April 2006

Visceral dysfunction and the head and neck

by Dr. Howard Loomis

In my last few columns, I've been explaining a five‑minute source of stress examination. While this exam takes only a brief amount of time, it will yield many answers for locating hidden causes of pain. This month I continue with the head and neck.

Many problems found in the head and neck can be traced to systemic inflammatory problems related to dietary abuse and digestive inadequacy. What is often not appreciated by many clinicians is that structural problems found anywhere in the body can be traced to diet, digestion, and absorption of either carbohydrates or a combination of protein and lipids.

An important part of any examination should be to palpate the face and neck for painful stress points. Pain found in these areas can be characterized and used in differential diagnosis. For example, stress points on the ulnar surface of the arm can be traced from the head and neck to the mid‑supraclavicular space and shoulder (last month's column), then down the arm to the elbow, wrist, and onto the thumb and index finger. Stress points on the radial surface of the arm can be traced from the sternum laterally to the mid‑axillary line of the rib cage, up to the shoulder, down to the head of the radius, onto the wrist and middle, ring, and little fingers.

Painful areas can be classified as acute or chronic, based on the symptomatology and reaction of the patient. For example, acute symptoms are characterized by pain on light pressure and include spasms, contractions, and edema as well as signs of inflammation, such as heat, redness, and swelling. Chronic signs manifest as dull pain on deep palpatory pressure.

Spinal palpation

Palpate the muscles of the spine at the level of the fifth cervical to the third thoracic vertebrae. Press from lateral to medial into the musculature. Recall that the seventh cervical is very seldom misaligned, and it is often unwise to attempt adjustments to that vertebra. Most of the time reflexes involving this vertebra can be relieved at the temporomandibular joint.

No attempt will be made here to delineate all the problems associated with the temporomandibular joint, other than to say that the problem is often caused by misalignment of the teeth, and this cause should be ruled out before proceeding. Once that is ruled out, search the cervical spine for the cause. Subluxations of the Atlas often crowd the temporomandibular joint, causing it to misalign.

To examine the masseter itself, have the patient relax the jaws so the teeth do not touch. Palpate by pressing backward on the leading edge of the muscle. Stress points found in the masseter muscle may be associated with inadequate protein metabolism and calcium deficiency (Chvostek's sign).

The lower cervical dermatomes overlap, and similarity exists between the tissues supplied by the fifth, sixth and seventh pair of cervical nerves. In cases where problems exist in the bronchi, tenderness may be found superior to the seventh cervical vertebra and traced around the neck to the episternal notch.

Stress points found in the posterior cervical spine most often involve the upper thoracic vertebrae and posterior ribs. The sympathetic nerve supply to the head and neck originates from T1 to T3 and runs through the three cervical ganglia to the eyes, sinuses, salivary glands, and thyroid.

Stress points involving the fifth, sixth and seventh cervical vertebrae and the anterior cervical musculature most often affect the shoulders, arms, forearms, and hand. Great care must be taken in palpating and treating these areas because of the carotid artery.

Press into the triangular space above the clavicle with your thumb and move onto the carotid tubercle on the anterior portion of the sixth cervical transverse process. The tubercle is usually large and prominent. Palpate all the anterior cervical transverse processes.

Move onto the sternocleidomastoid at the tip of the mastoid process. This muscle descends down over the neck to attach to both the sternum (breastbone) and the clavicle (collarbone). Check out the two lower attachments on the sternum and clavicle. Stress points here have enormous significance in such problems as dizziness and referred pain from the ears, eyes, and teeth.

It is a good idea to start near the base of the skull and, using all four fingers, move down just behind the sternocleidomastoid at half‑inch intervals, pressing toward the muscle and then away. Most people have tenderness here, especially those who have had a whiplash injury. Behind the sternocleidomastoid are several vulnerable muscles often involved in shoulder tension, as is the Levator scapulae. The three scalene have similar properties.

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment or ask a question, write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit www.loomisinstitute.com online or call 800‑662‑2630 for information on upcoming Loomis Institute seminars.)