Deep Cervical Extensor Static Manual Release (Soft Tissue Mobilization)

Differentiation

1. It is likely not possible to differentiate the deep extensors of the cervical spine (longissimus, semispinalis, rotatores, multifidus ), but all of these muscles have similar fiber angles and contribute to the same joint actions. Some muscles may contribute more to one joint action than another, but from the perspective of improving the quality of movement, there is likely no reason why it would be necessary to release one muscle while not affecting the others. The multifidus may be the largest of these muscles and is most often referenced in research; however, this muscle should be considered a model for the behavior of these muscles as a group.
2. These muscles are deep to the upper trapezius and splenii.
3. Palpating these muscles requires palpation through the upper trapezius and splenii, in the laminar trough (between the spinous process and transverse process), and attempting to identify fibers with the angle from superomedial (spinous process) to inferolateral (transverse process).

Potentially Sensitive Tissues

• These muscles are posterior to the transverse processes. Providing that the practitioner is relatively accurate with hand placement and responsible for the amount of force applied there are no sensitive tissues to be concerned with.

Trigger Points

• Trigger points occur in the middle of the muscle bellies of these muscles; however, these muscles are small, occur at every segment, and are segmentally innervated. In short, trigger points in the area of the deep cervical flexors can occur at any level within the laminar trough.

Release Technique:

1. Although this technique can be performed with the patient prone or supine, it is likely most comfortable with the patient lying supine and the practitioner sitting at the head of the table.
2. The practitioner slides both hands under the patient's head, flexing the distal interphalangeal (IP) joints of digits two through five.
3. The practitioner allows the weight of the patient's head to press the soft tissue of the cervical spine into the patient's fingertips.
4. The practitioner then adjusts the fingertips so the fingers are in the laminar trough.
5. The practitioner may extend and ipsilaterally rotate the head to add slack to the superficial posterior cervical muscles, making it easier for the fingers to sink deep into these muscles or flex and contra-laterally rotate the head to increase tension in these muscles
6. The practitioner then "strums" the fibers "up and out" (inferomedial to superolateral) looking for taut bands and dense tissue. Because these muscles are so small, there is no need to "search the length of a fiber for dense nodules". Dense areas are likely both taut band and dense nodule in these small structures.
7. The practitioner may move the head to control the amount of tension within the muscle and adjust the force in a superior or inferior direction, to aid in pinning and compressing the nodule and achieving a release.
8. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).