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Massage Therapy for Neck PainSupervised by:DR. dr. Tirza Z. Tamin, SpKFR-K

Presented by:Setia Wati Astri Arifin

Tinjauan Pustaka-1

Good morning all. Thank you for coming. Today Ill present my first literature review about massage therapy for neck pain.1


First I will review about the neck, which including 4

Cervical Vertebral Column

There are 7 cervical vertebral column The 3rd - 6th vertebrae is a typical cervical vertebraeThe 1st, 2nd, and 7th are atypical cervical vertebraeTypical cervical vertebrae hasrectangular bodies with articular uncinate processes on their lateral aspectstriangular vertebral foraminabifid spinous processes and transverse foramen5

Cervical ROMMovementDegree ()TotalAOJAAJC2-C7Flexion6010545Extension80251045Rotation (each side)75-4530Lateral flexion (each side)4551030

Normal movement of cervical area includes flexion, extension, rotation and lateral flexionThe total movement of cervical area is consist of combination movement from AOJ, AAJ, and 2nd to 7th cervical vertebral columns


Cervical Spinal Nerves

There are 8 cervical spinal nerves come out from foramen intervertebralis, despite of 7 cervical vertebral columnsThe 1st cervical spinal nerve comes out from above atlas/C1/1st cervical vertebral columnthe 8th cervical spinal nerve comes out from foramen intervertebralis between C7-T17

Cervical Spinal Nerves

Motoric component cervical spinal nerves innervate variuous muscle according to the levelSensoric component cervical spinal nerves has segmental area of innervation known as dermatomes8

There are two plexus that arise from cervical spinal nerves root9

These are the ligaments in the cervical area10

These are the veins in the neck regionThe important superficial veins are External Jugular Vein that close to the SCM muscle12

Deep Cervical Lymph NodesJugular TrunkRetroauricularNodesSuperficial Cervical Lymph Nodes

The lymphatic vessels from thead, face and neck will drain into the superficial & deep cervical lymph nodesAnd then to the right and left jugular lymphatic trunkThe right jugular lymphatic trunk will drain directly into right venous angleBut the left jugular lymphatic trunk will drain into the left venous angle through the thoracic duct

Arahnya kemana Pijatan Otot origo insersio13

Muscles of The Neck

And now the muscles of the neck divided into 3 parts14

This is platysma muscle 15








MusclesFlexionExtensionLateral FlexionAxial RotationSternocleidomastoideus XXXX (upper)XXXXXX (CL)Scalenus anteriorXX-XXXX (CL)Scalenus mediusX-XXX-Scalenus posterior--XX-Longus colliXX-XX-Longus capitisXX-XX-Rectus capitis anteriorXX (AOJ)-X (AOJ)-Rectus capitis lateralis--XX (AOJ)-Splenius capitis -XXXXXXXX (IL)Splenius cervicis-XXXXXXXX (IL)Rectus capitis posterior mayor-XXX (AOJ & AAJ)XX (AOJ)XX (IL) (AAJ)Rectus capitis posterior minor-XX (AOJ)X (AOJ)-Oblikus capitis inferior-XX (AAJ)-XXX (IL) (AAJ)Oblikus capitis superior-XXX (AOJ)XXX (AOJ)-Keterangan: AOJ : atlanto-oksipital joint AA J : atlanto-aksial joint CL : contralateralIL : ipsilateral

This is the summary The muscle involved 23

Neck pain



Jangan lebih dari 1 slide26



The most common neck pain is non-specific mechanical neck pain caused by muscle strain, ligament sprain, spasm, or a combination No specific lesions, or findingsUsually caused by daily activitiesEtiologyPhilip D. Sloan, Essentials of the family medicine , Chapter 37 Introduction , Wolters Kluwer , 6th edition

(eg, disk bulging or degeneration, osteophytes, spondylolysis, congenital facet abnormalities) 30

PatophysiologyIrritation or inflammation on cervical tissue can produce pain The nociceptive sites on cervical area are:Anterior & Posterior Longitudinal LigamentOuter Annulus Fibrosus DuramaterSpinal Nerve Root Facet Joint Capsule Muscles

Caillet R. Neck and Arm Pain, 3rd ed., Philadelphia: F.A.Davis, 1991.

PatophysiologyTwo major mechanisms of neck pain are trauma and arthritisTrauma:External traumaPostural traumaTension traumaArthritis: Degenerative arthritis Sequelae of acute inflammation arthritis

PatophysiologyExternal Trauma: The neck received external forces that cause abnormal cervical vertebrae position or movement that leading to injury and pain

Jadiin 2 slide33

PatophysiologyPostural Trauma:Wrong posture can cause various trauma to the musculoskeletal system, especially the vertebral column:Forward head postureDropping shoulder

Caillet R. Neck and Arm Pain, 3rd ed., Philadelphia: F.A.Davis, 1991.Image Source:

Postural cause of neck pain is frequently found and leading to disabilityNormal cervical postur is defined by cervical lordosis that maintained to keep the head in line with gravity line, where the head is slightly anterior to the gravity line Upper point of gravity line is on the outer ear cavity


PatophysiologyTension Trauma: Emotional factor hypothalamic limbic system physiologic & neuromuscular system Tension within the neuromuscular system manifest as a sustained isometric muscular contraction No period of relaxation blood flow Ischemic pain lymphatic flow nutrient & O2 metabolic waste, lactic acis

Jadiin 2 slide35

Classification by Onset

Classification by ICD-10

Classification by ICF

Clinical ManifestationPain on neck or pain from neck, with or without radiation to the head, back, shoulder and upper extremityFatigueSleep disturbanceHeadache Pain with movementLimited ROMPalpated trigger pointRadicular pain: Sharp or dull, burning sensation or shocking pain depend on ventral or dorsal nerve root involvementDistributes according to the dermatomal or myotomal areaNeurologic symptoms such as tingling sensation, paresthesia, numb or weakness

in shoulder, arm and hand, with the most frequent site in interscapula area with or without radiation to the occiput, shoulder or arm


1. Trunk or lower extremity neurologic symptoms, especially long-tract signs. 2. Bilateral upper extremity pain. 3. Remote symptoms with neck movements (lower extremity). 4. Signs of sphincter dysfunction, bowel or bladder dysfunction or incontinence. 5. Fever, unrelenting nocturnal pain, weight loss, chronic fatigue. 6. Recent infection or surgery. 7. Polyarthralgia. 8. Dysphagia. 9. Nuchal flexion or extension rigidity, especially in the absence of trauma. 10. Cranial neurologic deficit or central nervous system symptoms. 11. Cervical pain related to general exertion (i.e., after climbing stairs). 12. Symptoms unchanged or progressive, despite previous functional management. 13. Onset of cervical pain associated with direct head trauma, loss of consciousness. 14. Sudden onset of cervical pain without trauma or incident. 15. Neck or occipital pain with a sharp quality and severe intensity, or severe and persistent headache, which is sudden and unlike any previously experienced pain or headachePrecautions Symptoms that Should Raise Suspicion That The Presenting Cervical Pain Is Not Of Mechanical Origin (McMillin)

Flynn TW, Cleland JA, Whitman JM. Users Guide to the Musculoskeletal Examination: Fundamentals for the Evidence Based Clinician. Evidence in Motion. 2008.

The Scientic Evidence Strongly Supports the Use of: Screening protocols in emergency care in low risk patient with blunt trauma to the neckCT-scanning in emergency care for high-risk patients with blunt trauma to the neckFor non-emergency neck pain:Manual provocation tests in patients with neck pain and suspected radiculopathyThe combination of history, physical examination, modern imaging techniques, and needle EMG to diagnose the cause and site of cervical radiculopathySelf-reported patient assessment to evaluate perceived pain, function, disability, and psychosocial statusNordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, et al. Assessment of Neck Pain and Its Associated Disorders. Eur Spine J. 2008 Feb 29;17(1):10122.

fleksibilitas spina servikal, re-edukasi postur dan penguatanpartisipasi aktif pasien44

Neck Exercise

This is the neck exercise, which include 45

Isometric Neck Exercise

EvaluationPhysical Examination:Palpation of trigger point & tendernessCervical Range of Movement (CROM)Manual Muscle Testing (MMT)Pain Perception:Visual Analog Scale (VAS)Functional Assessment:Neck Disability Index (NDI)46,47

Cervical ROM Examination

Image Source:

Image Source: annals.orgImage Source:

The VAS is best at detecting change in patients who improve in pain. 49

Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manip Physiol Ther 1991; 14:407-415.

The NDI, a neck-specic functional status questionnaire, 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation.the NDI has proofed to be a valid tool for functional assessment of neck disability. & the most commonly used self-report measurefor neck painThe NDI can be used to evaluate the patients status at present and to evaluate the evolution during the therapy50


Therapeutic Massage therapy

Massage TherapyMassage Therapy a group of procedures, which are usually done with the hands, and include friction, kneading,