simple technique for suboccipital

[pht3k]

i just want to share a treatment technique i found usefull

sometimes the suboccipital muscles are pretty tight and unresponsive to typical treatment (traction, mobs with pnf, stretching, massage) and and thoses cases i found that doing gentle rythmic stabilisation of C1 works very well to releive those mucles hypertonicity.

i guess it works because:

contracting mucles a different way, changing the input to the brain
contracting muscles, brain sees that some muscles have a high tone level and adjust it
it challenge stability and maybe wake up some inhibited muclesmy 2 cents

[bernard]

doing gentle rythmic stabilisation of C1
Perhaps a bit of explanation will help? :angel:

[pht3k]

hum ok i supposed everybody knows :/

i learned first this technique to help stabilization for shoulder...

for the C1 here what i do:

i take C1 between my fingers and try to push it in different directions while the patient try to avoid any movement with active musc contraction, but he must not rigidify all his C spine but C1 as specific as he can do. i keep the pressure for 2-3 seconds then change direction, in a random fashion. the movement i want to do are: ant, post, lat and rotations. the patient try to be as fast as possible to change direction as i do.

is it clear enough?

bedtime.
cya

[kongen]

This is similiar to Eyal Ledermans "re-abilitation" concept that he describes further in his book. In short the concept is to retrain the upper motor system in regards to the ability to control co-contraction and reciprocal inhibition.

[pht3k]

so i am not the creator of this technique? argh :cry: :shade:

[Diane]

pht3k, there's not a whole lot that is new (in touching people therapeutically) under the sun. The only thing that changes (and it changes constantly, or at least should..) is how one interprets things one does based on new information, so that one's perspective is not at odds with it.

[Kim LeMoon]

hum ok i supposed everybody knows

I, for one, don't know. C1-related restrictions are sometimes resistant to other methods, as you have said. Be patient with me, I'm trying to get this technique down in my mind before I try it out.

i take C1 between my fingers

Are your fingers touching both C1 transverse processes or just one at a time?

and try to push it in different directions while the patient try to avoid any movement with active musc contraction, but he must not rigidify all his C spine but C1 as specific as he can do.i keep the pressure for 2-3 seconds then change direction, in a random fashion. the movement i want to do are: ant, post, lat and rotations. the patient try to be as fast as possible to change direction as i do.

Are you saying that the patient tries to match the direction and force of your pressure and to respond as soon as they feel your fingers shift?

is it clear enough? Not quite.

[Baecker]

Here is a link http://cpdo.net/res/vid1.html from Lederman showing harmonic technique and shoulder re-abilitation.

[Kim LeMoon]

Although there might be some similarities between pht3k's technique and Harmonics in theory, the addition of pressure to the co-contraction does appear different.

I do something akin to pht3k's technique, but have only used one plane of motion and pressure (Supine, finger contact on lateral C1 TP, ask the client to roll their head towards me and we match pressure, hold 3 secs, on release I roll a little over the TP while they rotate head to the contralateral side). I'm curious about incorporating other directions of pressure.

What position is your patient in pht3k?

[pht3k]

Are your fingers touching both C1 transverse processes or just one at a time?
my indexes are on the posterior arc and thumbs arejust anterior to the tip of the transverse processes.

Are you saying that the patient tries to match the direction and force of your pressure and to respond as soon as they feel your fingers shift?
exactly.

What position is your patient in pht3k?
supine

[bobmfrptx]

I use a similiar technique...client lying supine have them place the pads of index middle and ring fingers along the eyebrows. Next press gently with the right hand and resist the rotation isometrically...use very gentle pressure so as to just engage the upper cervical muscles. Hold 1-2 then press with the left pads and resist again hold 1-2. Do this for 6- 12 reps. Rest and then perform active rotation thru the painfree range holding at each end range at least 30 secs. Repeat 2 or three times. Next have them place there finger pads above the ear and repeat the above pattern of exercise. This will engage the lateral flexors. This theoretically is a self mobilization technique which influences the proprioceptors and aids in reeducation of muscle recruitment.

[ginger]

mobilisation by any other name is still mobilisation folks. You will almost certainly find even better tone reductions and normalisation if you had the patient just relax, and continue to move C1 for as long as it may take to achieve effective tone reduction. C1 and C2 protective tonic change may also be set up , as it were , by bruxing/clenching (nocturnal behaviour). Something worth addressing in the throws of assisting a more permanent resolution at the upper cervical area.

[bobmfrptx]

couldn't agree more ginger. Definite connection to clenching not only nocturnally but throughout the day. The technique i mentioned is for self mobilisation...I also tell my clients to be aware of their mandibular holding technique. Lips together teeth apart. When they catch themselves clenching I instruct them to allow the jaw to go slack, take a nice breath, let it out and smile. Soon they are smiling more often and hurting less.

[kongen]

ginger,

There is a difference between active and passive mobilisation. And I suspect different patient presentations will benefit more from one over the other.

[Luke Rickards]

Anders,

I suspect Ginger will disagree with you.

[ginger]

hello kongen, yes , no doubt the method locus of control and a host of other variables are different in self mobilisation/movement compared to passive mobs.
I contend , that the apparatus, consisting of joints/nerves and soft tissues, responds in much the same way. Which is , to move from adaptive protective states of high muscle tone, to lesser states of the same, allowing for increases in joint freedom and reductions in associated nociception.
Both have their place in the introduction of usefull effects leading to normal movement.

[Luke Rickards]

Well, I was wrong. It seems there is a willingness to consider active movements as effective as continuous passive ones for particular presentations.

I wonder, Ginger, how then do you decide when active movements will be more appropriate? And what treatment procedure would you use?

[ginger]

I would very rarely choose the slower less immediate effects of exercise ( active movements ) over the powerful ,lasting , immediate and thoroughly more successful effects of CM .Why would I ?

[Luke Rickards]

Both have their place in the introduction of usefull effects leading to normal movement.Sorry Ginger. I must have gotten confused. I thought you were telling Anders that both approaches have their uses.

[kongen]

Ginger,

I can agree with you that using exercise to relieve certain painful problems is mostly futile, but I happen to believe (there's that word :)) that the techniques described in this thread differ from the traditional cardio/gym exercises usually offered.

To answer Luke's question of when to use an active versus a passive mobilisation technique, I would answer the following based on my relative short experience in this field compared to most of you:

I have found passive mobilisation (Maitland, CM) to be beneficial when referred pain is the main complaint (lower/upper limb problems, headache), not so much in biomechanical problems (localised pain that alters with position and movement).
I would consider using active mobilisation/stabilisation in patients with recurrent biomechanical problems (acute low back, acute wry neck), after helping them getting the pain down to a minimum.

[ginger]

Luke and Kongen, good morning ( at least it is here ), my very brief answer to your question luke was after a very full day arriving home at 8.30 pm, so was too short on detail really . My use of active movements is kept to a minimum in the course of a series of treatments as my first response is to deal with the complained of pain/dysfunction. It is most often the case , with MSK presentations , that referred events are participating , so , Cm is the speediest way to resolve these concerns . Next on my priority list is to sort out any biomechanical concerns that may have impacted on the spine to create protective responses there. Lastly I may encourage exercise to promote movement. I usually demonstate abdominal "crunches " as a means to promote core stability. At no time would I suggest specific active movements in an effort to fix the complained of problem , rather as a parting suggestion after the resolution has been provided by manual therapies , including CM.
Hope this gives a more complete picture. It is rare for this combination not to work with immediate and usually lasting effect. Obviously some individuals with spinal pain can not be 'cured" with manual therapies when acute injury is part of the presentation, and when severe breakdown of structural parts figures as a driver for protective responses. Help is possible with CM here as a way to reduce spasm and restore movements to viable segments. In these cases exercise may play a bigger role.
Cheers

[pht3k]

hmm sorry for my french native language... i am not use what you refer to when u say CM. cervical manipulation? i need to be sure to follow this thread.
thanks

[ginger]

CM in this context means Continuous Mobilisation. ( of zygo apophyseal facet joints )