LEVATOR SCAPULAE

toward the right against the firm resistance of your left hand, while you also push back toward the cushion with your neck. At the same time shrug your shoulder, which should not be able to move very much because you are lying on your hand.

• Hold these combined contractions for 5–7 seconds.

Figure 3.7 Head and hand position for MET treatment of suboccipital muscles

8. LEVATOR SCAPULAE

Associated problems

MET positions and methods A. MET(PIR) levator scapulae stretch in lying position

• After 7 seconds or so release all these efforts, breathe fully and slowly in and out and as you breathe out, use your left hand to pull your head a little further to the right (side bending and rotating the neck further), taking it to its new barrier of resistance and increasing the tension in the shortened muscle.

• Then lift your buttock and stretch the right hand toward your feet a little further and then lie on the hand again.

• Hold this stretch for not less than 30 seconds and then repeat the procedure once more before treating the other side in the same way.

• Make sure that no pain is created by your efforts to contract and then stretch the muscle. If pain is caused you are probably trying too hard so ease off and perform the procedure more gently (see Fig. 3.8).

• Sit in front of a table with a pillow between your chest and the edge of the table.

• To treat the right side levator scapula, circle your left arm around the pillow.

• Your right arm should rest on your lap.

• Turn your head to the right, to its fullest comfortable degree, side bend it to the left and rest the left side of your head on the pillow.

• You will feel a slight stretch down the side of your neck toward your shoulder blade.

• Consciously make an effort to ease your shoulder blade downwards, toward your lower back, and hold this for 5–7 seconds. This contracts the antagonists to the levator scapula and produces RI.

• As you release this effort slip the right arm off your lap and let it hang down between your legs and at the same time increase flexion of the neck. Take your neck a little further into rotation to the right, as well as side bending left.

• Hold this position for not less than 30 seconds to stretch the levator scapula.

Repeat and then perform the same sequence on the other side (see Fig. 3.9).

Figure 3.8 MET treatment of levator scapulae on the right B. (MET-RI) levator scapulae stretch in seated position

The trapezius is a flat, triangular muscle covering the back of the neck and shoulders. Its fibers run from the base of the skull to the neck, outer aspect of the collar bone and tip of the shoulder. Its action is to draw the head backwards and to stabilize and lift the shoulder when arm movement is taking place.

Neck and shoulder and arm problems. Trigger points in this muscle can cause pain in the jaw region, face and the side of the head and may be involved in pain and problems in the ears and eyes.

See the following tests in Chapter 2: Functional tests 5, 6; Shortness tests 29, 30

Note: Assessment 30 (Fig. 2.35 in Chapter 2) describes and shows the posi-tions involved in assessment of shortness in upper trapezius, which are identical to those used in its treatment.

• Lie on your back on a bed or the floor, using a thin pillow.

• Grip the edge of the bed or table with the hand on the side you are treating (right side in this example) with your arm at about a 45° angle from your shoulder. If you are on the floor place the hand and wrist under your buttock and lie on it to lock it in position.

• Turn your head fully to the left and side bend it fully to the left (in this example) to engage the posterior fibers of the muscle.

• Note: After completing the stretching of these posterior fibers, as described below, the same procedures should be followed with the head half turned to the left (for middle fibers) and turned slightly to the right (for anterior fibers). Whichever fibers are being treated, side flexion to the left (in this example) should also be introduced.

Figure 3.9 Self-treatment of levator scapulae in seated position

9. TRAPEZIUS (UPPER FIBERS)

Associated problems

MET (PIR) position and method

• With your other hand, reach across the top of your head and pull your head as far to the left as is comfortable.

• When all the slack has been taken out, introduce an isometric contraction by trying to bring the tip of your right shoulder and your right ear toward each other.

• This should be totally resisted by your left hand and the fact that your arm is fixed because you are lying on it.

• After 5–7 seconds inhale slowly and as you release your breath, ease your neck/head into slightly further left side bending and rotation, while at the same time lifting your buttock and taking the hand further toward the feet before lying on it again or stretching further down to grasp the edge of the bed or table (see Fig. 3.10).

• This stretch should be held for not less than 30 seconds before repeating once more and then treating the middle and anterior fibers, before self-treating the other side.

Figure 3.10 Treating fibers of upper trapezius.

A: Posterior. B: Middle.

C: Anterior

These muscles are designed to support and move the shoulder blade from below. They are type 2 (phasic) muscles that become weak when the upper trapezius is overactive. They seldom shorten overall but can house trigger points and in treatment of these stretching is required.

Related to trigger point activity which can refer pain to the mid-back, lower back, shoulder, chest and abdomen.

• Sit at the edge of a chair that has armrests.

• Cross your arms so that each hand rests on the opposite armrest.

• Bend forward so that you round your middle and upper back.

• At the same time tuck your chin to your chest so that you feel a stretch in your middle back.

• Rotate away from the side that you intend to stretch, as far as is comfortable (to the left in this example), to stretch right middle and lower trapezii.

• Bracing yourself in the forward bend and rotation, simultaneously pull on the arms of the chair, as though you were bringing your shoulder blades together, and also twist back an inch (2.5 cm) or so toward the midline and sit upright a little.

• Hold this combined contraction for 5–7 seconds.

• On releasing, go further into forward bending and left rotation and hold this position for not less than 30 seconds.

• Repeat on the other side (see Fig. 3.11).

Associated problems

MET (PIR) position and methods 10. MIDDLE AND LOWER TRAPEZIUS

Figure 3.11 Seated self-treatment of lower and middle trapezii

• In precisely the same seated, slumped and rotated position, introduce a series of mini-pulsations (20 in 10 seconds) toward the direction of rotation.

• After this series relax and ease yourself further into stretch and repeat the process.

Sternocleidomastoid (SCM; commonly called sternomastoid) runs from the