Therapist Notes – Stiffness at the base of the neck

This trigger point comes from the splenius cervicis muscle. The trigger point is actually near C7 at the base of the neck but does not release easily or completely when the costovertebral joint of T3 is displaced.

The lower cervicals should be mobilized before attempting to release the tendons in the pocket between the upper trapezius and the upper ribs. This can be done with nmt anterior cervical work or stretches #6, #7 and #8 from The Box.

This trigger point is governed by proprioceptive input from the third costovertebral joint. Specifically, the rib head at T3 has moved posterior and needs to be freed from its displaced position. Reach up under the supine client to find the third costovertebral joint. It will be the obvious, harder and protruding rib head. Lift the rib head until it softens. This often takes 90 seconds or so. When you return to the classic technique in this pic, the trigger point releases more easily and with longer-lasting results.

Releasing the splenii tendons.

This routine targets the tendons but can be rough on the thumb and painful for clients without the pre-release of the rib heads and anterior cervicals. This protocol requires a little deeper penetration for the splenius cervicis.

Follow up with smoothing and stretching.

The inferior glides of the cervical lamina routine can be extended into the upper thoracics to help release this muscle.

Gently assess and stretch the splenii by rotating the head in both directions. Then rotate the head toward the side with tension and gently tilt the head away from the shoulder.

The active participation of the client makes the stretch more comfortable and with a greater range of motion. Focus on guiding the head passively while minimizing assistance.

Here’s a section from Neuromuscular Assessment


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Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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