By Wayne Oliver and Lee Jarvis. Contributions from Callan Sinclair. Proofreading and editing by Tiffany Best.
The following is based on an interview conducted with Wayne Oliver M.OMSc in March of 2024 which was then transcribed by Lee Jarvis.
When working in your office and seeing many patients daily, it is not uncommon to fall into habits of your own creation. Certainly, for every practitioner there are methods that work better than others that make our work easier to perform. Even your own body proportions and mechanics will favour ways of working that are perfectly fine to utilize regularly. We all eventually develop tools for parts of the body that we prefer to use and there’s nothing inherently wrong with that. However, it can be that constant use of the same methods in Osteopathic practice lets the practitioner fallback on methods that work “most” of the time. This has a secondary effect in which the practitioner then doesn’t need to think about findings and process as they are performing methods that are likely to work. This is a potential problem for the future, as a practitioner that has removed themself from their work is no longer learning and possibly missing important data. This may necessitate a change in how they are performing their assessment, structural diagnosis, and treatment processes.
Whenever we can take a step outside our normal process, we tend to learn more about how the body works and how we understand our practice. Exercises like the one described in this article will take the practitioner out of their comfort zone but it is often here that both the practitioner and patient benefit when work is put into performing the exercise. The process described below works with any appendage however the neck is an ideal region as it is highly supported by muscles and thus its reaction in the form of movement capacity can be easily seen. We will describe this exercise around the assessment and treatment of the neck, though please understand that the region can be switched out for another, with similar results as long as you are willing to assess the region accurately.
Begin this exercise with a thorough assessment of the neck. This is inclusive of fascia pliability, general position, and the movement capacity from the large to the small. For the purpose of this article and exercise you would find the neck to move poorly and potentially be painful as well. (Of course, in real practice if you were to find the neck moving well and feeling good in all ranges, this is great for the patient however, it is the wrong patient for this exercise as there will be minimally noticeable results). For illustration purposes in this article, let’s also say there is reduced capacity of the neck to side bend/limited motion in the Coronal (aka Frontal) Plane. The fascias on the side(s) of the neck are short, rigid, and are what is holding/preventing the neck from side bending through a full range.
The real trick and difficulty in performing this exercise is to now ignore the neck, the neck that you want to help, the neck that the patient is asking you quite specifically to help them with. In this situation it is a habit to want to make the patient feel heard and attended to by working on mobilizing the neck for at least a short time once it has been found. Any practitioner should want to do things that help their patient(s) feel better (arguably this should be a large component of what motivates in doing any of our work). In jumping to this treatment of the neck we may be missing a learning opportunity that benefits the patient and the practitioner.
In the next step of this exercise, we will assess and treat everything else in the body other than the neck. At the end of the treatment you will re-assess the neck to see what (if any) changes have occurred. The goal is to completely “de-load” the neck first, remove anything in the body that might be contributing to the neck’s reduced movement whatever the relationship. In doing so you should better support and understand that relationship as you go. As you work through the rest the body make note of any other areas and attempt to see connections.
Here are a few simple examples to help illustrate these connections:
Starting with an area very close to the neck; A restriction of the scapula in the coronal plane. The Scapula glides on the Ribcage through the coronal plane mainly with some elements of transverse plane motion, in the action of protraction and retraction. The Scapula is brought downward (what is called “Scapular depression”) by the lower portion of the Trapezius muscle. The upper portion of the Trapezius, along with the Levator Scapulae, attach superiorly into the cervical spine region. In a neutral position of the head, a favouring or held depression of the scapula would require the neck to create contraction of the lateral flexors in order to maintain a level head. In this scenario the neck position is a resultant of the Scapula’s tendency of motion and no movement of the neck is likely to result in a lasting change of the necks capacity to move through a full range in the coronal plane.
Moving inferiorly, the 12 vertebrae of the thoracic spine are inferior to the 7 cervical vertebrae and serve as direct attachment points for the spinal muscles that cross and create movement in both regions. If the lower thoracic vertebrae are being held in a side bending position and are therefore restricted in motion in the coronal plane, a person may be forced to lean towards the restricted side unless other locations can compensate for this abnormality. As in our previous example, because bending to the side is a movement, fixing multiple components, this person would also be forced to use some side benders more than others, the cervical spine being one of those potentials. Their cervical spine may need to side bend towards the opposite side of the thoracic spine in order to keep the person’s posture as straight as possible or to maintain normal range of motion.
Though, further away we could even take this movement contributing relationship into the leg region. As we bend to the side some of that coronal plane motion may be occurring at the hip joint. In this case, the pelvis drifts to the opposite side of the bend, normally with the legs staying in place. Though technically this is pelvis on femur motion, we could call this abduction of the hip with all bones being relative. Were the person less capable of abducting their hip, this would also mean that overall side bending is limited and again compensation strategies of the body have to be enacted.
Returning to our real patient, once the body has been assessed and thoroughly treated, making real changes wherever possible, re-assess the neck to see if there’s a difference. Make note of any original findings that didn’t change and see if they correspond to what was found in the body.
In review of what has occurred and to help guide your learning, you can then ask yourself the following questions:
Was the type of tissue rigidity seen in the neck similar to the related parts in the body below?
Was the amount of motion loss in the neck comparable to other areas of lowered mobility?
Were the same or different planes of motion affected?
If the neck did not change, does the lack of change at the neck reflect the lack of change in the primary areas viewed elsewhere in the body?
If the neck did change, was it comparable to the changes perceived to have occurred in the rest of the body?
When there is a significant and beneficial change in the neck often no other work needs to be done, the treatment can end and the patient can be on their way.
As previously stated, the value in this practice is the potential for reduced effort by the practitioner along with better understanding of body integration. Whenever we can change the way a part of the body works for the better without directly interacting with it, we now have a new way of achieving the same goal. In particular, this may benefit us when we cannot directly touch the restricted or painful structure that requires relief. For instance, the neck also had an incision that was just recently stitched but has a great deal of muscular tension as well. Also, and this is likely the most important aspect of this practice, we can determine when the restriction and pain in the neck is not actually caused by the neck itself, demonstrating the importance of a whole-body approach whenever possible.