The following article is based on an interview with Marc Tellez M.OMSc in December of 2023. What follows are the words and explanations of Marc, transcribed and interpreted by Lee Jarvis.
The neck region is a commonly complained about area by many patients of Osteopathic Manual Therapists. The transition between the Cervical and the Thoracic Spine (henceforth “CT junction”) has a significant relation to the position and mobility (or immobility) of the neck, and is well worth the time to explore different positions and movement applications. It is typical for practitioners to work on the CT junction in the supine position as it easily lends itself to utilizing the weight (and therefore the leverage) of the head to generate movement and/or myofascial release. It is also worth considering that lying on one’s back is often a more comfortable and relaxing position for the patient. There is nothing wrong with working on the CT junction in the supine position, however, a different position often allows for learning opportunities as well as positional advantages for specific applications of treatment. Another way of saying this is that the setup of your patient grants access to different leverage, anatomy, and treatment options that are not as readily available in other positions.
The prone position has the capacity for allowing easy lean-on pressure by the practitioner and as such can be very powerful when applied properly. With the practitioner at the head of the table we can set our hands over the CT junction with straight arms. The relatively straightened arms (extended elbows) allow us to lean into the patient by relaxing our back muscles and bending at the hips. When executed properly there is a transfer of force/weight from the upper body to the CT junction without any loss of pressure or excess muscular effort from bent elbows. An experienced practitioner is well aware that an overuse of muscular effort is quite costly in the long term and should be replaced with a smart application of leverage whenever possible.
Assessment and diagnosis of structural findings (which all treatments should begin with) will determine what treatment needs to be rendered. The need for direct, indirect, or balanced methods and the angle at which these will be applied dictates hand position and vectors of force in this and any other technical applications. This also means that even before we place our hands on the CT junction and lean into the application we should consider the position and rotation of the patient’s head and neck. Since rotation and side bending are coupled motions in the spine, this patient setup can be integrated into the treatment to either further exaggerate or challenge this position directly.
Once you and the patient are effectively set up you will find it is easy to “close” the facet joints by pressing directly upon them. The term “close” here means to bring the two surfaces of the joint closer together, what might be called rotation or extension when taken as a whole. On a tissue level when this “closing of facet joints” is done we are typically reducing the length of fascial tissues around the joint leading to a reduction in the tissue tonus. Simply by determining extension or rotation and adding lean-on pressure, so as to further exaggerate the existing position, we can bring smaller or larger areas around the joint into an indirect treatment position. This same concept also works well when applying direct inhibition such as with acute muscle irritation. This position can easily be used to put a gentle sustained pressure on a myofascial region that is actively contracting.
The position also useful for the chronically rigid tissue through sustained pressure to the area to generate myofascial release. As always, we are likely (and wiser) to do this direct work after one or more of the previous indirect or inhibitory methods have been employed to reduce active tissue resistance. Once we can be sure the neural component of the dysfunction has been reduced then we can use this position to create de-rotation of a curvature or vertebrae. The hand(s) can be placed on the same side as rotation and the pressure is applied again with a lean. When properly paired with positioning of the head and neck we often see a positional change that is significant and lasting.
There are of course other areas and options that work in the same position but hopefully this will help to stimulate learning and understanding, and inspire new approaches to practice.