COMT Techniques of the Neck

COURSE DESCRIPTION

Clinical Orthopedic Manual Therapy (COMT) for the Neck covers the major clinical orthopedic assessment and treatment techniques for the neck. This course is a 2-day hands-on workshop.

Day one begins with orthopedic assessment for the common neuromusculoskeletal conditions of the neck. We then cover body mechanics for deep pressure for working the neck in supine, prone, side-lying, ¾ side-lying, and seated positions. With proper body mechanics, you will learn how the neck can be worked deeply with little effort. We also learn how to palpate and safely and effectively work the scalenes and longus musculature of the anterior neck.

Day two covers stretching and Arthrofascial Stretching (AFS): Soft Tissue Joint Mobilization techniques. We begin with basic stretching for the functional muscle groups of the neck and then learn how to target each specific neck muscle with multiplane stretching. We then cover advanced neural inhibition stretching techniques, including Contract Relax (PNF/PIR), Agonist Contract (the basis for AIS), and Contract Relax Agonist Contract stretching techniques. Day two concludes with Arthrofascial Stretching (AFS): Soft Tissue Joint Mobilization for Manual Therapists (including traction) for the cervical spine. AFS is the only effective means of stretching specific hypomobilities of the neck.

Clinical treatment strategy as well as precautions and contraindications are also covered. These manual therapy skills will empower you to do effective clinical orthopedic work. Throughout this hands-on workshop, Dr. Joe Muscolino reinforces the underlying mechanisms for each of the assessment and treatment techniques, encouraging critical reasoning skills.

Clinical Orthopedic Manual Therapy for the Neck is part of the COMT Regional Approach Certification. The other hands-on workshops in this series cover the thoracic spine / ribcage, low back / pelvis, upper extremity, and lower extremity.

COURSE OBJECTIVES

After attending this workshop, the participant will be able to:

Explain and demonstrate the principles of using core body weight and larger muscle groups for efficient body mechanics.
Perform orthopedic assessment tests for the neck to determine the ability to safely perform deep pressure massage, stretching, and Arthrofascial Stretching.
Describe and be able to work the entirely of the scalene group and also access and work the longus colli muscle.
Explain the fundamental concepts of stretching and apply these concepts to the musculature of the neck.
Demonstrate how to stretch each of the functional muscle groups of the neck.
Explain and demonstrate how to stretch each of the muscles of the neck in all three cardinal planes.
Explain the physiologic basis for and demonstrate how to perform contract relax (CR; also known as PIR/PNF) stretching, agonist contract (AC) stretching, and contract relax agonist contract (CRAC) stretching techniques.
Explain the physiologic basis for and demonstrate how to perform Arthrofascial Stretching (AFS, Grade IV joint mobilization) of the neck.

DETAILED TIME LINE

Following is the usual time line for this workshop. Note: This time line is often adjusted as needed based on the needs of the particular group.

DAY ONE:

Introductions: 15 min

Introduction to the content of the class
Introduction of instructor and workshop participants to each other

Orthopedic assessment of the neck: 90 min

Discuss concept of space-occupying conditions (pathologic disc and bone spurs compressing nerves)
Foraminal compression test
Maximal foraminal compression test
Cervical distraction test
Cough test
Valsalva maneuver
Slump test
Vertebral artery competency test

Break: 15 min
Body mechanics and supine neck work: 90 min

Work laminar groove musculature
Orient core in line with stroke
Keep elbow in
Stack joints
Work perpendicular to contour of client’s/patient’s body
Maintain angle of elbow joint
Lean in with body weight / core
Support patient’s head
Work hands in concert

Body mechanics & prone neck work: 30 min

Table must be low
Perform “scoop” stroke ending with cephalad traction of the head
Use body weight

Lunch: 60 min

Body mechanics side-lying, ¾ side-lying, and seated neck work: 90 min

Diagonal angle of work for pure side-lying
Use body weight for ¾ position
Elbow for ¾ position
Support head on shoulder for ¾ position
Work on stretch with head off the end of the table for ¾ position
Seated position: stabilize client’s/patient’s forehead
Keep elbow in and stack joints
Work hands in concert

Working the anterior neck: 60 min

Use SCM as landmark
Find lateral border of the clavicular head of SCM and drop laterally onto scalenes
Work perpendicular
Slacken with flexion, ipsilateral flexion, and contralateral rotation to work deep to clavicle and SCM for attachments
Note brachial plexus of nerves
Find medial border of the sternal head of SCM and drop medially onto longus muscles
Feel for carotid pulse
If necessary, gently displace larynx and drop posteriorly for longus musculature

Break: 15 min
Basic stretching (concept and body mechanics): 30 min

Stretching is a mechanical protocol for making a soft tissue longer
For a muscle, it involves passively bringing the patient’s neck into a position that is the opposite of its action(s)
Concept of stabilization: how to figure out how to stabilize
Introduce concept of functional groups of muscles (right lateral flexors, left lateral flexors, right rotators, left rotators, extensors, flexors)
Incorporate body mechanics with elbow joint in, stacked joints, and using the core
Workshop all six functional groups

Multiplane stretching: 30 min

Begin with functional groups and narrow the scope to be able to target a specific muscle within the functional group
Consider all planes of motion (i.e., all joint actions) must be considered to optimally stretch a muscle: example: right upper trapezius, right splenius capitis, etc.

Review: 15 min

Question and answer
Discuss treatment strategy

DAY TWO:

Introductions: 15 min

Question and answer over material from Day 1

Review of stretching (basic and multiplane): 30 min
Contract Relax (CR) stretching: 90 min

Principle of Golgi tendon organ reflex
Demonstrate CR protocol for lateral flexor group
Workshop CR technique for each of the major functional groups
Workshop CR for specific target muscles

Break: 15 min
Agonist Contract (AC) stretching: 90 min

Principle of reciprocal inhibition reflex
Demonstrate AC protocol for lateral flexor group
Workshop AC technique for each of the major functional groups
Workshop AC for specific target muscles

Lunch: 60 min

Review CR and AC stretching: 15 min

Question and answer
Discuss integration of treatment techniques

CRAC stretching: 60 min

Demonstrate CRAC protocol for lateral flexor group
Workshop CRAC technique for a few of the major functional groups
Workshop CRAC for specific target muscles

Overview of Arthrofascial Stretching (AFS, Grade IV joint mobilization): 15 min

Explain concept of pinning a bone and moving adjacent bone relative to it
Patient contact: facet
Therapist contact: index finger pads, thumb pad, radial side of proximal phalanx of index finger
Steps: 1) Place pin. 2) Bring joint to tension. 3) Mobilize.
Hold for less than a second, 3-5 oscillations
Soft tissue pull to trap underlying bone
Contraindications…
Use hands in concert
Utilize body mechanics

Break: 15 min
AFS – supine: 60 min

Workshop AFS technique with the client/patient supine
Begin with gentle flowing technique
Become more focused and assertive

AFS – seated: 30 min

Stabilization contact on forehead
“V” contact across facets posteriorly
mobilize with each lateral flexion motion
note range of motion higher in neck versus lower in neck

Towel traction: 30 min

Sagittal stance
Three steps: 1) Lift anteriorly to grab skin. 2) Lift diagonally to seat towel under occiput. 3) Perform traction by leaning from front foot to rear foot.
Add in lateral flexion and/or rotation components (change to frontal plane stance)

Review and paperwork: 15 min

Question and answer
Fill out evaluation forms
Hand out Certificates

WORKSHOP PARTICIPANTS SHOULD BRING

1. Massage table with face cradle
2. Stool
3. Bolster and pillow
4. Sheets and face cradle cover
5. King-sized pillow case, preferably flannel (or thin/threadbare bath-sized towel)
6. Water-based lotion
7. Soft foam cushion (approx. 6×10 inches) or bath towel
8. Participants should wear an open-neck shirt that allows access to the neck