Neck Treatment Using Hands for Therapists and Patients

There are 24 spinal segments stacked vertically in a sweeping, elongated 'S' bend that gives us our typically human posture. Each vertebral segment has a front compartment (the intervertebral discs) and a back compartment (the paired facet joints) situated either side of the spinal nerve roots. The discs and facet joints have wholly different structure and functions - but both can cause pain.

The intervertebral discs are water filled pillows that are pressure-packed by virtue of their bursting hydrostatic pressure. The hardworking discs are tough, bloodless and insensate - except for their very outer 'skin' which can easily be traumatised. A central tenet of The Sarah Key Method is that these focal points of inflammation cause common-or-garden back or neck pain. And the good news is that this 'simple back pain' can easily be settled with appropriate tinkering manual pressures. Hands!

Excessive compression squashes the daylights out of the discs, particularly if it is 'sustained' as in one long go. It smothers them so they literally can't breathe. At the same time, sustained loading squeezes too much fluid out of the discs. Decompression, in the way of on-off spinal loading, does the opposite. It is 'life giving'. It stimulates the discs and the alternating pressures suck and sluice a tidal exchange of nutrients in and out of the discs - which keeps them well fed (and repairing!).

Although a human spine is amazingly sophisticated in the way it moves and what is does, you can unlucky and suffer a chance errant glitch of movement, which pierces through the spinal defences and tweaks the sensitive outer disc wall. The local micro-trauma sets off a protective response from the spinal muscles which adds tp the pain - and which also locks the segment out of spinal movement. The segment then becomes palpably stiff - easy to find in the stretched-out spine - and painful to the touch. This stiff spinal link is the most common form of back pain.

Human fingers are ideally suited to delving around in spines; playing up and down, like tinkering on a keyboard and finding movement blockages at one or more spinal levels (a blockage feels like a plug of cement in a rubber hosepipe). But here's the important bit: Sarah believes that something 'almost magic' happens when that stiff, painful segment is rumbled by knowing hands; something out of all proportion to the effort involved in touching that pain. This is why Sarah exhorts you to believe in your hands and not be frightened to use them in a more purposeful therapeutic way. She says 'the body seems to welcome that skilled incursion into the pain and comes forward to offer it up'.

You will learn that this is a normal protective response, which swings into play as soon as you do something to hurt your back - how ever that may be (sleeping on a too-soft bed, struggling with a bag of chaff - you name it). Things get worse however, if you become pre-occupied and doom-laden about being in trouble again and this adds another dimension of holding and binding and guarding to the spinal segments, which makes everything so-oh-ohhhh much worse. 

Unlike to lower back, which is a more solid pillar of support, with one main role of bending forward and straightening, the neck moves in all directions to put the head about. The neck is anatomically complex while also being a balance and communication superhighway, alongside a rich arterial blood supply to the brain. In other words, there's a lot going on inside a neck - and you must always be CAREFUL, CAREFUL, CAREFUL when you tinker in there with your hands.

A bad neck can not only be stiff and painful and cause headaches and migraine, it can cause a myriad other less-well-defined symptoms (such as head 'fog' and poor mental concentration, labile emotions, depression) as well as more physical symptoms such as swallowing and visual disturbances (flashes, auras) and aural symptoms such as tinnitus - which all evaporate when the neck is running smoothly again. On the other end of things, you can also make your neck bad in the first place by having weak arms/shoulders and lifting poorly, just as you can with poor breathing habits that over-use neck muscles instead of using the diaphragm.

A video showing normal and abnormal neck postures and where the neck begins (at C1) and ends (C7-T1) from the the outside.

Sarah shows the anatomical layout of the neck on the spine model: the base of the skull and when they spinal cord enters the spine at the base of the brain, the 7 cervical vertebrae, the intervertebral discs at the front, the facet joints at the back and the spinal nerve roots coming out bilaterally at each spinal level.

A video showing normal cervical alignment and ranges of normal motion into flexion/extension, left and right rotation and side flexion.

These are the most effective and oft-used manual mobilization techniques at every spinal level. On the plastic spine, the video shows the placement of the thumbs back-to-back on the spinous processes (the backward projecting fins at the back of each vertebrae) and the direction and amplitude of these important pressures.

The video shows the placement of the thumbs back-to-back on the knobs you can feel through the skin at the back of the living neck and then using the side of the hand and the heel of the hand to deliver PA pressures over a wider area. Sarah  discusses the concept of using a non-pure, slightly angled from-the-side PA pressure to elicit the greatest resistance. Sarah calls this 'finding bite' which delivers a bigger bang for your buck (read more effective treatment) in a mobilization session.

Showing on the spine model another very important spinal mobilization technique directly onto the cervical facet joint from behind. This is pressure straight to the joint itself (through its joint capsule) whereas the PA is a more indirect pressure, using the spinous process as a bony lever to gain movement of the vertebra on its intervertebral disc.

The video on the living neck with the patient lying face down, shows the thumbs feeling the chain of facet joints running down either side of the neck; travelling up and down to find those of greatest resistance. Sarah gives running commentary on the 'feel' of the different facets, indicating if some are harder and more fibrotic (chronic), while others are more tense from fluid trapped in the facet joint capsule (acute).

This is another of 'Sarah special' techniques where she shows on the spine model how to access the cervical facets from the front with the head turned one way, then the other. She points out where the brachial nerve roots are (so as to avoid compressing them un-necessarily), where the vertebral artery travels up through holes in the transverse processes and also where the vagus nerve runs.

With the patient lying in supine, the video shows Sarah carefully turning the neck in order to thrust up the facet joints in the side-front of the neck for easy access. It shows using the hands in all sorts of different way to mobilise blocked facet joints from the front - using the knuckles, the side border of the hand, the heel of the hand and both hands cupped over one another. In this last pressure Sarah talks about stimulating the vagus nerve and the widespread systemic benefits of this.

The video shows on the spine model how cupping the fingertips all lined up in a row under the occiput and leaning back makes it possible to distract the head from C1 and to a lesser degree all the cervical vertebrae below.

Manual traction on the living neck with the patient in supine. The video shows the placement of the fingers and the deep relaxation state of the patient, with relatively minimal visible signs of neck elongation movement.

Sarah showing on her own neck how it's possible to do PA pressures using force through the middle fingers back-to-back on either of the spinous processes. Sarah also shows her fingers penetrating the neck at a slight angle on the spinous processes to seek out 'bite'. She describes how the varying degrees of stiffness from segment to segment create differing degrees of discomfort - from the shrill to the more mellow - as almost like different musical notes.

Sarah frequently uses transverse pressures on the spinous process as a way of 'unscrewing' a stiff spinal segment. The laterally directed pressures target the diagonal mesh of the disc wall (annulus) and bodily loosen the segment, while they also gap open the facet joint on the side of access. Transverse pressures rapidly facilitate more freedom in the PA direction. 

This can be an uncomfortable technique to get right, so may be better used as a self treatment technique to avoid un-necessary pressure pain in the side of a patient's neck. Sarah shows this gentle technique of feeding the vertebrae sideways; gliding them back and forth between her own fingers with pressures to the tips of her own transverse processes. 

Probably not as readily done as the same technique in supine, where it is usually combined with neck rotation, it never the less may be useful if you can get comfortable on the floor (the nose not being too squashed for comfort).   

When treating your own neck it's more relaxing lying on your back, which also makes it possible to get more passive movement of the facet joints. Sarah first uses her middle fingers back-to-back down the chain of facets and then moves to turning her head away and using her thumb metacarpal transversely across the facet joints, reinforced by the other hand. This is the most highly effective self-treatment technique for a painful neck.

Self-traction of the neck is not easy (as the head is so heavy) but it is highly effective when the neck is in acute crisis, or in cases of severe migraine and nausea.

Possibly creating a greater sense of welbeing than using the BackBlock for the lower back, the block under the thorax stretches not only the spine but the ribcage, the intercostal muscles and the shoulders. It is the ultimate stretch for modern day computer users and helps to realign stooped and poke-necked postures.

In this exercise, rolling up and down centrally on the spine mobilizes the thoracic vertebrae, rather like rolling your forearm down over a keyboard depressing each key in turn. Tipping left or right over onto the ribs as you go up and down mobilises the ribcage, where a problem rib (which sits up proud) will be more uncomfortable and stiff as you roll over it. You will see in a later course Proper Breathing in the 'Healer Within' series that this exercise is essential to recovery as it loosens tight, inelastic chests and increases lung capacity.

The muscles on the problem side of a neck will always be tighter. So although this is more a formal stretch rather than a functional one, loosening into the sideways bend will help restore mobility of other more 'useful' neck movements. Bending to a more restricted side will often cause discomfort right up under the skull on that side. So go carefully.

As you will learn from your theory lectures, uninhibited neck freedom relies on an invisible tier of background mobility from the thoracic spine. This is particularly true of neck rotation, where for the neck to get 90 degrees around either way - chin to shoulder- the twist must start at waist level. Turning in the chair left and right, it immediately becomes obvious where the tight thoracic restrictions are.

This is an end-stage neck exercise and not to be contemplated if headaches or migraine are in evidence.  It employs the principle of stimulatory on-off loading helping regeneration of both joint cartilage (of the facets) bone density of the neck vertebrae. The loading also stimulates intervertebral disc metabolism. It is particularly effective with necks with crepitus (grating noises on movement). Desist if loading causes tinnitus (ringing in the ears). To be avoided in cases of advanced osteoporosis but an exercise of choice in cases of osteopenia.

The Ma Roller can be brutal therapy if it's overdone (I do not give it to my Type A patients who always tend to do more than less!). It is highly effective if used sparingly - and with subtlety.  Even so, the Ma Roller should not be used more frequently than once a week.