cpd/ce-workshop for reflexologistsnerve reflex points for the accessorius nerve (11th cranial nerve)...

CPD/CE-workshop for reflexologists

Round About: The Neck

© 2021 www.touchpoint.dk Dorthe Krogsgaard & Peter Lund Frandsen

http://www.touchpoint.dk/

Round About: The Neck Contents

Contents

Anatomy ........................................................................................................................................ 3

Pathology ...................................................................................................................................... 4

Biomechanical assessment ........................................................................................................... 6 Neck mobility ............................................................................................................................. 6

Neck reflexes on the medial aspect of the lower leg ..................................................................... 7

Nerve reflexology .......................................................................................................................... 8 Spinal nerve with ventral and dorsal root ................................................................................. 10 Nerve reflex points for cervical and thoracic spinal nerves ...................................................... 11 Nerve reflex points for the accessorius nerve .......................................................................... 12

Nerve reflex point for the phrenic nerve ................................................................................... 13

Spine reflexes ............................................................................................................................. 14 Medial view of the foot skeleton ............................................................................................... 14

Classical reflex for the spine .................................................................................................... 14 Touchpoint reflex for the spine ................................................................................................ 14

Muscle reflexes ........................................................................................................................... 15

The suboccipital muscles......................................................................................................... 15

Trapezius, Levator scapula,and the Scalenes ......................................................................... 16 Sternecleidomastoid ................................................................................................................ 17 Overview of techniques for the sternocleidomastoid muscle ................................................... 18

Fascia release for the suboccipital muscles ................................................................................ 19

Relaxation technique for the neck ............................................................................................... 20

Exercises ..................................................................................................................................... 21

Suggested treatment sequence .................................................................................................. 22

References, literature and links ................................................................................................... 23

Legend:

= Use classical reflexology technique = Use Nerve Reflexology technique

© 2021 by Touchpoint, Denmark All rights reserved. No part of this material may be reproduced in any form or by any means without permission in writing from Touchpoint. Disclaimer The content of this workshop and the methods applied have been developed according to the standards of the Reflexology Profession in Denmark. When using these techniques in other countries please make sure you are not violating legal restrictions that may apply in your region. Reflexology is not intended to be a substitute for medical care. If you have a health problem, consult a medical professional.

Round About: The Neck Anatomy

Anatomy

A typical cervical vertebra The cervical spine

Palpation

• Palpation of the structures in the neck is best performed with the client in the supine

position, which relaxes the neck muscles.

• Use moderate pressure with the middle finger or middle and index fingers together.

• Some tenderness is a normal finding when palpating periost and muscle attachments. The transverse process of C1 is often quite sore, which is also normal.

Round about: The neck Pathology

Pathology

Neck pains – causation and connections

Because the neck constitutes the ”main cable” connecting the head and brain to the rest of the body, a large number of different structures may be influenced by muscular tensions or dislocations of joints and vertebra:

• The Vagal nerve – connections with inner organs

• The Phrenic nerve – connections with respiration and organ fascia

• Lymph vessels and nodes on the neck: Even a small misalignment can reduce the lymphatic drainage and cause congestions in for example the sinuses.

The high cervical spine The upper neck area (C1-C3) is of particular interest because it also contains:

• Proprioceptors registering the position of the neck – sense of equilibrium.

• The lower portion of the brain stem containing among other things the Trigeminal nucleus – This area forms a melting pot of sensory input including information from the face (via the trigeminal nerve), the innervation field for C1-C3, the phrenic nerve and feedback loops with the sympathetic nervous system in T1-L2.

Keeping the eyes level has a high priority in the brain. Therefore, even small misalignments of the loin or pelvis are being compensated by the neck bending to one side. It is important to realize this relation in order to understand the deeper layers of causation with neck problems or problems in the structures passing through the neck.

Round About: The Neck Pathology

Trigeminal Nucleus The trigeminal nucleus comprises a collection of neurons in the brain stem forming the origin of the trigeminal nerve – the fifth cranial nerve. The trigeminal nerve is the main sensory nerve of the head. All sensory information from the nerve’s innervation field is assembled in the trigeminal nucleus. Below the head the nervous system is organised in segments, with the sensory information from each segment merging in the spinal chord in the dorsal horn of the same segment. The trigeminal nucleus can be seen as an upper extension of the dorsal horn, collecting sensation from the head. The trigeminal nucleus extends along the entire brain stem and down into the high cervical spine. It performs a multitude of tasks:

• contains motor neurons for the masticatory muscles

• contains sensory nerve cells for:

• the entire cranium including meninges and blood vessels

• spinal nerves from C0 to C3

• accessory nerve

• phrenic nerve

• vagus nerve The trigeminal nucleus functions as a melting pot of information because it receives:

• sensory impulses from all of the head: eyes, nose, mouth, meninges, vessels, etc.

• impulses from the upper neck from facet joints, ligaments and muscles

• impulses via the accessory nerve from the sternocleidomastoid and trapezius muscles

• impulses via the phrenic nerve from thorax-abdomen: pericardium, diaphragm, peritoneum, fascia around liver, gallbladder, stomach, pancreas, spleen

• impulses via the vagus nerve from it’s vast innervation field The huge amount of information gathered in the trigeminal nucleus makes it very susceptible to become sensitized. Such an overload could give rise to symptoms such as:

• spasms in the suboccipital and other neck muscles with pain and reduced mobility

• spasms in the sternocleidomastoid and trapezius with shoulder pains and reduced range of motion

• all forms of headaches

• spasms in the diaphragm

Round About: The Neck Biomechanical assessment

Biomechanical assessment Neck mobility

These tests do not comprise a thorough evaluation or diagnostic procedure, but they do give the reflexologist valuable hints in assessing the necks condition, planning the treatment and - most importantly - following the course of changes.

Flexion

The neck is bent forward as much as possible. Ask for any pains.

Range of motion? Pain? (could indicate muscular problems), Where?

Extension

Bend the neck backwards (ask for pains). Range of motion?

Pain? (could indicate muscular problems), Where?

Rotation upper neck

With maximum flexion rotate the head left and right. The rotation is mainly in C1 and C2. Range of motion? Pain? Where?

Rotation mid neck

Rotate left and right with the head in neutral position. This tests mainly C3 and C4. Range of motion? Pain? Where?

Rotation lower neck

With maximum extension rotate the head left and right. Now the movement takes place in C5-C7. Range of motion? Pain? Where? If this movement elicits pain radiating to shoulder/arm/hand, it indicates root pressure on one or more of the lower spinal nerves, possibly disc herniation.

Round About: The Neck Karl-Axel Lind method

Neck reflexes on the medial aspect of the lower leg Karl-Axel Lind method, system II

© Touchpoint and Medika Nova AB, Anna-Kaarina Lind, Finland

Vertebrae, joints and ligaments are treated on the medial edge of tibia (bone to bone).

Neck muscles are treated on the adjacent part of the calf muscles (soft tissue to soft tissue)

Round About: The Neck Nerve Reflexology

Nerve reflexology

Origin: Developed in Germany by Walther and Ellen Froneberg, as part of the treatment method called Manual Neuro-therapy. Further developed in Belgium by Nico Pauly.

Reflexology model: Eunice Ingham / Hanne Marquardt Points: More than 150 nerve-reflex points have been mapped out using

electro-myographical measurements. All points are found on the periost of the foot skeleton. The points are small and demand an exact localisation.

Treatment technique: With a few exceptions all nerve reflexology points are treated by

pressing with the ulnar side of the distal phalanx of the thumb, see illustration below. A moderate static pressure is applied, no masage or rotation. Use a pressure as hard as you can just feel the patients bone against the bone of your finger

Duration of pressure: see next page.


Spinal nerve with ventral and dorsal root

© Touchpoint

Rd = Ramus dorsalis = dorsal root Rv = Ramus ventralis = ventral root

Dorsal root Ventral root

Pressure direction

Directly from medial to lateral = 0o

45o angle between the finger and the foot

Innervates • Vertebrae

• Facet joints

• Discs

• Deep back muscles

• Skin on the dorsal side

• Skin and muscles lateral and ventral sides of the body

• Forms the large nerve plexi, which supply arms and legs: Cervical plexus C1-C4 Brachial plexus C5-T1 Lumbo-sacral plexus: L1-S4


Nerve reflex points for cervical and thoracic spinal nerves

Diagram of pressure direction

Treatment techniques

(© Touchpoint with permission from MNT-NR International, Belgium)


Nerve reflex points for the accessorius nerve (11th cranial nerve)

Diagram of pressure direction

Treatment technique

Origin The brain stem, cranial nerve XI

Function Motor innervation of the sternocleidomastoid and trapezius muscles.

Reflexological importance Effective with tensions in these muscles.

Nerve reflex point Position: Pressure direction:

1) Lateral/dorsal edge of the proximal phalanx of the great toe.

2) Dorsal on the heads of metatarsals 2, 3 and 4. Two points on either side.

Pres in a 45° angel from dorsal to lateral

© Touchpoint with permission from MNT-NR International


Nerve reflex point for the phrenic nerve

Treatment technique

(© Touchpoint by permission from MNT-NR-International)

Origin C3, C4, C5 (cervical plexus)

Function Motor innervation of the diaphragm. Sensory innervation of the peritoneum below the diaphragm and fascia around the upper abdomen organs (= pain elicited by swollen organs). Connection to trigeminal nucleus.

Reflexological importance Effective with stress problems and tension/pain in the diaphragm. Pains in the diaphragm may project to the lower neck and shoulder region via the phrenic nerve. Therefore, this point should be included with neck/shoulder problems.

Nerve reflex point Location: Pressure direction:

On the lateral sesamoid bone at the distal joint of the great toe. ”Hang” in the point and pull towards the tip of the toe (distal).

Round About: The Neck Classical Reflexology

Spine reflexes

Medial view of the foot skeleton

Classical reflex for the spine

Touchpoint reflex for the spine

(© Touchpoint)


Muscle reflexes The suboccipital muscles

A good technique is to slightly flex the big toe, and work the small reflexes with the index finger.

Muscle Anatomy Innervation Function

1) Rectus capitis posterior major

2) Rectus capitis posterior minor

3) Obliquus capitis superior 4) Obliguus capitis inferior

The muscles connect the basis of the skull with transverse processes of C1 and C2

Dorsal root of spinal nerve C1

These muscles control fine extension and rotation movements of the head. Contain many proprioceptors, that meassures the position of the head.

(© Touchpoint)


Trapezius, Levator scapula,and the Scalenes

No Muscle Origin Insertion Innervation Function

1 trapezius Cranial basis, spinal processes of C1-T10

clavicle (lateral 1/3), acromion, spine of scapula

accessorius nerve

extension of the shoulder girdle. Upper fibers lift, and lower fibers lower the shoulder

2 m. levator scapulae

transverse processes of C1-C4

Upper corner of shoulder blade

rami ventrales of C3-C4

Elevates and rotates the sholder blade

3 scalenes (mm. scalenus anterior and medius)

transverse processes of C1-C7

1st rib rami ventrales of C2-C7

flexion and side bending of the neck, elevation of 1st rib (inspiration)

(Note: The reflexes are found symmetrically on both feet)

© Touchpoint


Sternecleidomastoid

Muscle Origin Insertion Innervation Function

Sternocleidomastoid sternum, medial part of the clavicula

mastoid process

accessory nerve

side bending, rotation and flexion of the neck

(Note: the reflexes are found symmetrically on both feet)

© Touchpoint


Overview of techniques for the sternocleidomastoid muscle

Analogy of shape between the SCM and the psoas major.

A tilted pelvis may compromise the entire back including the neck.

Classical reflex for the SCM. Nerve reflex points for the accessorius nerve innervating the SCM.

Stretching

© Touchpoint

Round about: The Neck Fascia release

Fascia release for the suboccipital muscles Use this technique to gently stretch the fascia over the deep occipital muscles and release tension in the area.

1. With the client lying supine, sit behind the head and place your upwards facing hands close together.

2. Let the client rest the head on your bent ring, middle and index fingers placed close together on both sides of the midline.

3. Engage the tissue (imagine your fingertips sinking in through the outer layers of tissue until they reach the deep fascia.

4. Ask the client to slowly bend the head forward while you slowly open the hand and let the fingers glide down the muscles.

5. Repeat a couple of times. The technique should not be painful. If the client feels pain, try to do it even slower.

Round about: The Neck Neck relaxation

Relaxation technique for the neck This is a technique inspired by the therapeutic modality Ortho-Bionomy.

1. Hold your hands together as shown on the photo and place them under the clients head. 2. Find a good stable position that allows you to stay relaxed, while carrying the weight of

the clients head. 3. Slowly lift the clients head off the table, and ask her to relax and let go of the head. 4. Hold the head still for a while, and then start to make tiny, slow movements in different

directions. 5. There must be absolutely no pain or tension. It should feel good at all times for both client

and practitioner. 6. Communicate about this with the client. Try to offer larger movements and find out what

she prefers. 7. Ideally after a while it should feel like the head is guiding you where it wants to go.

For a good result this technique requires at least 4-5 minutes.

Round About: The Neck Exercises

Exercises With problems in the movement system it is always a good idea to give the client homework in the form of exercises. Only assign one exercise at a time, then chances that it will actually be done, is much greater! Below are examples of some good exercises out of many possible.

Exercise for neck mobility 1) Sit or stand and look straight ahead. 2) Move the head forward as far as possible without moving the shoulders. 3) Move the chin towards the chest as far as it will go. 4) Pull the chin up along the breast bone and back to the starting position. 5) Combine the previous steps into a smooth movement and repeat several

times in both directions.

General exercise to strengthen the neck muscles

1) Sit or stand with one hand behind the neck. 2) Press the head backwards and make a counter pressure with the hand. 3) Repeat with the opposite hand.

Round About: The Neck Treatment Sequence

Suggested treatment sequence (Blue = Classical reflexology Red = Nerve reflexology Green = Karl Axel Lind method): Palpation and assessment of posture mobility and muscles Page 7

Reflexology Neck and neck muscles on the lower leg Page 8 Spinal nerves (C1 –T9) Page 12 Accessorius nerve Page 13 Trapezius muscle Page 17 Sternocleidomastoid muscle Page 18 Suboccipital and other neck muscles Page 16+17

Related organs, (focus on thorax + upper abdomen) ( Respiration, Digestion)

Autonomic nervous system (focus on brainstem) ( Stress) Phrenicus nerve Page 13

Phrenic plexus and diaphragm ( Stress, Respiration)

With inflammation: Immune system and intestines ( Immune sys., Digestion)

Fascia release Page 20 Relaxation of the neck Page 21 Repeat assessments Page 7 Instruction in exercises Page 22 With all classical reflexes we one or more of these Touchpoint techniques:

• Deep Touch Technique

• Subtle Touch Technique

• Bilateral Technique

• Link Touch Technique

• Resonance Technique

Round About: The Neck References

References, literature and links Anatomy / Physiology

Sobotta Atlas of Human Anatomy, Lippincott Williams & Wilkins, 2001 Atlas of Human Anatomy, Frank Netter, Icon, 2002 Atlas of Anatomy, Thieme, New York, 2005 Medical Physiology, W. F. Ganong, Lange, 1981

Biomechanical assessment

Musculoskeletal Examination, Jeffrey Gross, Blackwell Science, 2002 Myofascial Pain and Dysfunction - The Trigger Point Manual, Travell & Simons, Williams

& Wilkins, 1983 Reflexology

Reflexotherapy of the Feet, Hanne Marquardt, Thieme, 2001 Manual of Nerve reflexology Level I - III, Nico Pauly, Touchpoint, 2020

Miscellaneous

Explain Pain, David Butler, Noigroup, 2003 The Sensitive Nervous System, Noigroup, 2000 Anatomy Trains, Thomas W. Myers, Churchill Livingstone, 2001 Lehrbuch der Ortho-Bionomy, K.G. Weber & M. Wiese, Sonntag, 2001. (In German) Kramer, Fritz: Lehrbuches der Elektroakupunktur, Karl F. Haug Verlag, Heidelberg (In German)

Links

Touchpoint Denmark: www.touchpoint.dk/eng International Association for Manual Neurotherapy and Nerve Reflexology: www.mnt-nr.com

http://www.touchpoint.dk/eng

http://www.mnt-nr.com/

cpd/ce-workshop for reflexologistsnerve reflex points for the accessorius nerve (11th cranial nerve)...

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