Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch15 p.1 TK INSTRUCTOR MANUAL: CHAPTER 15 The Head and Neck Chapter manuals include: Objectives Lecture Notes Suggested Classroom and Student Development Activities For other chapter-by-chapter resources, see: Key Term Quizzes Muscle Origin and Insertion Worksheets Muscle OIAs List by Chapter MyTest Test Bank For additional resources see “Teaching Tips and Tools”: 7 research-based learning principles for kinesiology courses in massage 5-step self-directed learning cycle for body mechanics courses Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories OBJECTIVES List eight cranial bones and 14 facial bones and describe the location of each one. Name and describe three cartilaginous structures of the head and neck. Describe the structure and function of the hyoid bone. Demonstrate palpation of cranial and facial bones and miscellaneous structures of the neck. List four cranial sutures, describe their locations, and demonstrate palpation of each one. Describe the structure of the temporomandibular joint (TMJ) and its range of motion. Describe the atlantoaxial and atlanto-occipital joints and their range of motion. Identify the origins, insertions, and actions of the muscles of the head and neck. Demonstrate the active movement and palpation of each muscle of the head and neck. Identify the trigger points and pain referral patterns of the muscles of the head and neck. Discuss the role of the facial muscles in emotional expression and describe each one. LECTURE NOTES BONES OF THE HEAD AND NECK Introduction Contains brain and major sensory organs Houses equilibrium structures, orients body in space Central location for structures coordinating movement Eight cranial bones Frontal Occiput Sphenoid Ethmoid Temporals (paired bones) Parietals (paired bones) Fourteen facial bones Maxillas (paired bones) Vomer Mandible Nasals (paired bones) Lacrimals (paired bones) Palatines (paired bones) Inferior nasal conchae (paired bones) Zygomatic (paired bones) Miscellaneous structures of the head and neck Thyroid cartilage Cricoid cartilage Trachea Thyroid gland Hyoid bone JOINTS OF THE HEAD AND NECK Overview: Four major joints in head and neck juncture Cranial sutures Temporomandibular joint (TMJ) Atlanto-occipital joints Atlantoaxial joint Cranial sutures Fibrous joints, manipulated in cranial-sacral therapy Subtle motion in sutures is controversial belief Coronal suture: Between parietal/frontal bones Sagittal suture: Between parietal bones Lamboid suture: Between occiput and parietal bones Squamous suture: Between temporal and parietal bones Temporomandibular joint (TMJ) Between mandibular condyle and glenoid fossa of temporals Complex compound condyloid joint Sometimes classified as ball-and-socket Joint has two compartments Upper part of joint moves with gliding motion Lower part of the joint moves with hinge-like motion Endures wear and tear of continual use Lacks hyaline cartilage Fibrous connective tissue over joint surfaces CT allows continual remodeling Temporomandibular disk Articulating disk pads joint Disk slides forward while opening Disk slides back while closing Temporomandibular joint motion Six movements of TMJ Lateral excursion (lateral deviation): Jutting to the right and left Protrusion (protraction): Jutting forward Retrusion (retraction): Pulling back Elevation: Closing Depression: Opening TMJ development First joint to develop before birth Mouthing patterns create baseline for bilaterality Mouthing initiates handmouth, handeye coordinations Speech and vocal production Temporomandibular dysfunction (TMD) TMD includes a range of musculoskeletal dysfunctions Premature wear to disk or articulating surfaces Muscular imbalances that misalign jaw Head and jaw traumas from falls and impact injuries Bruxism (grinding teeth) Emotional holding patterns Atlanto-occipital (AO) joint Between base of occiput and atlas (C-1) Two ellipsoid synovial joints (one on each side) Primary action is flexion /extension: Nodding Minimal rotation and lateral flexion Atlantoaxial (AA) joint Combination of atlas (C-1), axis (C-2), and occiput Pivot joint complex that consists of two parts: Medial part: Dens process and two small synovial cavities Lateral part: Two facet joints with horizontal surfaces Generates 80% of axial rotation in cervical spine 15 degrees of flexion and extension Range of neck motion Rotation 5080 degrees to each side Occurs primarily at atlantoaxial joint Flexion 4060 degrees. Occurs primarily at atlanto-occipital joint Hyperextension 4075 degrees Occurs in every segment of cervical spine MUSCLES OF THE HEAD AND NECK Overview Muscles covering the scalp Muscles of the TMJ Muscles of facial expression Muscles attached to the hyoid bone Posterior suboccipital muscles Anterior and prevertebral neck muscles Muscles covering the scalp Frontalis: Relaxation produces alpha brain waves O: Supraorbital margin of frontal bone I: Superior aspect of galea aponeurotica A: Elevates eyebrows, furrows brow Occipitalis O: Galea aponeurotica over superior area of occipital bone I: Inferior aspect of galea aponeurotica and superior nuchal line A: Anchors galea aponeurotica against frontalis contraction Temporalis: Thick meaty muscle above ear O: Temporal fossa and temporal fascia I: Coronoid process of mandible A: Elevates and protracts mandible, maintains neutral position of jaws Muscles of the TMJ Masseter: Powerful, thick, square muscle O: Medial and inferior surfaces of zygomatic arch of maxilla I: Coronoid process, angle and ramus of mandible A: Bilaterally elevates the mandible, unilaterally deviates lower jaw to that side Lateral pterygoid O: Superior head – Greater wing of the sphenoid Inferior head – Lateral pterygoid plate of the sphenoid I: Internal surface of mandibular condyle, temporomandibular joint capsule A: Depresses and protrudes lower jaw, unilaterally deviates lower jaw to that side Medial pterygoid O: Lateral pterygoid plate of sphenoid, maxilla, and palatine bones I: Internal posterior inferior surface of ramus and angle of mandible A: Elevates and protrudes lower jaw, unilaterally deviates lower jaw to that side Muscles of facial expression Serve an important role in human relationships Allow us to read emotional states of others Thin, flat muscles attach to superficial and other muscles Around eyes and mouth: Orbicularis oris and orbicularis oculi On forehead: Frontalis, procerus, corrugator Below lips: Mentalis, depressor labii inferior, depressor anguli oris Above lips: Depressor septi, nasalis, levator labii superioris, levator anguli oris In cheeks: Buccinator, zygomatic major, zygomatic minor, risorius Hyoid muscles Suprahyoid muscle group: Form floor of mouth and chin, elevate hyoid Digastric Geniohyoid Mylohyoid Stylohyoid Infrahyoid muscle group: Depress hyoid bone Omohyoid Sternohyoid Thyrohyoid Digastric O: Posterior belly – Mastoid process Anterior belly – Internal inferior mandible I: Ligamentous sling on superior rim of hyoid A: Bilateral action elevates and stabilizes hyoid during swallowing and speaking, posterior belly depresses mandible Geniohyoid O: Inner surface of mandible I: Anterior surface of hyoid bone A: Elevates hyoid bone Mylohyoid O: Inner surface of mandible I: Middle part of anterior hyoid bone A: Elevates hyoid bone Omohyoid O: Inferior rim of hyoid I: Ligamentous sling on medial clavicle, lateral side of superior, anterior scapular border A: Depresses hyoid, assists cervical rotation with side-bending Stylohyoid O: Styloid process of temporal bone I: Hyoid bone A: Elevates and retracts hyoid when lifting tongue and swallowing Sternohyoid O: Inferior rim of hyoid I: Top of manubrium A: Depresses and stabilizes hyoid, protects organs along anterior neck N: Ansa cervicalis Thyrohyoid O: Along thyroid cartilage I: Inferior rim of hyoid A: Depresses and stabilizes hyoid, protects organs along anterior neck Posterior suboccipitals Important stabilizers, prevent neck flexion Constantly active during subtle head movements Susceptible to tension from postural strain Overactive and short with forward head posture Develop painful TrPs and headaches if tight/asymmetrical Rectus capitis posterior major O: Spinous process of axis (C-2) I: Lateral part of inferior nuchal line of occipital bone A: Bilaterally extends head, unilaterally assists rotation of head to same side Rectus capitis posterior minor O: Posterior tubercle of atlas (C-1) I: Medial part of inferior nuchal line of occipital bone A: Bilaterally extends head, unilaterally assists rotation of head to same side Oblique capitis inferior O: Spinous process and upper lamina of axis (C-2) I: Transverse process of atlas (C-1) A: Rotates head to same side Oblique capitis superior O: Transverse process of atlas (C-1) I: Occipital bone between nuchal lines A: Extends head, assists rotation to same side Sternocleidomastoid (SCM) Divides neck into anterior and posterior triangle O: Clavicular head – Medial third of superior border of clavicle Sternal head – Lateral side of sternal notch of manubrium I: Mastoid process and lateral half of superior nuchal line A: Bilaterally flexes the neck, unilaterally side-bends the neck to same side, rotates the neck to opposite side SCM dysfunction can cause dizziness, loss of balance Unilateral contraction rotates head in opposite direction Often adaptively shortened from forward head posture Unilateral tension causes torticollis Prevertebral neck muscles Stabilizers of anterior cervical spine, assist flexion Longus capitis O: Anterior tubercles of transverse processes of C-3 to C-6 I: Occipital bone anterior to foramen magnum A: Bilaterally assists head flexion, unilaterally assists side-flexion of head Longus colli O: Superior section ? Anterior arch of C-1 (atlas) Medial section ? Vertebral bodies of C-3 to T-3 Inferior section ? Transverse processes of C-5 to C-6 I: Superior section ?Anterior tubercles of transverse processes of C-3 to C-6 Inferior section ? Vertebral bodies of T-1 to T-3 A: Assists cervical flexion, cervical stabilization Anterior suboccipitals are difficult to palpate Assist upper cervical flexion, restrict hyperextension Rectus capitis anterior Rectus capitis lateralis SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES PROVIDE AN OVERVIEW OF THE CLASS Before class, write a short schematic overview of the class on the board, then go over it at the beginning of class. For example: Today's class covers: Bones of the head and neck Joints and ligaments Muscles of the head and neck Activities: Review, lecture and assessments, palpation exercises, recap STRUCTURAL OBSERVATION EXERCISE: The head, neck, and spine Have three student volunteers stand next to each other so that the other students can observe their movement. Have the volunteers all turn a quarter turn to the right, so that the class is looking at a side view. Use the following prompts and questions to study the head and neck alignment and movement: Is the head centered over the thorax and pelvis? If not, in which direction is it displaced? What is the position of the spine under the head? What is the overall pattern of the spine: lifted, collapsed, or stable and centered? When the spine is collapsed, the curves increase; when lifted, the curves tend to flatten or arch. It is important to look at the position of the spine when studying headneck patterns because if the spine is off-center, it will be impossible to get the head centered over the body. Is the pelvic bowl level or tipped? If tipped, in which direction does it tip, anteriorly or posteriorly? Is the occiput level with the upper palate? If not, in which direction does the cranium tip? MOVEMENT OBSERVATION EXERCISE: The head, neck, and spine Flexion and extension: With the volunteer still standing sideways, have them nod their heads, rocking in a yes motion. Notice where the axis of motion is in the neck. At what vertebral level does the flexion and extension of the neck occur? Does the head rock directly on top of the neck? Or does the head look like its falling behind the body? It does when the axis of motion is in the mid- or lower cervical segments. In this pattern, the neck bends in the middle like a hinge. Flexion and extension should occur at the atlanto-occipital (AO) joints. The axis of movement can be approximated between the transverse processes of C-1, in the hollow spot behind the ears (see Figure 15.66c). NM patterning of the head and neck The trick in NM patterning for the neck is to isolate movement in the upper cervical unit while maximizing support and stability in the lower cervical unit (see exercise Neuromuscular patterning to engage the neck stabilizers, p. 541). If the head is falling behind the body, encourage the volunteers to find the axis of lift and motion at the AO joints. To help them engage the intrinsic support, use these prompts: "Lift your occiput without dropping your chin. Then slowly nod your head at the uppermost part of your neck. Keep the middle and lower part of your neck stable." EXPLORING TECHNIQUE EXERCISES Passive range of motion for the neck (p. 511) Tracing the facial muscles (p. 528) PALPATION EXERCISES Cranial bones and bony landmarks (p. 492) Facial bones and bony landmarks (p. 496) Ears, nose, hyoid, and throat structures (p. 499) Cranial sutures (p. 502) Temporomandibular joint structures and motion (p. 507) Frontalis, occipitalis, and temporalis (p. 515) Masseter, lateral pterygoid, and medial pterygoid (p. 520) Suprahyoids and infrahyoid muscles (p. 532) Suboccipitals (p. 535) The sternocleidomastoid (p. 539) SELF-CARE EXERCISES Temporomandibular patterning and stretching (p. 508) Stretching the neck (p. 512) Neuromuscular patterning to engage the neck stabilizers (p. 541) © 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology