Understanding Neck Pain in Massage Therapy... Another Article About The Neck. Or Is It?

Here it is. Another article about how to work on the neck. Except, I am hoping this one is a little different than the ones you have read before. I am hoping that this one helps you to think a little differently about how to approach the neck, and, maybe how to feel a lot less intimidated by all the red flags and “scary” structures that exist here. Because, ultimately, when we work on a client’s neck, we are not just manipulating a levator scapula or a subocciptal. We are really, in no uncertain terms, accessing the deepest layers of their very personality.

The Emotional Side of Neck Pain in Massage Therapy

The neck is a bridge. Most obviously, it joins the head to the body. But it also connects the mind to the soul, the brain to the heart, and the thinking to the feeling. And while each of these layers might conger up different ideas for different people, the truth of the neck, the reality of each and every structure and tissue wrapped under the cervical epidermis, is rimming with pathways of communication. Sure the muscles are working hard to hold the head up and move the head around. But the persistent flow of blood, lymph, hormones and nervous impulses is essentially a convoluted highway ripe for a complicated traffic jam. 

Often unwittingly, the position of the head is the forward facing presentation of the deep truths of our core. For example, a gut filled with shame might hold the chin down and one ear slightly tilted to the side. Or a stomach filled with pride might hold the head high and the nose turned up. Or, a more curious instinct might hold the head slightly forward and rotated to one side for better hearing. These are positions that tend to be innate and, over time, become imbedded into our very mannerisms. Doing all the things, day in and day out, will always start with these deeper foundations.

Why Chronic Neck Pain Isn’t Just Structural

So while carrying a purse or a backpack repeatedly on one shoulder, or sleeping with a non-ergonomic pillow, or constantly looking down to check your social media, or attending too many heavy metal concerts may trigger a painful situation, most likely what is really happening is that the circumstance is exacerbating an already existing issue. A spasm in the levator scapula may be the result of chronic anxiety. Or a trigger point in the upper traps might be the culmination of low grade depression. Or a tense SCM might simply belong to a very excitable human. 

While all of these are possibilities, this adds an entirely new layer to your assessment. Please don’t mis-read this. Your health history and physiologic assessment skills are still incredibly important. But evaluating the entirety of a person is a different skill. It takes a long time for a client to reveal these inner truths and an even longer time to master implementing what you learn.

THIS is why it can feel a bit unnerving when a client presents with neck pain. Especially when addressing neck pain in massage therapy, the emotional layers can be just as complex as the physical structures. We may, on the surface, be fearful of pressing too hard on the jugular vein or sinking too deep into the transverse processes. But we are commonly also facing stubborn issues that seem to not resolve. The quandary a lot of massage therapists struggle with is wondering why all of their amazing work doesn’t seem to be helping. And this concealed layer to underlying chronic pain is very difficult to pinpoint.

How Massage Therapists Can Reframe Neck Work

As a technique article, you may not walk away from reading this with a fancy new tool to implement in your practice this week. Because the most valuable technique is also the most simple. Listening. It’s the oldest tool in the book. And definitely the least exciting. I am not sure, though, how to underscore the greatness of this one. We learn it on day one in massage school. And we spend a lifetime honing it.

Try this: with each client this week, use all of your senses (except taste, obviously) from the moment they walk through your door. Get a sense of the initial feeling they give you. Don’t give it too much weight as people often try to be something they are not. But pay a little more attention to what they smell like, sound like, and look like. Try not to play the part of care-taker. Be the observing character. Watch and notice how they hold their head, how their jaw operates, and, of course, how they move. Try not to measure degrees and ranges right off the bat. Just listen to what your gut is telling you and, without judgement, imagine what it would feel like to be that person.

From there, once they are on the table, use these perceptions to formulate your work. Maybe they need balance more that they need trigger point therapy. Maybe they need to connect to their breath more than they need increased range of motion. Or maybe they just need to feel safe. Chances are, when you see your clients as a whole human, the depth of your work is felt without you breaking your back to get there. 

If you like what you read and want to read more content like this, head over to Associated Bodywork & Massage Professional's website to read their latest issues of Massage & Bodywork magazine.