There are many reasons not to manipulate the neck with cavitation: the patient is too old, their neck is too tight, etc. But the most common reason is that plenty of patients are afraid of "the crack," mostly because of the bad publicity about that procedure. Enter myofascial therapy using ischemic compression, which is effective in just about all cases of neck pain. It can easily replace or be added to the manipulation.
Palpation and Compression
Examine the symptomatic area pinpointed by the patient; you will easily feel the hypertensive and hyperirritable region – for example, let's say the first three vertebrae on the right. With the patient in pronation, the contact is taken with the thumbs, one on the other, on the posterior part of the transverse processes of these vertebrae. One contact is normally sufficient to reach all three vertebrae.
Your arms should be at a 45 degree angle in relation to the patient's neck and perpendicular to the patient. The 8 second pressure you apply has to be painful, but bearable, to the patient's tolerance level.
In my experience, this treatment gets rid of the irritation and is anti-inflammatory; it should be repeated at each visit until complete elimination of the irritation is achieved. In order to accelerate the results, you can repeat this treatment with the patient supine, their head turned to the left; and a third time with the patient kneeling perpendicular to the table with their forehead on the left arm. These three treatments should be administered consecutively.
Normally, amelioration is felt by both practitioner and patient within 5-6 treatments. In chronic cases, 10-15 treatments may be necessary.
Cervical displacements, tensions or neuromuscular irritations all seem to respond to this approach when repeated as necessary. When treating cervicalgia, we must check the 7th cervical and 1st, 2nd and 3rd dorsal vertebrae. Firm pressure on the spinous processes, at a 45 degree angle laterally, will reveal the irritation when present.
A Supplemental Exercise
The following exercise for the neck helps eliminate residual pain and prevent recidivism. It is particularly useful for people who work long hours in front of computers. This exercise should be performed in two phases. First, with the patient sitting, head straight forward, they turn their head to one side as far as possible (for this example, let's say the left side). Patient then pushes their chin with the right hand in order to rotate the head a little farther. This should elicit tension and a little pain.
Next, patient puts their left hand behind the head in order to flex the head forward as far as possible. The head is kept in maximum rotation and flexion for 30 seconds. This mobilization has to be uncomfortable and a little painful; and should be repeated on the opposite side. Repeat on both sides once a day for at least a month to ingrain the exercise in memory.
From that point on, the patient can use it whenever they feel a little neck tension. In my clinical experience, it can even stop a headache when done early.
We have to demonstrate to the patient precisely how to do this exercise; first do it yourself and then have the patient do it. Most patients catch on the first time, but for some, it's hard to master. You may need to repeat the demonstration over the course of the patient's next few visits.
