The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
TREATMENT OF THE NECK
Treatment of the neck, as of other parts is, in
its specific application, always removal of lesion. The following
general description of methods of work in treating the neck is for the
purpose of laying before the student in a simple manner the general principles
involved in our work. Later specific application of these general
principles and methods will be made.
I. With the patient upon his back, the
guiding hand is laid upon his forehead and the head is rolled gently from
side to side a few times to aid in relaxing the muscles. The fingers of
the operating hand are laid, palm down, upon the muscles of the throat
on the side opposite to the practitioner. As the head is moved away
from the practitioner, these muscles are loosened through the shortening
of that side of the neck. At the same times the operating hand draws
these muscles toward the median plane of the neck. The head may be
now moved from side to side, while the fingers upon one side of the throat
and the thumb upon the other manipulate the tissues. All the tissues
of the anterior aspect of the throat may be included in this treatment,
contracture and tension at any given point being thus removed. The
treatments must be gentle in order that sensitive necks may not be irritated.
The operating hand must not be rubbed over the tissues,
but they must be moved by the motion of the hand.
Holding or pressing gently but continuously against
a contracture, while the head is being slowly moved about, will relieve
the tension and remove the lesion.
II. The ligaments of the temporo-maxillary
articulations, and the muscles and blood-vessels below the inferior maxillary
bone may be relieved of tension, and be restored to free action, by springing
the mouth open against resistance;
The patient lies upon his back and the practitioner
stands at the head of the table, placing the palms of his thumbs upon the
malar prominences, and the palms of the fingers beneath the jaw.
The patient is now directed to open the month widely and then to gradually
close it. Resistance is made by the operating hands to the first
motion, and the fingers press the superior hyoid muscles downward and forward
toward the median plane of the neck during the second motion.
The ligaments of the temporo-maxillary articulations
may be sprung by thrusting a finger deeply into each glenoid fossa after
the patient has opened his mouth, holding them there while the mouth is
shut. It is necessary to avoid hard pressure here.
III. The hyoid bone may be held between
the thumb and finger and be moved vertically and laterally, stretching
the hyoid muscles.
IV. Pressure may be in some measure
applied to the pneumogastric, glosso-pharyngeal and spinal-accessory nerves
by deeply pressing the finger upward and inward behind the angle of the
jaw, in the direction of the jugular foramen.
The pneumogastric nerve may be manipulated by deep
pressure behind the anterior border of the sterno-mastoid muscle.
These three nerves are also influenced by manipulation
on their closely related nerves, the sub-occipital, great occipital, small
occipital, and great auricular, reached in the sub-occipital fossae as
V. Pressure upon the phrenic nerve may
be applied at the points described in Chapter III.
VI. The sterno-mastoid muscle may be
manipulated, following the method described for treatment of muscles of
the throat under I of this chapter.
The muscle upon one side may be stretched by turning
the head toward that side and slightly upward, thus increasing the distance
between the mastoid process and the sterno-clavicular origin of the muscle.
VII. The lateral and posterior muscles
of the neck may all be treated in a manner similar to that described under
I of this chapter.
The practitioner may also stand at the head of the
table, and with the palms of the hands upon each side and the back of the
neck, gently grasp handsfull of the muscles, manipulating them thoroughly
while slowly moving the head in all directions. Pressure and manipulation,
together with motion, all gently and patiently applied, will relax the
most obstinate contracture, loosen all deep fibrous structures, free blood-vessels
and nerves, and prepare the way for what is usually the real object of
the treatment, the reduction of bony lesions.
VIII. With the patient supine, the
head is pushed as far as may, be easily done without resistance, first
to one side and then to the other, and it is noticed whether it turns as
far to one side as to the opposite side. Inequality between the two
sides indicates lesion usually upon the side toward which the head turns
After relaxation of the tissues, turning the head
to its limit toward each side will sometimes aid in the reduction of bony
lesion, especially with the aid of pressure applied to force the part into
IX. (1) In lesion of the atlas the patient
lies supine and the practitioner, standing at the head of the table, holds
the head between the hands, with a thumb or finger upon each transverse
process. The head is now moved in a direction to exaggerate the lesion,
and with traction, rotation, and pressure upon the processes, the atlas
is forced toward its position.
(2) The operator may stand at the side of the head,
one hand upon the forehead and the other pressed firmly just below the
skull, in the region of the lateral arch of the atlas, on the opposite
side. Exaggeration of the lesion, rotation, and strong pressure aid
in replacing the part.
(3) The patient sits and the practitioner, standing
in front, places one knee beneath the chin, while the hands grasp the sides
and back of the head, and the fingers are firmly pressed upon the lateral
arch of the atlas upon each side. Exaggeration of the lesion, traction,
pressure, and rotation are now applied as before. The chin is slightly
raised and drawn forward by motion of the knee beneath it.
The head is rocked upon the atlas gently, the requisite pressure being,
made upon the lateral arches to press the bone back to its position.
(4) The patient sits and an arm is passed about
his head, the bend of the elbow coming beneath the occipital protuberance
and the hand beneath the chin. The head is now forcibly raised with
the idea of moving it upon the spine in the desired direction, while the
free hand makes pressure upon the spine or neck in the direction necessary
to aid in reposition.
(5) Dr. Still uses the following movement in setting
the atlas. He stands in front of the patient, who is sitting, and
clasps his hands behind the neck, just below the skull, pressing the pisiform
bones firmly against the lateral arches of the atlas.
Now the proper movement is made to rotate the head
to the affected side, "sinking" it down upon the spine, and to press the
atlas into place.
(6) With the patient lying upon his back, the practitioner
stands at the head of the table, holds the head between his hands, presses
his fingers against the lateral arches of the atlas, while the head is
slightly raised from the table and supported by pressure from his own body,
pressing it down upon the spine. Now the proper movement is made
to exaggerate the defect, rotate the head, and press the atlas into place.
These various treatments may be applied to any of
the usual lesions of the atlas. The same principles may be applied
to the different malpositions of any of the cervical vertebrae. Generally
patience and time are necessary to the gradual restoration of the bones
to place. Much attention must be given to the thorough and gradual
loosening of all parts in preparation for replacement.
X. The axis is generally displaced laterally.
The tissues upon its transverse and articular processes are quite tender
and contractures are found in the muscles about it. Exaggeration
of lesion, rotation and pressure usually restore it to place.
XI. The scaleni muscles may be stretched
by pressing the head down toward the side in question, pressing the fingers
behind the clavicle upon the first rib to force and hold it down, while
the head is now drawn to the opposite side.
XII. Thorough loosening of all cervical
tissues may be accomplished by a somewhat "spiral" treatment. The
patient lies on his back, the guiding hand is placed upon the forehead,
and the other hand is slipped beneath the neck and grasps it. The
head and neck are now raised slightly, the head being rotated in one direction,
while, as far as possible, exactly the opposite motion is given the neck.
The hand travels up and down the neck treating its different portions alike.
XIII. Flexing the head strongly upon the thorax
stretches the ligamentum nuchae and posterior tissues of the neck.