck fall under two categories - Ipsolateral rotators and Contralateral rotators. Ipsolateral rotators rotate the head and neck to the same side (that is, an ipsolateral rotator on the right hand side of the neck will rotate the head to the right) whereas a contralateral rotator will rotate the head to the opposite side (that is, a contralateral rotator on the right hand side will rotate the head to the left).
Examples of ipsolateral rotators = levator scapula, splenius capitis/cervicis
Examples of contralateral rotators = trapezius, sternocleidomastoid, scalenes.
So when the head is rotated to the right (say), lev scapula and the splenius group on the right will be contracting and lev scapula and splenius on the left will then be in relaxation. During the same motion traps, SCM and scalenes on the left will be contracting and the corresponding muscles on the right will be in relaxation.
If there are flexibility issues with rotation of the head and neck to the right (say) it could be due to tightness in any of the muscles that are in relaxation during this action which is therefore lev scap and splenius on the left or traps, SCM or scalenes on the right.
Client feedback with regard which side the stretch is felt will help narrow down which muscle groups are restricted.
Of course, there could be other reasons for the restriction other than flexibility (for example, weakness in the agonists in this action) but that is probably a subject for another thread.
Does this help or muddy the waters???
Seymour
Answers:
Brilliant and just the motivation I needed this morning to gear me into more revision!!
Thanks Seymour
[sm=hug.gif]
Answers:
Hi seymour
I've just read your post, thanks it is a brilliant explanation. I gradually figured out what muscles were in play and I think as it was early days in my studies our tutor was trying to keep things simple.
Hope you find the time to share some more of your great wisdom.
Excellent!
Answers:
Hi there, My name's Daniel, I'm a PT student at Queen's University. I'm presently doing my musculoskeletal placement and treating a Motor Vehicle Accident (MVA) patient. Although many modalities are useful in treating these patients (i.e. heat, cold packs, accupuncture, TENS, etc) I prefer to use manual therapy as my primary technique of choice.
In any case, I am presently performing cervical tractioning whereby i sit behind the patient's head and hold the patient lying in supine at the occipetal fossa and proceed to pull back with the palmar aspect of my hands to give the upper fibers of the traps a gentle stretch.
Following this I proceed to stretch the right levator scapulae by placing my left palm under the patient's neck, pulling it further to the left, rotating the head to the right, and using the thenar eminence of my right hand I push down on the superior border of the scapula, in particular at the superior medial angle of the scapula. Thus providing a right levator scapulae stretch.
Now my supervisor is grilling me on the question of which way should I rotate the head (to the left or to the right) in order to provide the most effective stretch of r. lev scap (even though she showed me, and confirmed this technique as effective before).
Seymour, your explanation was quite thorough, what do you think of my situation? Do you think it applies the same way to what I'm performing on the patient? That is, according to your explanation, in order to stretch the r. levator scap, because it is on the ipsilateral side, I would then have to turn the patient's head to the left and push down on the scapula to achieve the desired effect?
Thank you all in advance for your replies.
Daniel
Answers:
hi daniel,
only just caught this thread. there does seem to be many different versions of the passive assisted levator stretch. here's what i've experienced in my remedial treatments. happy to be corrected, if only to realise that my intuition has been misplaced....
stabilising the scapula and taking the head into contralateral flexion (away from the side being stretched) is one way. but with this techinique you also seem to engage the upper traps as well, which can often be more shortened than the corresponding levator.
from this position, taking the head into cervival flexion increases the stretch but seems to still engage the upper traps and also the middle scalenes.
from this position, taking the head into ipsolateral rotation (towards the side being stretched) seems the engage the anterior scalenes and possibly the scm, especially if you choose the stabilise the clavicle rather than the scapula.
however from this position, taking the head into contralateral rotation seems to isolate the levator.
so in short, rotating the head to the left (in your example) isolates and increases the stretch on the right levator.
does this tie with anyone else's experiences?
warm regards
henry
Answers:
Henry. sounds good to me.. I would add... what feels tighter, more restricted... you can learn all the corrrect protocols and muscle functions but if you dont feel what is going on, it wont help, do both sides and ask the patient which side they feel is tighter and also what you feel and go from there.
see you
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