myofascial techniques

BY TIL LUCHAU

In a rear-end impact or a backward fall, the head and neck are thrown into hyperextension, which overstretches and injuries
soft tissues of the anterior neck, such as the sternocleidomastoid. Image courtesy of Primal Pictures. Used with permission.

108 massage & bodywork may/june 2010

Working With Whiplash, part 2
Cold Whiplash
In the previous article, I
wrote that whiplash has
metaphorically “hot”
and “cold” phases, and
described some approaches
for working with hot patterns.
Here, I will describe
two techniques from
Advanced-Trainings.
com’s Advanced Myofascial
Techniques seminars that
are particularly effective for
working with cold whiplash.
I will also share some of our
instructors’ advice and best
practices for strategizing
whiplash sessions.
A brief review of our hot/cold
distinction: hot whiplash is usually
(but not always) more recent, generally
less than six weeks since being injured.
Hot whiplash is characterized by
sympathetic nervous system (“fight
or flight”) arousal, inflamed and
hypersensitive tissues (anywhere in
the body), and immobilization and
guarding via muscular contraction and
spasm. Once some time has passed, an
older but still unresolved whiplash can
show the “cold” pattern of hard, dense
connective tissue restrictions (versus
muscular spasm), especially deep around
Cervical Core/Sleeve Technique: Gently use
the joints, which also limits mobility.
the backside of a soft, semi-open hand to ease
Hot whiplash needs to be worked
the outer layers of the neck posteriorly. Do not
very carefully to avoid increasing
put any pressure on the underlying structures of
the tissue inflammation and further
the throat and neck—the styloid process, lymph
aggravating the client’s autonomic
nodes, carotid artery, and vagus nerve are all in
arousal. While cold whiplash can
this region and merit special care.
usually be approached more directly,
we’re not out of the woods yet: cold
whiplash can easily be reactivated into
violently overextend and injure the
a hot pattern if worked too much, too
soft tissues of the anterior neck 2. Once
deeply, or too fast. Go slowly until
the inflammation of the hot stage has
you learn how your client responds.
diminished and the rest of the body
The primary goals in working
has been prepared (see Strategizing
with hot whiplash are to calm the
Your Sessions, page 112), you can begin
aggravated nervous system responses
addressing the tissues of the anterior
and to encourage whole-body motility
neck by working the neck’s outer
(self-generated movement), which
“sleeve”—the superficial cervical fascia
minimizes connective tissue scarring
and the sternocleidomastoids (SCM).
and adhesion. Only when a whiplash has
Since we’re beginning with
progressed to the cold stage do we add
superficial layers, the tool we’ll use
the additional primary goal of restoring
is the soft fist, as the drier texture of
local mobility (the ability to move
the skin on the dorsum of the hand
or be moved) by directly addressing
is better suited for superficial work
movement and tissue restrictions.1
than the palm. Rather than a hard,
closed fist, the soft fist is open, easy,
Cervical Core/
and relaxed, with both the fingers and
Sleeve Technique
thumb out and comfortable (Image 2).
As shown in Image 1, a sudden
It is important to keep the wrist and
backward acceleration of the head,
metacarpals aligned with the forearm—
such as that caused by a rear-end
this protects your wrist from strain and
impact or a backward fall, will
connect with your colleagues on massageprofessionals.com 109
Strategizing your Sessions: Whiplash Tips from the compression, and allows you to work
less, making your touch more sensitive.
Advanced Myofascial Techniques Faculty Using the proximal knuckles
Three of our lead instructors at Advanced-Trainings.com of your soft fist, gently catch the
share some of their key considerations for strategizing outer layers of the neck, just anterior
whiplash sessions: and superficial to the SCM belly.
We don’t use oil or lotion at this
Tip 1. Begin with light touch in the first session. stage—we want the gentle friction of
The trauma of whiplash and its aftereffects can trigger hyperarousal the soft fist to differentiate and free
of the nervous system, which can make working with whiplash clients up the tissue layers we’re working.
challenging. The nervous system of an injured person is on overload, Using gentle posterior friction, take
and needs to be approached with care. Work gently to gauge how the up any slack in the outer wrappings of
client will respond, especially in the first session. Remain patient, and the neck. There are delicate structures
avoid aggravating the tissues and nervous system. Trying to get too in the neck, so be sure you’re staying
much done in any one session can be overwhelming for the client. If you superficial. Think about just catching
work too deeply too quickly, it can create more guarding and trauma. the outer collar of a turtleneck sweater,
without putting any pressure on the
—Ellyn Lindquist, CAMT CR
deeper structures, or without pulling
Tip 2. Work from appendicular to axial. the “collar” too tightly across the front
Imagine you are sitting at a stop sign looking in your rearview mirror and you of the throat. Your client should be
see the car behind you isn’t slowing down and is about to hit you. You brace for comfortable—if he or she feels that
impact by clutching the steering wheel and stomping both feet into the pedals you’re pressing too deeply, or pulling
and floor. This reaction is initiated to help protect the body from the impact too much on the front of the throat,
that is about to occur. As a practitioner, if your client’s arms and shoulder girdle readjust your pressure, layer, and/or
are still compressed from this response, you cannot effectively release the neck. direction until there is no discomfort.
The same goes for the feet, legs, and pelvic girdle. Release the shoulders, arms, After carefully taking up the slack
feet, legs, pelvic girdle, and low back early in your whiplash work. Working here of the outer layers of the neck, ask your
helps release the protective compression these parts exert on the axial spine. client to gently turn his or her head
away from the side you’re working. Your
—Larry Koliha, CAMT CAR
working hand stays static, so any sliding
Tip 3. Be sure to integrate and close your work. is initiated by the client’s movement
After working with whiplash, it is important to finish your session judiciously, and tissue release. Make sure your
making sure that primary shock points where injury can accumulate are left client’s movement is slow and focused—
free and adaptable. The atlanto-occipital junction is one of these places “muscling through” the movement
and the therapeutic effects that cascade throughout the body by releasing won’t help him or her learn an easier
restrictions at this neural/myofascial crossroads are difficult to overestimate. way of moving, and might even cause
The sacroiliac (SI) joint is another; decompression of the myofascial structures you both to miss the cues that keep your
embedded here enables better adaptability and function at this critical pressure safe. Optimally, your client’s
structure. Working the SI joint complements and completes the circle of head and neck should stay aligned,
integration when having worked with the spine, neck, or upper body. moving around the longitudinal axis
of the spine, rather than rolling off to
—George Sullivan, CAMT CAR
the side. In Image 2, my right hand is
gently guiding my client’s head with
notes
1. Til Luchau, “Preparing the Neck and Shoulders for Deep Work,” Massage & Bodywork (January/
this alignment in mind. You can repeat
February 2009, page 120), and “Working With the Cervical Core,” Massage & Bodywork (March/April this anchoring and turning in two or
2009, page 122). three places between the base of the
neck and the base of the skull, and at
the slightly deeper layer of the SCM.
Then, repeat on the opposite side.
This technique can also serve
as a great finishing move. Dr. Ida
Rolf (the originator of Rolfing
structural integration) often used a

connect with your colleagues on massageprofessionals.com 111

myofascial techniques

To assess cervical translation, cradle and move

the head together with the vertebrae above
the individual vertebrae being assessed. In this
case, left translation of C4 is being assessed.
Not visible from this angle are the finger pads
isolating the translation movement at a single
cervical vertebra (as in Image 6). It can help
to imagine the vertebrae like a stack of coins;
hold and move the whole stack above the
individual “coin” that you want to assess.

similar technique to make sure her

The ligamentous structures surrounding a cervical vertebra. The purple arrow indicates
client’s neck was adaptable, long,
placement and direction of gentle pressure for the release phase of the Translation technique
and free at the end of her sessions.
(shown in Images 5 and 6). Source image courtesy of Primal Pictures. Used with permission.

Lateral Cervical
Translation Technique
The deepest soft-tissue structures of
7). These very deep structures are individual vertebra, do this by cradling
the neck, such as the zygapophyseal
difficult to palpate directly, but using and moving the head together with the
(or facet) joint capsules and ligaments,
translation allows us to effectively entire cervical spine above (cephalad to)
can be primary sources of pain and
assess and release any of the structures the vertebra you’re assessing (Image 4).
movement restriction long after a
that are restricting free motion. Assess the entire length of the neck
whiplash injury has occurred. Once the
To perform the technique, begin before trying to release individual
inflammation of the original injury has
by gently feeling for the boniest lateral restrictions; assess each vertebra in
settled, restoring mobility to these deep
projections of the cervical vertebrae, turn, for both left and right translation.
structures can provide significant relief.
at and just posterior to the lateral I find it easier to be thorough by
Lateral translation refers to side-
midline of the cervical spine. These starting at the base of the neck and
to-side movement of one vertebra
projections are the small transverse working upward. Typically, you’ll find
in relation to another. In order to
processes, and the articular processes that some vertebrae translate easier
check for deep soft-tissue restrictions,
just behind them. Together, these to one side than the other. If there’s
we’ll feel for the freedom of this
lateral protrusions form a relatively been a whiplash injury, these left-right
important movement at each vertebra,
wide platform for your touch (Image differences are often quite pronounced.
since the other movements of the
4). Don’t worry about being too Beginning with one of the most
neck—flexion/extension, rotation,
exact—simply feel for the most restricted vertebra, encourage easier
and lateral bending—will be affected
prominent bony lateral projection. translation in the restricted direction
by the same connective tissues that
Next, using the broad, soft pads of by sidebending the neck around the
restrict translation. Any of several deep
several fingers on these projections, feel fulcrum of your touch (Images 5
structures can be involved: the facet
for straight side-to-side movement of
joint capsules, the ligamentum flavum,
each cervical vertebra. Stay broad and
as well as the small intertransverse
soft; avoid poking. Although you’ll want
ligaments and muscles (Images 4 and
to feel for isolated movement at each

112 massage & bodywork may/june 2010

 You can see these techniques in Massage & Bodywork’s digital edition, which features a video
clip from Advanced-Trainings.com’s Advanced Myofascial Techniques DVD and seminar
series. The link is available at both www.massageandbodywork.com and www.abmp.com.

To release translation restrictions, gently sidebend the neck around the fulcrum of
your fingers (arrow) and wait for the subtle softening of a ligamentous response.
Pictured here is the direction of release for a vertebra that resists left translation.

and 6). This is a direct approach—in students gave several well-reasoned

other words, you’ll encourage the
restricted vertebra to translate more
in the direction it doesn’t easily go, by
sidebending the neck around your firm-
yet-sensitive, broad-yet-specific touch.
Since we’re asking for deep, ligamentous
change, you’ll need to be patient and
wait for the body to respond—for four
to six breaths, at least—until you feel a
gradual softening or easing of the hard
restriction. Then, recheck. If you’ve
been specific enough, gentle enough,
and patient enough, you’ll feel more
movement in the previously restricted
direction. Repeat this procedure for
each translation restriction you find.3
Whole Body
While the techniques presented in
these two articles will give you very
effective tools for working with
whiplash, it would be wrong to give the
impression that this is all you’ll need to
be expert in this complex injury pattern.
Locally, the techniques for working
the neck’s superficial fascia and the
deep posterior compartment described
in previous Myofascial Techniques
articles4 will be helpful for addressing
the local effects of cold whiplash.
Most importantly, working with
whiplash requires a big view of the
body. Ida Rolf, reportedly asked one
of her classes: “Where in the body do
you start working with whiplash?” Her
answers—the sacrum, the jaw, the
arms, the lower back. “Wrong,” she
said, “you start working whiplash
at the big toe.”5 The implications
of this point of view have inspired
several generations of Rolfers and
other integrative practitioners to
study the complex interconnections
that make up a living body.
As Larry Koliha and George
Sullivan describe in the sidebar tips,
all of us can learn from Rolf’s insight
that whiplash is an entire-body
phenomenon. As a result, untangling
the effects of whiplash often means
focusing less on the local injuries
involved and more on the whole
body—from the big toe up.
Til Luchau (www.Facebook.advanced-
trainings.com) is a member of the
Advanced-Trainings.com faculty, which
offers continuing education seminars
throughout the United States and abroad.
He is also a Certified Advanced Rolfer
and a Rolf Institute faculty member.
notes
1. In both hot and cold whiplash, there are also
secondary symptom-specific goals, such as gentle
headache relief in the case of hot whiplash, or
decompressing neurovascular pathways in the case
of cold whiplash with upper limb numbness, etc.
The ligamentous capsules of the facet
joints (green) and the intertransverse
muscles (orange) are two structures that
can limit translation when shortened or
restricted. The arrow indicates placement
and direction of pressure for a vertebra that
resists left translation. Source image courtesy
of Primal Pictures. Used with permission.
2. In addition to anterior neck tissue injury, violent cervical
hyperextension also causes posterior damage, such
as the “nutcracker injury,” where the posterior arch of
C1 is crushed between the extending occiput and the
spinous process of C2. Deeper anterior structures,
such as the pre-spinal complex of longus capitis and
the anterior cervical fascias, can be injured as well.
3. Some variations of Lateral Cervical Translation
Technique: 1. This procedure is described with the neck
in a neutral position, that is, neither flexed nor extended.
By passively flexing or extending the neck slightly during
assessment and release, you’ ll sometimes find even
more restrictions; 2. Occasionally, an indirect release is
helpful with a particularly stubborn area. This involves
sidebending the neck in the opposite direction to that
described above—in other words, taking the restricted
vertebra further into its easier direction, instead of into
the barrier. We’ve found that patient and sensitive direct
work is effective for the majority of restrictions, however.
4. Til Luchau, “Preparing the Neck and Shoulders
for Deep Work,” Massage & Bodywork (January/
February 2009), and “Working With the Cervical
Core,” Massage & Bodywork (March/April 2009).
5. This story was relayed to me by body
therapist William “Dub” Leigh.

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