Taught by Christopher Sovereign- LMT, CNMT, CBAT, COSMSovereignseminars@gmail.comSovereign Seminars on Facebook

Cervical Anatomy 360º + Massage

Cervical Anatomy 360º + Massage Taught by Christopher Sovereign- LMT, CNMT, CBAT, COSM

In this class & manual we shall delve layer by layer through the neck, examining the individual tissues. Goal 1. Show the muscles individually.

Goal 2. Increase your understanding of location and jobs of the cervical muscles.Goal 3. Show basic massage techniques for each tissue.

The posterior neck is classically divided into 4 layers of muscles- AVIIAUpper trap ^Spleni VSemispinalis IIMultifidi & rotatores ^

LandmarksTrapeziusSpleni VSemispinalis capitis IISemispinalis cervicis IIMultifidi & Rotators ^Erector Spinae group Spinalis Longissimus cervicis Longissimus capitisSuboccipitals

Lateral neck Scalenes Levator scapulae Sternocleidomastoid

Anterior neckHyoid muscles A. supra-hyoids B. Infra-hyoidsLongus coliLongus capitis

Various Interspinous Rhomboid minor Serratus Posterior Superior

Sovereignisms

Bump AKA: External Occipital protruberence Superior Nuchal

Line (SNL)SNL

Inferior Nuchal Line

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1 1

Note the space between the

‘transverse processes’ and the articular pillars

T1; note- large, but smaller than C7.

May stick out farther but less massive

Lateral mass. The

group of these are known as an articular

pillar

C7; note- this is the largest spinous process of the upper body

C2 ; note- large spinous, the largest in the upper cervical. Smaller than C7 spinous process.

C1; note- Does not have a spinous

process. It has a small bump called a tubercle

SpleniSplenius capitis & cervicis V 13/36

Upper Trapezius Cranial attachment: External occipital protuberance (EOP),

medial portion of superior nuchal line, nuchal ligament, possibly to

spinous processes of C2-5.

Laterally connects to: Lateral 1/3

of posterior clavicle. [middle

trapezius attaches to scapula @

acromium & spine of scapula]

Upper trap: lateral attachment: > Lateral 1/3 of the posterior aspect of the clavicle.

Note: the upper trap does

NOT attach to the scapula.

clavicle

Jobs: Elevation of scapula, lateral flexion of head & neck, helps resist weight carried on shoulder, upward

rotation of scapula. Stabilization &

checkrein of head.

Of note: One of the most common

muscles to have trigger points,

commonly referring to temple &

mastoid process (& inferior of it).

Trapezius

Massage: Glide with skin @ EOP

& superior nuchal line, midline &

nuchal ligament, glides from

midline out to posterior clavicle

( lateral 1/3 to acromium ). Thumbs are perfect for clavicle work when

client is supine.

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Normally, this structure would be thought of as two structures- one going to the cranium & one to the upper cervicals. In my

mind, this is more like a biceps muscle- a muscle with one base and 3 additional insertions. A cervical triceps if you will.

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Anatomical landmarks: Spinous processes; mastoid process;

C1 TP; C2 & 3 posterior tubercles

From the midline-

From C3 lateral spinous process to T6

lateral spinous process.

Cervicis section looking

medially- Curls around to the lateral neck inserting into the

posterior tubercles & posterior transverse processes of C1 &

C2 & maybe C3.

Capitis: to the mastoid process and

medially to the occiput between superior & inferior nuchal lines. This

attachment is deep to ( underneath ) the SCM mastoid attachment.

Cervicis section- posterior view- note it’s

curling about to the lateral.

Of note: Remember this one by V

13/36: Bilaterally this is in a V shape and attaches above to C1-3

& below to C3-T6

Jobs: Stabilization of head & neck,

rotation of head to same side. Bilaterally: Stabilization & extension of head &

neck.

Massage: Glides from C3-T6 spinous

processes upward & laterally towards mastoid process. Also treat mastoid

process & lateral attachments @ C1-3

Multifidi & Rotatores

Semispinalis Capitis: ˆC46-T17From above:to occiput in between

the superior and inferior nuchal lines.

From below: C4-C6 articular processes, Transverse processes of T1-6 or 7

Actions: Stabilizing of Head in

flexion, extension of head

It lays in the lamina groove but does not attach to the spinous processes.

Semispinalis cervicis: ˆ25/16

SP 25, TP 16Above: spinous processes of C2-5

Below: Transverse P. of T1-5 or 6

Actions: stabilization of neck in

cerv. flexion, extension of c-

spine, rotation to opposite side.

Semispinalis Cervicis and Capitis Mainly straight up the spine

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These muscles work

together typically. Of note: Each one of these

is a mini-biceps ( rotatores ) or mini-quadriceps ( multifidi ) as from one location on a

transverse process these ‘reach up’ to multiple vertebrae above.

MultifidiAbove- Mid- lateral spinous processes of C2-C5Below- Articular processes of C4-C7 This

muscle spans 2, 3 or 4 vertebrae.

RotatoresAbove- Spinous

process starting at C2 This muscle spans

one to two vertebrae.

Below- Transverse process starting at C3

and continuing on.Overall- stabilization & specific positioning of individual vertebraeBilaterally- Extension of vertebral column

Unilaterally- help rotate vertebral column towards opposite side.AKA: these muscles tighten on right and the neck is turned to the left.

Massage:Gently sink into the lamina groove and perform small glides from a transverse process

to the spinous process up one, up two, up three & up four. Repeat at the next vertebrae, working small and gently.

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Erector Spinae Group:

Spinalis, longissimus & iliocostalisSpinalis cervicis- a rainbow m. part of the erector spinae group tends to help control ROM.

This is what I call a rainbow muscle. If you looked at this muscle

while someone were on their side-it is sharped just like a rainbow.

Others think of it like suspension springs on a car. The fibers that attach to the spinous process of C2 have the longest fibers and go all the way back to the spinous process at T3, likewise C3

goes to T2 ( and is slightly shorter in length, C4 to T1, C5 to C7 ( and is

the shortest )Functions: Bilaterally- 1. Stabilization of the vertebral column 2. assist in

extension of the vertebral column

Unilaterally- lateral flexion of vertebral column ( side bending ) minor playerMassage: sink in and gently work into the lateral spinous processes.

Longissimus capitis & cervicis

Longissimus capitis:

a smaller strap of a muscleBelow- To the articular processes ( lamina groove ) of C4 or C5 & T1-T4

or T5 Transverse processesAbove-Mastoid processFunction- 1. Bilaterally-Extension of the head ( think of what this might do in forward head posture ) 2. Unilaterally-Helps to laterally flex the

head 3. Rotate head towards same side

Longissimus cervicis

Below- Superior portions of transverse processes of T1-T4 or T5

Above- Posterior tubercles of C2-C6

Functions: 1. Bilaterally-Extension of the vertebral column 2.

Stabilization of cervical vertebrae Unilaterally- 3. lateral flexion towards

the same side.

Massage: Sink in using gentle glides in the lamina groove out to the

transverse processes & the inferior mastoid process.

Iliocostalis cervicis The most lateral of the 3 groups comprising the erector spinae muscles.

Connects long fibers from the sacrum to the posterior tubercles of the lower cervical vertebrae. Note it is lateral of the transverse processes.Massage: Work between mid thorax and the lateral cervicals.

Part of this shall put you in the lateral rhomboid area, as well as very near the posterior scalene.

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Major & minorRectus Capitis Posterior Major-Connects C2 spinous process to the

occiput @ inferior nuchal line starting

one thumb width lateral of the midline.

minor- Connects C1 tubercle to the

occiput @ inferior nuchal line starting

at midline, is one thumb width wide.

Their actions: Primary: stabilizing

head, micro adjustments to C1 & C2

vertebrae.

Assist in extension (Bilat) & rotation to

same side.

Massage: Sink into the C1 tubercle &

press into the occiput & glide

superiorly. Shift one thumb width

lateral and repeat from C2.

Superior & inferiorObliquus Capitis SuperiorConnects C1 transverse process &

occiput in between superior & inferior nuchal lines. Lateral section is near mastoid process.

Obliquus Capitis inferiorConnects C2 spinous process to C1 transverse process.

Their actions: Primary: stabilizing head,

micro adjustments to C1 & C2 vertebrae.Assist in extension (Bilat) & rotation to

same side.Massage: find C1TP-work the small area

slightly posterior & above for superior. For inferior- work between the large C2

spinous process and C1TP using small partial glides & static pressure holds. Its

longer than you might think.

SUBOCCIPITALS This group of 4 muscles on each side are small and important. In their actions they

act similar to the spinal ligaments and multifidi lower in the spine, tho acting on the head & first 2

vertebrae. They are frequently involved in headaches via trigger points

Scaleni- anterior, middle & posterior.Of note: The subclavian artery, brachial plexus & auxiliary artery run between the anterior & middle scaleni. These have the ability to compress these arteries directly and the ability to raise up the first rib, compressing this neurovascular bundle indirectly. None attach to C1. The scaleni do not attach in the lamina groove, rather the tubercles of the transverse processes.

Scalenus anterior: 36/1 middle vertebrae

connects the anterior tubercles of C3-6 to the anterior border of the first rib.

Scalenus Medius: 27/1 connects the posterior tubercles of C2-7 diagonally

with the superior surface of the first rib.

Scalenus posterior: 57/2 lower neck:

Connects the lowest 3 vertebrae via almost horizontal fibers to rib #2.

Jobs: From above: Inspiration. From

below: Lateral flexion of the cervical spine ( almost and extension of the lev.

scap.), neck flexion, neck stabilization.

Scalenus minimus: 7 [exists in at least half/3/4 of people on a minimum of one side] Connects the plural dome with the

neck, allowing increased lung expansion.

Massage: Minimus we can’t get to.

Anterior is difficult. We won’t be treating in this class.

Medius is easily found- it’s just strait lateral and meaty.

Posterior is best found in side lying position. From the side it is an easy and

short stroke in the lower cervicals.

Working the posterior scalene Glide from 2nd rib to C5 (where line is)

My favorite is w/ client in sidelying and using

my thumb

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From above: Transverse

process of C1-4 (Posterior tubercles of C2-4)

From below: Posterior edge of the superior angle of the scapula

Jobs: Elevates shoulder, side bends neck,

stabilizes/

counterbalances neck in

FHP, May insist in same

side ROT, Bilat. cerv.

ext. Assists in rotation to

same side.

Think Bi-14

Notes: Lev. Scap does elevate

the shoulder ( duh ! ) when the

neck is fixed. It also can pull the neck laterally

C1 (Atlas) @TP

C2 (AXIS) @ Post Tub

C3 @ Post Tub

C4 @ Post Tub

Note the 90º twist from

scapula to

vertebrae

Levator Scapulae

High attachments: C2-4 Transverse

processes (C2-4 posterior tubercles)

Find the lateral articular pillars Sink fingertips to bone level Stay at bone level and shift slightly anterior to slight boney

prominences ( post. tubercles) .

Superior attachment work:

Find C1 TP just inferior to

mastoid process. It might be

slightly anterior.

Scapular attachment: Posterior superior angle of the scapula.

Find the spine of the scapula at its medial end Glide slightly superior. Massage the posterior edge.

Note: At the superior angle is

a sandwich- levator scap then

serratus anterior.

Levator Scapulae11

Superior attachment is at mastoid process and posterior to

lateral half of the superior nuchal line

From above: Lateral surface of the mastoid process, lateral half of the superior nuchal line of the occiputFrom below: Sternal Head: Anterior superior surface of the manubriumClavicular Head: Medial 1/3-1/4 superior and posterior surfaces of the clavicle

Actions:

Bilaterally: Neck flexion, pulls head forward,

brings chin to chest, checkrein against hyperextension,

stabilizes (with trapezius) head during talking and chewing Unilaterally: Rotates the face towards the opposite side,

w/traps- side bends neck.

Basically, almost every movement of the neck involves help from the SCM

Note: the SCM does not attach to the neck !

The two lower heads of the SCM:

1.Sternal @ the manubrium

2. Clavicular

The greatest name in muscles

Sternocleidomastoid:

Keys to success with the SCM: > Forget working the inferior attachments. They are almost always tender and do not improve much. Plus, clients hate it and get little improvement, a lose/lose.

> Do work the mastoid attachment as it can improve and can be involved with

headaches.

> Many MTs mistake with the SCM is

not working the deep portion. they work the

superficial section only. The deepest part needs the most work and is also the hardest to

get to.

> A pincher grip works best to go around

the superficial tissues. Once you grasp the

tissue, you can hold and release or work your fingers back and forth gently.

You can see from this graphic that the SCM is quite thick and wide.

Also note: the neurovascular bundle

resides on the posterior aspect of the

SCM. Don’t pinch 360º and you’ll be

fine.

In the supine position, the fingers are

recommended to treat the cranial attachments at the mastoid process and

lateral superior nuchal line. Sink in, then

determine pressure. Moving with the skin in

a line back and forth or circles is excellent In prone, thumbs are recommended.

! ! ! SCM! ! Carotid Artery Internal Jugular Vein

working the deep SCM.on left- sidelying

Working the mastoid attachment

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Hyoid muscles

Two different functions of these tissues attaching to the hyoid bone ( located where the jaw/mandible meets the

neck ) : Supra hyoids- meaning above the hyoid.

These are the ones you use when you do a hard gulp. Massage: these we gently work the ‘floor’ of the mouth. Follow the midline and also along the line of the medical jaw, always using easy pressure and

slow speeds.

Infra hyoids- meaning below the hyoid bone. They depress/pull down on the hyoid.

Very important in swallowing.

Massage: these we will use extra gentle

pressure & use light finger circles onto the thyroid cartilage, then following the

muscles down to the sternum.

Deep anterior throat muscles. Similar is design & function as the erector spinae, but for the cervical spine.Caution: We shall not be massaging them in this class. They can be worked, but this is not

recommended unless you have had very specific instruction.Longus coli This powerful cervical flexor is deep and

directly attaches to the anterior of vertebrae.

Longus coli connects

C1-C6 superiorly attaching closer to the

midline and as it is inferiorly- moving

laterally into the transverse processes of C5 & 6.Jobs: Powerful cervical flexor working

bilaterally, assists in lateral flexion.

Longus Capitis Connects the occiput to the transverse processes of C3-6 via a ^ shape.

Jobs: Flexion of head, side flexion of head.

Rectus Capitis Anterior & Lateralis These are two small anterior & anterior-lateral sub occipitals mirror their posterior compadres. They connect the anterior occiput & mastoid process with the transverse process of C1. Jobs: Micro movements of C1, flexion of the head, side flexion /tilting of head.

Longus coli & capitis along with the more lateral Rectus Capitis Anterior & Lateralis.

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Rhomboid minorRhomboid minor does cross from the thorax into the realm of the cervicals. Connects spinous processes of C7 & T1 to the upper medical border of the scapula. Jobs: Elevate, downwardly rotate & adduct the scapula. Massage: Glides between C7 spinous process & the angle just inferior of the superior angle.

Interspinous This is a series of tiny muscles that connect the inferior border of one spinous process with the superior border of the next one. Jobs: It’s main action is micro movements of the spinous processes. Massage: Tiny and hard to reach. May be worked gently with a t-bar or an add-on pencil eraser

Serratus Posterior Superior This muscles hides deep to the rhomboids and under the scapula. It does connect the C7 spinous process (& T1-3) with ribs 2-5. Jobs: Assists with inspiration Massage: move scapula as much out of the way as possible. Detailed work @ spinous processes followed by glides laterally & inferiorly.

1.Start Gentle2. Work without lubrication for a while3. Soft & slow improves the flow4.Trust your intuition.

5.Trust your hands. They will take you far. And, the more you

trust them, the better you will be.

6. Let tissue rest before you work it more7.Tell tissue what you are going to do, do it, then remind tissue

what you did. AKA general, specific, general8. Biathlon thinking: Fast works great for flow and for general

strokes; slow is important for detail. Sitting down helps you

shift gears, give the time you need9. Full body w/equal time everywhere is over-rated. Feel free to

skip full areas or just say hello to allow more time for more

important areas. AKA: where they asked for it !!10. Talk less, Communicate more11. Ask12.Practice. Practice. Practice.

13.Finish Big !

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