Treating Golfer’s and Tennis Elbow with Active Release

Golfer’s Elbow

Golfer’s Elbow (Medial Epicondylitis) refers to the pain and inflammation that occurs at the inside point of the elbow (medial epicondylitis).

Golfer’s Elbow can be caused by any activity (not just golf) that requires forceful and repeated bending of the wrist and fingers. For example: when the golfer swings his club, the flexor muscles and tendons of the arm tighten just before the club makes contact with the ball. This repeated action stresses the muscles, causing micro- tearing of the flexor tendon, and inflammation of the soft-tissues. RSI problems occur when these muscles and tendons continue to be re-injured while the small tears are still in the process of healing. These new injuries cause the body to lay down additional adhesive scar tissue between the muscle layers in an attempt to stabilize the affected soft-tissues.

This adhesive scar tissue forms attachments to adjacent layers of tissue and structures, and inhibits the normal movement or translation of these soft-tissue structures. This lack of smooth movement causes friction and generates an ongoing cycle of inflammation and scar tissue formation.

Elbow injuries often require the practitioner to address a much bigger picture than just the elbow area. Symptomatically, what initially appears to be an elbow injury may actually be the result of poor core stability and lack of strength. This requires treatment of a much larger kinetic chain than just the elbow.

The Kinetic Chain of Golfer’s Elbow

The game of golf emphasizes one-sided activity of the body; you are either a right-handed golfer or a left-handed golfer. This unilateral focus is the cause of numerous injuries as golfers tend to develop muscle imbalances which cause a wide array of myofascial restrictions.

Golf, in its ideal form, is all about efficiently storing and releasing energy from your core out into your extremities. The classic golf swing engages your entire kinetic chain from your feet which form a solid stance, up through your hips and core, to finally release energy through your shoulders and arms right into the club head. This is much like a coiled spring, storing energy, then suddenly releasing it.

Unfortunately, for most golfers, this “coiled spring” is either broken or functions only minimally. Many golfers find that in the game of Golf, much of their energy and focus is spent on learning how to compensate for muscle imbalances, poor posture, and the multitude of myofascial restrictions that have developed over time.

Many patients who come to our clinic suffering from Golfer’s Elbow, also show these other common problems:

• Rounded shoulders (anterior posture).
• Restriction in the neck and low back (hypertonic or tight muscles with numerous trigger points).
• Tight restricted hips which are causing abnormalmotion patterns.
• Poor balance.

The Problem with Abnormal Motion Patterns

A tight muscle on one side of your body almost always creates muscle imbalances, which in turn initiates a cascade of other events.

First, these muscle imbalances result in abnormal motion patterns, which then cause the body to compensate by using other structures to perform the required action.

These abnormal motion patterns result in increased friction between tissues layers, with the friction creating micro-tears in your muscles. The micro-tears induce increased inflammation and the eventual formation of scar-tissue.This scar tissue inhibits motion. Inhibitions in motion result in numerous additional compensations throughout the body, initiating yet another ongoing cycle of dysfunction.

In the case of a golfer, a restriction in the hips often causes the golfer to over-compensate with their shoulders during a golf swing. Over time, this over-compensation creates restrictions in that shoulder, along with a corresponding alteration in posture. This in turn leads to a cascading series of injuries and restrictions along the entire kinetic chain.

Tennis Elbow

Tennis Elbow is a painful condition at the outside point of the elbow that typically involves inflammation and irritation of the extensor tendon where it attaches to the lateral epicondyle.

The injury process for Tennis Elbow (lateral epicondylitis) is identical to that of Golfer’s Elbow (medial epicondylitis). However, for Tennis Elbow, the pain manifests on the outside point of the elbow.

Tennis Elbow involves the extensors (the muscles that bend the wrist back). The extensors attach to the lateral epicondyle, on the outside of the elbow. The common extensor tendon also attaches to the lateral epicondyle. Both these structures are susceptible to micro-tears when they are exposed to repetitive actions.

As with Golfer’s Elbow, Tennis Elbow (Lateral Epicondylitis) can be caused by a variety of activities. Any activity that involves excessive supination (turning the hand, palm side up) and pronation, or lifting objects with your elbow in full extension (elbow straight) can cause this condition.

The repetitive motions of these activities result in the formation of micro-tears, inflammation, scar tissue, and physical restrictions which then manifest as Tennis Elbow. In addition to the layers of soft-tissue that surround the elbow, practitioners should also consider the numerous kinetic chain relationships when attempting to resolve this condition. Some of the affected structures are near the elbow while others are quite distant. Several layers of soft-tissues are typically involved in this injury, including:

• The deep annular ligament.
• The supinator and anconeus muscles.
• The superficial structures of the extensor muscles.
• The fascia that surrounds and penetrates through all these areas.

In most cases, both Golfer’s Elbow and Tennis Elbow can easily treated with Active Release Techniques. This is especially true if the practitioner applies a kinetic chain perspective to locate and treat ALL the affected structures.

The key point is to find all the affected structures and then treat each affected structure as needed. This type of treatment requires a high level of tactile sensitivity by the practitioner. Equally important for full recovery, the patient should carry out specially designed exercise routines that focus upon all the structures of the affected kinetic chain.

This information is derived from the second edition of "Release Your Pain". This second edition of "Release Your Pain" will be available in the early spring of 2012. If you would like to more information or to purchase our books please go towww.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Effects of Excessive Pronation on the Knee

For an example of the interactions between the structures of the knee’s kinetic chain, let us take a look at a person whose foot is excessively pronated (rolled inwards). This pronation causes the person’s foot to flatten out during normal walking. This flattening then causes the tibia to rotate inwards (medially) and the femur to rotate outward (laterally).

These actions place a considerable amount of stress on the knee, eventually leading to friction, inflammation, altered motion patterns, and injury of the soft- tissues of the knee. Thus, a problem that started at the foot ends up causing abnormal hip and femur rotation, which in turn leads to knee problems.

From a therapy perspective, it is possible to achieve moderate success by treating just the immediate structures of the knee. However, in order to truly resolve the problem, we should also treat those structures that were the original cause of the excessive pronation – that is, the structures in the knee’s kinetic chain. For example, restriction in any of the following structures may be the actual cause of the excessive pronation:

• Peroneus longus and peroneus brevis muscles help you to point your feet and aid in eversion (rolling inward) of the foot when walking or running.
• Tibialis anterior lets you bend your foot upwards (dorsiflexion) and also helps to invert the foot (roll outwards) when you walk. Proper inversion of the foot is an important part of a normal gait pattern.
• Abductor hallucis, this muscle is responsible for flexing the big toe and allows your big toe to move laterally (sideways). This is important since a normal walking/running stride requires us to push-off with our big toe.
• Flexor hallucis brevis, this muscle is responsible for flexing the big toe and for supporting the medial arch of the foot.
• Flexor hallucis longus, this muscle is responsible for flexing the big toe, supinating the ankle (turning inwards), and in pointing your foot (plantar flexion).

Restrictions in any of these structures can cause excessive pronation, which in turn leads to hip restrictions, and subsequent knee problems.

Obviously, in such situations, treating just the structures in the knee will not resolve the knee problem. Instead, the practitioner must treat the knee, and then, based on the biomechanical analysis, treat all other affected structures in the knee’s kinetic chain. The knee problem will only be resolved when restrictions in all these affected structures are removed.

Exercise

For every restriction that occurs, an altered muscle-firing pattern is also created. These dysfunctional movement patterns will still remain after the restriction (adhesion/ scar-tissue) has been removed. Only a corrective program of exercises will re-establish a normal motion pattern by retraining these structures to properly work together. This is why it is essential to combine the removal of the adhesions with appropriate and specifically designed exercise protocols.

Bottom line, as good as any therapy is without rehabilitative exercises the problem will most likely return.

This information is derived from our publications on soft tissue injuries and sports performance. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Knee Pain - Ligament Injuries

Ligaments of the Knee

A ligament is a tough band of white, fibrous, slightly elastic tissue that forms an essential part of skeletal joints, and acts to bind bones together. Ligaments prevent dislocation, and restrict excessive movement that might cause injury.

There are four main ligaments as well as supporting ligamentous structures that should be addressed for all knee problems.

The Iliotibial Band (ITB) is a wide, flat ligamentous structure that originates at the iliac crest and inserts onto the outer aspect of the tibia, just below the knee. The ITB serves as a ligamentous connection between the femur (at the lateral femoral epicondyle) and the lateral tibia (at Gerdy’s Tubercle). Since the ITB is not attached to bone (as it passes between the femur and the tibia), it is able to move forward and backward with each knee flexion and extension.

Anterior cruciate ligament (ACL) is often injured by a sudden rotational motion of the knee. Cruciate means ‘crossed’. The anterior and posterior ligaments cross each other in the middle of the knee joint. The ACL attaches to the front of your shin bone (the anterior intercondylar area of the tibia) and acts to restrict anterior motion (prevents forward displacement) of the tibia (shin bone) on the femur (leg bone). The ACL works with the muscles in the back of the knee to prevent hyperextension of the knee.

Posterior cruciate ligament (PCL) is often injured by the effects of a direct impact such as might occur in a sporting event, or a motor vehicle impact. This ligament attaches to the back of your shin bone (the posterior intercondylar area of tibia) and works to restrict posterior motion (prevents backward displacement) of the tibia (shin bone) on the femur (leg bone). Squatting actions cause increased stress on the PCL.

Medial collateral ligament (MCL) is often injured by some type of trauma to the outside of the knee. MCL injuries are common in hockey, football, rugby, or other high-contact sports. The MCL runs from the inside of the leg bone (femur) to the inside of your shin bone (upper medial shaft of the femur). This ligament stabilizes the inside (medial side) of the knee joint.

Lateral collateral ligament (LCL) can be injured by an impact to the inside of the knee. The LCL runs from the outside of the leg bone (femur) to the outer bone just below your knee (head of the fibula). This ligament stabilizes the outside (lateral side) of the knee joint.

All these ligaments work synergistically and independently to stabilize the knee without the active participation of the surrounding muscles. For example, when your knee is extended, all these ligaments tighten up. However, when your knee is slightly bent, numerous other muscles come into play to stabilize the knee.

Your body maintains a fine balance of structural activity when moving from passive ligament stabilization to active muscle control. Restrictions in either ligament motion or muscle contraction can create a weak link in the kinetic chain. These weak links creates friction-related syndromes, increases inflammation, and causes development of scar tissue or adhesions.

Levels of Ligamentous Injuries

The type of traditional treatment that is prescribed for ligamentous injuries is dependent upon the degree of injury and the type of activities the patient will be involved in after the injury. Ligamentous injuries are classified into the following major grades:

• Grade 1 describes microscopic tears of the ligament. Grade 1 injuries typically respond well to soft-tissue treatments and rehabilitative therapies.
• Grade 2 describes partial tears of the ligament. Grade 2 injuries also respond well to soft-tissue treatments, and generally do not require surgical intervention if treated correctly.
• Grade 3 describes complete tears or rupture of the ligament. Grade 3 injuries require surgical intervention to correct the problem.

Upon the initial onset of an injury to the ligaments, it is important to:

• Rest – Avoid putting excess stress on the knee. In some cases, if the injury is severe, crutches may be advisable.
• Ice – Use ice on the knee for 20-30 minutes, every 2-3 hours, until the swelling is reduced.
• Elevate – Elevate your knee to help reduce inflammation. Place a rolled up blanket or pillow under your knee.
• Compress – Apply an elastic tensor bandage to your knee to reduce swelling.

Manual Therapy for an Ligament Injuries

Manual therapy can make a huge difference in the recovery and prevention of an ankle sprain. By manual therapy, I am referring to techniques such as Active Release, Graston Technique, Massage Therapy, Fascial Manipulation, Manual Manipulation, and other manual procedures. In my opinion, these procedures are essential in the rehabilitation of any knee injury since they all act to break down and prevent scar tissue formation.

Manual therapy also speeds healing by increasing blood supply, oxygen, essential nutrients, and displace waste products that accumulate after an injury. This is especially important in treating ligaments because they generally have a very poor blood supply to begin with.

Manual therapy can also help prevent these conditions from ever arising in the first place. It does this by improving the quality of all the soft-tissues affecting the knee. By ‘quality’, I am referring to your muscle’s ability to store and release energy; much like an elastic cord that stretches and releases efficiently until multiple knots are tied into it. Muscles, much like elastic cords, function extremely well until they build up adhesions from repetitive motion, injury, or muscle imbalances.

The good news is that when these adhesions are removed, your muscles can absorb more shock, become stronger, and improve their reaction times.

Again, as with all injuries, the treatments must be accompanied by the appropriate exercise routines to rehabilitate and restore your tissue’s kinetic chains.

This information is derived from our publications on soft tissue injuries. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Ankle Stability - The Retinaculum

Usually when we think about ankle problems, we think about sprained ankles or a strained muscle, not something called a retinaculum. Yet these fascial structures play a significant role in a wide variety of chronic ankle problems.

So what is a retinaculum? From one perspective a retinaculum is a band of thick deep fascia that holds the long tendons of your ankle (those that cross the ankle) in place. Retinaculum also acts as a pulley system increasing mechanical advantage.

From the second perspective retinaculum are a major source of neurological receptors involved in balance and proprioception. Essentially retinacula have been hypothesized as key structures in spatial control for foot and ankle movements.

The following section is an overview of specific retinacula and what structures pass underneath them. As you look over the individual sections of the retinaculum also think of these areas as part of one large fascial interconnecting unit.

Retinacula do not exist as they are illustrated

At the second international fascia conference in Amsterdam it became very clear to me that retinacula do not exist as they are illustrated in textbooks. There is a lot of interconnecting fascia that has to be removed before retinaculum look the way they are presented in text books. Research is now showing that these fascial connections (which are removed by dissection) are very important for both force transmission and neurological function.

Retinaculum Anatomy:

Front (Anterior) Ankle Retinaculum

Extensor retinaculum (2 parts)

· Superior extensor retinaculum:

o This structure holds in place tendons from the following muscles; tibialis anterior,extensor digitorum longus, extensor hallucis longus, and peroneus tertius.

o The deep peroneal nerve also passes under the retinaculum.

· Inferior extensor retinaculum:

o The inferor retinaculum is shaped like a Y (once the entire surrounding fascia is removed) and has a lower and upper portion. The Y shape has the function of preventing “Bowstringing” of the tendons during ankle motion.

Pain/Symptom pattern: If there is a restriction in an extensor retinaculum, (front of the ankle) you may experience the following symptoms:

• Localized pain or restriction on the front of ankle when running or walking. It is a very common symptom that I see with runners.
• Tension can also alter the muscle firing patterns in the lower extremity. This can create a host of injuries and result in a substantial decrease in athletic performance

• 
  

  Outside (Lateral) Ankle Retinaculum

  Superior peroneal retinaculum:

  • This band of fascia holds the tendons of two muscles the peroneous longus and brevis in place just behind the outer ankle bone (fibular malleolus).

  Inferior peroneal retinaculum:

  • This band also holds the tendons of the peroneous longus and brevis muscles in place. This retinaculum is continuous with the inferior extensor retinaculum.

  Pain/Symptom pattern: Tension or a restriction in this area will often cause lateral ankle pain, altering both foot and ankle motion. This can easily lead to ongoing injury and a decrease in athletic performance.

  Note: Peroneal retinacula are often injured during ankle sprains (inversion injury). Anytime there is persistent pain after an ankle sprain, a retinaculum injury should be considered. For more information on ankle sprains read my six part blog on Ankle Sprains (Inversion Sprain).

  Inside (Medial) Ankle Retinaculum

  Flexor retinaculum:

  • This band holds the tendons of the following muscles in place: tibialis posterior, flexor digitorum longus, flexor hallicus longus, and the tibial nerve.

  Pain/Symptom pattern:

  • Restrictions of the flexor retinaculum are associated with what is known as Tarsal Tunnel Syndrome. In this syndrome people experience sensation of: Pain, tingling and altered sensation anywhere from the ankle, heel, bottom of the feet, to the toes.
  • A person with this syndrome will often experience an electric shock sensation, which travels into the foot, when they tap directly over the retinaculum. This is also known asTinel’s sign.

  Tarsal Tunnel Syndrome (TTS): Tarsal Tunnel Syndrome refers to compression of the posterior tibial nerve in the flexor retinaculum.

• Persons with flat feet (fallen arches) are susceptible to TTS. Also any type of enlargement in the Tarsal Tunnel can cause this syndrome which includes swollen tendon, cysts, arthritic bone spur, varicose veins, or even inflammation in the surrounding area.
• If this syndrome is left to progress it can lead to permanent nerve damage.
• Conventional therapy can often be very effective in treating this syndrome (Rest, Ice, and Exercise). Active Release Techniques has developed some specific protocols the release the posterior tibial nerve in the Tarsal Tunnel.

Injury To The Retinaculum

When functioning correctly, tendons glide under these retinacula without hindrance. With injury (trauma, repetitive strain), the retinaculum can become a site of tendon restriction, nerve impingement, and circulatory compression. Injury to the retinaculum will cause mechanical and neurological damage.

From a mechanical perspective, when tension is created between the retinaculum, and the structures that pass under them, a considerable amount of tension occurs. This tension can be a major problem since tension creates friction, which can cause micro-tears in the tissue,inflammation, and eventually adhesion formation. These adhesions inhibit relative motion, alter lower extremity biomechanics, and lead to a host of compensations.

From a neurological perspective, injury causes an alteration in neurological receptors (mechanoreceptors and proprioceptors). This leads to both ankle and foot instability. Instability of the ankle and foot creates abnormal motion patterns, compensations which can lead into numerous injuries throughout the body.

Treatment

Restrictions of the retinacula can be treated quite effectively with Manual Therapy (Active Release Techniques, Graston Technique, and Massage Therapy) and a series of corrective exercises. Treating with manual therapy involves breaking restrictions between the retinaculum and the tendon. Essentially the practitioner is restoring relative motion between the retinaculum and the tendons (and of course the muscles that the tendons are attached to).

The practitioners should also be focusing their treatment on the fascial lines of stress. Lines of stress in fascia are often created during injury in multiple locations not just at the site of pain. If these areas of fascial stress can be released, then normal fascial tension can be restored.

Restoring overall fascial tension, besides releasing adhesions between retinaculum and the soft tissues that pass under them, can have significant effects in resolving an injury.

Fascial interconnections are not theoretical entities; they are actual physical structures that have been mapped out. Researchers such as Thomas Meyers (Anatomy Trains) and Luigi, Carla, and Antonio Stecco (Fascial Manipulation) have spent decades researching these interconnections. During the second International Conference About Fascia at the University of Amsterdam, I had the privilege of listening to medical experts from around the world confirm this and related fascial research.

In my own clinical experience we have seen excellent results in improving ankle stability by removing adhesions at the retinaculum itself, but even better results when we work on restoring overall fascial tension

Exercise

Exercise plays a significant role in the rehabilitation of a retinaculum injury. Strengthening and flexibility exercises are needed, but because a significant component of a retinatculum injury involves neurological receptors, balance and proprioception exercises are also essential for full recovery.

The following links are examples of exercises that we often recommend for out patients with injuries to the retinaculum (from Core Performance).

• Ankle PNF D2.2 (Theraband)
• Dorsiflexion Stretch - Half Kneeling

This information is derived from our publications on soft tissue injuries. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Understanding Whiplash Injuries - Bio-mechanics & Anatomy

Whiplash Bio-mechanics

The first factor to consider is that Whiplash injuries (hyper-extension, hyper-flexion injuries) occur in an extremely short period of time. Most of these injuries occur in about one-quarter of a second. This means that the occupants of a vehicle which is struck from behind do not have time to react to the accident. Keep this time-frame in mind as we cover some of the actions that occur.

Vehicle Impact

Let us start with the onset of a standard rear-end collision. Let us consider what happens from the perspective of the driver of the vehicle that was hit from behind. On initial impact where the vehicle in the rear hits the car in front; The force of impact begins to move the front vehicle forward. Since the seat of the car is attached to its frame, the driver’s seat moves forward with the car. But the driver is not attached to the frame of the car, and he/she continues to remain in a fixed position; this is due to inertia. Physics defines inertia as “the tendency of a body to resist acceleration.” Keep in mind, all of this is occurring within milliseconds.

Then, within a faction of a second, the car seat is pushed into the driver’s lower and mid back. This rapid forward acceleration also pushes the lower part of the drivers neck forward (lower cervical spine). This has the effect of straightening out the normal curve in the driver’s neck (the lordotic curve) and the curve in the driver’s mid back (the kypotic curve). This creates an abnormal S shaped curve in their cervical spine (neck).

A considerable amount of damage can be done during this phase (vehicle impact).

o Normally, neck motion is the result of multiple vertebral joints, each of which contribute only a few degrees of motion to an action. Therefore movements like neck extension are made up of the summation of multiple vertebra each adding small degrees of motion to produce the total action.

o When the neck is in this abnormal S-shaped position, the joints of the neck (facet joints) are forced past what is consider their normal physiological range-of-motion limit. This excessive motion causes damage to the area around the spinal joints (facet joints). This damage can include: facet capsule ligament tearing, bony impingements, and intra-articular (within the joint) hemorrhages. The degree of joint damage depends on the severity of collision.

Chronic whiplash and whiplash-associated disorders: An evidence-based approach Journal of the American Academy of Orthopedic Surgeons October 2007;15(10):596-606 Schofferman J, Bogduk N, Slosar P.

Hyper-Extension Phase

This next high-speed, forward motion, jerks the driver’s head back. In many cases the head moves right back over the headrest. This often occurs since most people keep their headrest too low to be effective, or it can occur due to poor head rest design. If the impact of the accident is severe enough, a considerable amount of soft-tissue and joint damage can occur in the front of the neck as the head is thrown back.

Common areas of damage as the head is thrown back:

Joints

o Facet joints are the most commonly injured joints in the neck.

§ These synovial facet joints support weight and control movement between each individual vertebrae.

§ The facet joints are the most common source of chronic pain neck pain after a whiplash injury.

American Academy Orthopedic Surgery 2007; 15:596-606).

Chronic cervical zygapophysial joint pain after whiplash: a placebo-controlled prevalence study. Spine 1996;21(15):1737-1745

Ligaments

o ALL (Anterior Longitudinal Ligament)

§ This ligament runs down the front of the vertebral bodies and prevents excessive extension. Damage to this ligament causes instability in the neck (cervical spine), and can be a cause of chronic neck pain after a whiplash injury. This occurs due to force being transmitted through the posterior spinal structures (facet joints).

Ivancic PC, Pearson AM, Panjabi MM, Ito S. Injury of the anterior longitudinal ligament during whipash simulation. European Spine Journal 2004;13:61-68.

Cholewicki J, Panjabi MM, Nibu K, Macius ME. Spinal ligament transducer based on a hall effect sensor. Journal of Biomechanics 1997;30(3):291-293.

o Facet capsules

§ The facet capsules in the neck are often injured due to the severity of muscle contractions and vertebra motions during whiplash accidents.

An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area J. Anat. (2001) 198, pp. 455–461

Anterior Muscles and Nerves Injured During Hyper-Extension

o Longus Colli muscle

· This deep muscle runs along the front of your neck between the top vertebra in your neck (C1) and your mid-upper chest (T3) and is commonly injured in whiplash injuries.

· This muscle (Longus Colli) contains a high density of muscle spindlefibers. Muscles that contain a higher level of these fibers are used for fine motor control, muscle tone, and positional sense. Injuries to these muscles affect a broad range of motor functions.

Fiber composition and fiber transformations in neck muscles of patients with dysfunction of the cervical spine. Journal of Orthopaedic Research 1995;13:240-249

o Platysma muscle

· This superficial muscle overlaps the SCM (sternocleidomastoid muscle).This muscle arises from the connective tissue (fascia) on the upper parts of the neck, chest (pectoralis major), and extends out over the shoulder (deltoid) and down over the collar bone (clavicle).

· The Platysma is supplied by the facial nerve (CN-VII). Injury to this muscle can create trigger points which cause a prickling type of feeling across the face and upper chest.

o Scalene muscles

· These are a group of three muscles on the lateral side of the neck (anterior, medial, and posterior scalenes).

· A network of nerves (brachial plexus) and a major artery (subclavian artery) pass through the anterior and medial scalene muscles.

· This is an area that is commonly injured during whiplash accidents and can cause either neurological or vascular problems from the neck, right down to the hands.

o SCM (Sternocleidomastoid) muscle

· This superficial muscle is located on the lateral anterior side of the neck. It is involved in flexion and rotation of the neck

· Two major nerves (lesser occipital nerve and greater auricular nerve) pass by the SCM. Compression of these nerves generate symptoms ofoccipital neuralgia.

· Occipital neuralgia is a medical condition characterized by chronic pain in the upper neck, back of the head, and behind the eyes. This is sometimes known as C2 neuralgia or Arnold’s neuralgia.

· The Spinal Accessory Nerve provides input (motor innervations) to theSCM and Trapezius muscles. Compression of this nerve can result in limited range-of-motion and decreased strength of the SCM andTrapezius muscles. This will affect shoulder and neck strength.

Hyper-Flexion Phase

Next, the car seat springs forward causing the driver’s whole torso to move forward at a high velocity. Physics defines velocity as “rapidity or speed of motion; swiftness.” Keep in mind as your seat moves forward your head is still moving back. This action is similar to the final moment before a spring releases.

Then, almost instantaneously your torso and head are flung forward. This forward motion is so strong that if the driver does not have their seat belt on they could, depending on force of impact, be thrown right out of their seat into the steering wheel or even through the window. This strong forward action causes the driver’s whole spine to flex forward often past their physiological limits. This action can cause a considerable amount of posterior neck, mid-back, shoulder, and even low back damage.

Common areas of damage as the head is thrown forward:

Joints

o Facet joints - These joints are the most commonly injured joints in the neck.

Posterior Ligaments

o Supraspinous ligament - strong fibrous cord, which connects together the spinous processes.

Posterior Muscles and Nerves

o Erector spinae muscles (Iliocostalis, Longissimus, Spinalis).

· Group of back muscles that runs beside the vertebrae in an almost vertical direction.

· These neck extensors are commonly injured during whiplash accidents.

o Rectus Capitis Posterior Minor muscle

· Individuals with chronic neck pain exhibit muscle atrophy of this muscle as seen of MRI. This can be caused by trauma or compression of the first cervical branches of the spinal nerves (C1 dorsal ramus). This compression occurs because of entrapment within the rectus capitis posterior major muscle.

· Atrophy of this muscle and C1 injury causes symptoms such as: suboccipital headaches with radiation of pain behind the eyes, dizziness, and benign positional vertigo (BPV). With BPV you will feel a sudden sensation of movement, or spinning, when you move your head or hold it in certain positions.

NEUROGENIC ATROPHY OF SUBOCCIPITAL MUSCLES AFTER A CERVICAL INJURY: A Case Study American Journal of Physical Medicine & Rehabilitation, Volume 77(6) November/December 1998, pp 545-549 Andary, Michael T. MD; Hallgren, Richard C. PhD; Greenman, Philip E. DO; Rechtien, James J. DO, PhD

o Suboccipital Triangle – This is an area in the neck at the base of the skull surrounded by the following three muscles

· Rectus Capitis Posterior major

· Superior and Inferior obliques

o All of the suboccipital muscles are extremely important as they contain very high levels of muscle spindle fibers. Muscle spindles provide postural information to the central nervous system. Damage to these structure in experimental animals cause gait disturbances and ataxia (an inability to coordinate voluntary muscle movements)

o The Suboccipital nerve supplies input to the muscles of the suboccipital triangle. Compression of this nerve can occur at the superior oblique muscle.

o Semispinalis (Capitis, Cervicis)

· The greater occipital nerve is located directly under the Semispinalis Capitis. Compression of this nerve is one of the causes of cervicogenic headaches, these are referred to as occipital neuralgias.

§ Occipital neuralgia is a medical condition characterized by chronic painin the upper neck, back of the head, and behind the eyes. This is sometimes known as C2 neuralgia or Arnold’s neuralgia.

§ Research has shown that about 85% of patients with whiplash injuries have trigger points in the Semispinalis Capitis muscle.

A Distinct Pattern of Myofascial Findings in Patients After Whiplash Injury Archives of Physical Medicine and Rehabilitation Volume 89, Issue 7, July 2008, Pages 1290-1293

o Splenius (capitis, cervicis)

· This neck extensor is commonly injured in whiplash injuries.

Luo Z, Goldsmith W. Reaction of a human head/neck/torso system to shock. Journal of Biomechanics 1991;24(7):499-510

o Transversospinalis (spinalis cervicis, cervical multifidus, rotatores cervical)

· The spinalis cervicis muscle is not present in everyone (inconsistent muscle). Orginates from a ligament in the lower neck (ligamentum nuchae).

· The is some research showing the cervical multifidus msucle can cause increased loading of the joint capsule surrounding the joint in the neck (collision-induced loading of facet capsular ligaments).

· These deep posterior muscles are often injured during whiplash accidents.

Are cervical multifidus muscles active during whiplash and startle? An initial experimental study Gunter P Siegmund, Jean-Sébastien Blouin, Mark G Carpenter, John R Brault, and J Timothy Inglis BMC Musculoskelet Disord. 2008; 9: 80. Published online 2008 June 5. doi: 10.1186/1471-2474-9-80

o Trapezius (upper fibers)

· The third occipital nerve travels under the trapezius muscle until it pierces this muscle and ends up in the lower part of the head (occiput).Compression of this nerve causes occipital neuralgias.

This information is derived from our publications on neck injuries. If you would like to more information or to purchase our books please go to www.releaseyourbody.com . If you would like information about our clinic in Calgary Alberta please go towww.kinetichealth.ca.

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