The Practice and Applied Therapeutics of Osteopathy Charles Hazzard, D. O. 1905      CHAPTER IV   TREATMENT  OF THE NECK  
 
    Treatment of the neck, as of other parts is, in its specific application, always removal of lesion.  The following general description of methods of work in treating the neck is for the purpose of laying before the student in a simple manner the general principles involved in our work.  Later specific application of these general principles and methods will be made.
  I.  With the patient upon his back, the guiding hand is laid upon his forehead and the head is rolled gently from side to side a few times to aid in relaxing the muscles. The fingers of the operating hand are laid, palm down, upon the muscles of the throat on the side opposite to the practitioner.  As the head is moved away from the practitioner, these muscles are loosened through the shortening of that side of the neck.  At the same times the operating hand draws these muscles toward the median plane of the neck.  The head may be now moved from side to side, while the fingers upon one side of the throat and the thumb upon the other manipulate the tissues.  All the tissues of the anterior aspect of the throat may be included in this treatment, contracture and tension at any given point being thus removed.  The treatments must be gentle in order that sensitive necks may not be irritated.
    The operating hand must not be rubbed over the tissues, but they must be moved by the motion of the hand.
    Holding or pressing gently but continuously against a contracture, while the head is being slowly moved about, will relieve the tension and remove the lesion.
 II.  The ligaments of the temporo-maxillary articulations, and the muscles and blood-vessels below the inferior maxillary bone may be relieved of tension, and be restored to free action, by springing the mouth open against resistance;
    The patient lies upon his back and the practitioner stands at the head of the table, placing the palms of his thumbs upon the malar prominences, and the palms of the fingers beneath the jaw.  The patient is now directed to open the month widely and then to gradually close it.  Resistance is made by the operating hands to the first motion, and the fingers press the superior hyoid muscles downward and forward toward the median plane of the neck during the second motion.
    The ligaments of the temporo-maxillary articulations may be sprung by thrusting a finger deeply into each glenoid fossa after the patient has opened his mouth, holding them there while the mouth is shut.  It is necessary to avoid hard pressure here.
 III.  The hyoid bone may be held between the thumb and finger and be moved vertically and laterally, stretching the hyoid muscles.
  IV.  Pressure may be in some measure applied to the pneumogastric, glosso-pharyngeal and spinal-accessory nerves by deeply pressing the finger upward and inward behind the angle of the jaw, in the direction of the jugular foramen.
    The pneumogastric nerve may be manipulated by deep pressure behind the anterior border of the sterno-mastoid muscle.
    These three nerves are also influenced by manipulation on their closely related nerves, the sub-occipital, great occipital, small occipital, and great auricular, reached in the sub-occipital fossae as above described.
  V.  Pressure upon the phrenic nerve may be applied at the points described in Chapter III.
 VI.  The sterno-mastoid muscle may be manipulated, following the method described for treatment of muscles of the throat under I of this chapter.
    The muscle upon one side may be stretched by turning the head toward that side and slightly upward, thus increasing the distance between the mastoid process and the sterno-clavicular origin of the muscle.
 VII.  The lateral and posterior muscles of the neck may all be treated in a manner similar to that described under I of this chapter.
    The practitioner may also stand at the head of the table, and with the palms of the hands upon each side and the back of the neck, gently grasp handsfull of the muscles, manipulating them thoroughly while slowly moving the head in all directions.  Pressure and manipulation, together with motion, all gently and patiently applied, will relax the most obstinate contracture, loosen all deep fibrous structures, free blood-vessels and nerves, and prepare the way for what is usually the real object of the treatment, the reduction of bony lesions.
 VIII.  With the patient supine, the head is pushed as far as may, be easily done without resistance, first to one side and then to the other, and it is noticed whether it turns as far to one side as to the opposite side.  Inequality between the two sides indicates lesion usually upon the side toward which the head turns least easily.
    After relaxation of the tissues, turning the head to its limit toward each side will sometimes aid in the reduction of bony lesion, especially with the aid of pressure applied to force the part into its place.
  IX.  (1) In lesion of the atlas the patient lies supine and the practitioner, standing at the head of the table, holds the head between the hands, with a thumb or finger upon each transverse process.  The head is now moved in a direction to exaggerate the lesion, and with traction, rotation, and pressure upon the processes, the atlas is forced toward its position.
    (2) The operator may stand at the side of the head, one hand upon the forehead and the other pressed firmly just below the skull, in the region of the lateral arch of the atlas, on the opposite side.  Exaggeration of the lesion, rotation, and strong pressure aid in replacing the part.
    (3) The patient sits and the practitioner, standing in front, places one knee beneath the chin, while the hands grasp the sides and back of the head, and the fingers are firmly pressed upon the lateral arch of the atlas upon each side.  Exaggeration of the lesion, traction, pressure, and rotation are now applied as before.  The chin is slightly raised and drawn forward by motion of the knee beneath it.     The head is rocked upon the atlas gently, the requisite pressure being, made upon the lateral arches to press the bone back to its position.
    (4) The patient sits and an arm is passed about his head, the bend of the elbow coming beneath the occipital protuberance and the hand beneath the chin.  The head is now forcibly raised with the idea of moving it upon the spine in the desired direction, while the free hand makes pressure upon the spine or neck in the direction necessary to aid in reposition.
    (5) Dr. Still uses the following movement in setting the atlas.  He stands in front of the patient, who is sitting, and clasps his hands behind the neck, just below the skull, pressing the pisiform bones firmly against the lateral arches of the atlas.
    Now the proper movement is made to rotate the head to the affected side, "sinking" it down upon the spine, and to press the atlas into place.
    (6) With the patient lying upon his back, the practitioner stands at the head of the table, holds the head between his hands, presses his fingers against the lateral arches of the atlas, while the head is slightly raised from the table and supported by pressure from his own body, pressing it down upon the spine.  Now the proper movement is made to exaggerate the defect, rotate the head, and press the atlas into place.
    These various treatments may be applied to any of the usual lesions of the atlas.  The same principles may be applied to the different malpositions of any of the cervical vertebrae.  Generally patience and time are necessary to the gradual restoration of the bones to place.  Much attention must be given to the thorough and gradual loosening of all parts in preparation for replacement.
 X.  The axis is generally displaced laterally.  The tissues upon its transverse and articular processes are quite tender and contractures are found in the muscles about it.  Exaggeration of lesion, rotation and pressure usually restore it to place.
  XI.  The scaleni muscles may be stretched by pressing the head down toward the side in question, pressing the fingers behind the clavicle upon the first rib to force and hold it down, while the head is now drawn to the opposite side.
  XII.  Thorough loosening of all cervical tissues may be accomplished by a somewhat "spiral" treatment.  The patient lies on his back, the guiding hand is placed upon the forehead, and the other hand is slipped beneath the neck and grasps it.  The head and neck are now raised slightly, the head being rotated in one direction, while, as far as possible, exactly the opposite motion is given the neck.  The hand travels up and down the neck treating its different portions alike.
 XIII.  Flexing the head strongly upon the thorax stretches the ligamentum nuchae and posterior tissues of the neck.