The Many (Cervical) Facets of Neck Pain (with Til Luchau & Whitney Lowe)

Summary: The neck’s facet joints (or the harder-to-to pronounce and remember “zygapophyseal joints”) are the primary articulations involved in cervical movement. They are commonly thought to be involved in a range of painful cervical conditions. What do manual and massage therapists need to know? What are some helpful ways to think about and work with these joints? Whitney and Til think it through, and touch on topics such as:

  • Does or doesn’t head-forward posture cause pain?
  • What about text-neck?
  • A self-assessment, and,
  • A hands-on technique for working with the cervical facets.
  • And much more

 

Whitney Lowe:

Welcome to The Thinking Practitioner Podcast.

Til Luchau:

A podcast where we dig into the fascinating issues, conditions, and quandaries in the massage and manual therapy world today.

Whitney Lowe:

I’m Whitney Lowe.

Til Luchau:

And I’m Til Luchau.

Whitney Lowe:

Welcome to The Thinking Practitioner.

Til Luchau:

Welcome to The Thinking Practitioner.

Whitney Lowe:

Welcome to The Thinking Practitioner Podcast, which is supported by ABMP, the Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package including individual liability insurance, free continuing education, and quick reference apps, online scheduling, and payments with PocketSuite, as well as much more. ABMP CE courses, podcast, and the Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, including from Til and myself. Thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking.

Til Luchau:

Today’s in-house sponsor is something that I care about. That is advanced-trainings.com, my site. The pitch for that is are you ready to take your skills to the next level? Come visit us there with innovative self-paced programs ranging from one-hour certificate courses on the most common client complaints to our comprehensive CAMT certification program. We offer practice changing learning events with industry leading instructors and a supportive learning community that will take your work to another level. Plus, for a limited time, Thinking Practitioner listeners can enjoy a special offer. Sign up today at advanced-trainings.com and get a free month of our amazing ET subscription.

Explore our extensive library of courses, cancel anytime, and keep your credits all from just $20 a month with the first month free for you, Thinking Practitioner listeners. Enter Thinking Subscriber at checkout for this limited time offer at advanced-trainings.com. Plus, it’s not too late to join us for one of our amazing retreats like our Neck, Jaw, and Head Masterclass coming up in Puerto Rico, or our Walking Workshop with Robert Schleip on the Camino de Santiago in Spain next year, or our popular Arm and Shoulder Course live online in the new year. So, why wait? Visit advanced-trainings.com today.

Hey, Whitney, good to be back with you.

Whitney Lowe:

Hello, sir.

Til Luchau:

How are you doing?

Whitney Lowe:

How are you? You’ve been off for a couple episodes here. It was great to have you back, and today, we’re going to jump into some interesting specifics. What are we talking about today?

Til Luchau:

We are going to talk about the cervical facet joints and yeah, the role they might have in the people’s life that come see us and then some things we can do about what people complain about too.

Whitney Lowe:

All right, good.

Til Luchau:

A fun technical topic. Those are always interesting, and apparently, our listeners find them interesting too because whenever we talk about technical stuff, the click rate goes way up.

Whitney Lowe:

Yeah. Okay.

Til Luchau:

So thanks for clicking everybody. Let’s get to it.

Whitney Lowe:

Okay.

Til Luchau:

Can I ask you?

Whitney Lowe:

Yes.

Til Luchau:

I was going to ask you, what are the facets? What are we talking about there?

Whitney Lowe:

Well, I was going to start off with the Thinking Practitioner Podcast trivia question to start off at the beginning here.

Til Luchau:

All right.

Whitney Lowe:

So we are talking about the facet joints, but what is the technical name that’s given for those joints?

Til Luchau:

Oh boy. Should have been ready for that. Tell me.

Whitney Lowe:

Yeah, you’re right. Zygapophyseal joints.

Til Luchau:

Zygapophyseal, that’s it.

Whitney Lowe:

Spelled sometimes differently but Z-Y-G-A, zygapophyseal joints is the technical term, but nobody calls them that. So, I don’t know why we do that but yeah.

Til Luchau:

Anyway.

Whitney Lowe:

I’m going to start. Yeah, so the Z joints. All right, so we’re going to talk about the Z joints today. So, yeah, we’re talking about the cervical facets and these of course are the locations where adjacent vertebra are articulating with each other, one of a few locations, a very small location where they do articulate with each other. For those people who might be following along with us visually, you’ll take just a quick moment and we’ll put them up on the screen. So, we can take a quick look at these zygapophyseal joints.

So, the big thing about these is we notice the orientation of these joints being a little bit diagonal. So, here are the zygapophyseal joints. For those who are listening just on audio, they are of course the place where adjacent vertebrae touch each other. If you look at the cervical spine, there’s no contact between the big bodies of the vertebra where the main weight is born through those cervical vertebra. The facet joints are the one place where they do connect in contact with each other.

Til Luchau:

Between the bodies-

Whitney Lowe:

What’s that?

Til Luchau:

Between the bodies, you got the disc. The disc is keeping those vertebrae apart.

Whitney Lowe:

Keeping those vertebrae apart.

Til Luchau:

Yeah, and the facet joints. One vertebrae actually does come in contact with the one below or above it and that’s just a joint right there between the bones.

Whitney Lowe:

That’s right. These cervical facet joints are oriented diagonally. It’s interesting, if you look throughout the rest of the spine, the angle of those facet joints changes as you move through the spine and that has a lot to do with governing the motion that’s capable of these different joints. So, this diagonal angulation of these facet joints here in the cervical region gives them a lot of potential for different ranges of motion that we’ll be going through and taking a look at here.

Til Luchau:

Nice. Okay. I like to think of them as shingles.

Whitney Lowe:

I like that. Yeah.

Til Luchau:

Yeah, or snakeskin scales where one is lapped over the one below it at those little overlapping joints there. Like you said, they do determine a lot of what’s possible in terms of neck movement and perhaps position. That’s a sticky wicket that I hope to get into with you, certainly movement. So, what role do the cervical facet joints play in neck movements and stability? What do you think about that?

Whitney Lowe:

Yeah, so they are, as we noted, helping to guide that movement significantly because of their angulation and they will be compressed in certain positions. For example, when you bring your neck back into extension or hyperextension, those cervical facet joints are compressed.

Til Luchau:

That’s looking up.

Whitney Lowe:

Then as you tilt your chin towards your chest inflection and tilt your head downward, those facet joints gap or open up a little bit. One thing I just wanted to mention here too, to keep a note or keep in mind about these, when we talk about cervical facet dysfunctions and problems with them, there is a lot of emphasis on the joint contact surface between those adjacent cervical vertebrae, but it’s important to keep in mind that each one of those cervical facet joints has a joint capsule just like other joints do and those joint capsules are richly innervated.

So they may be a part of what’s going on with people with their cervical facet joint problems.

Til Luchau:

You got to show a picture. Can I show a picture of that?

Whitney Lowe:

Let’s see it.

Til Luchau:

Let’s see if I can do this as smoothly as you did. You have some practice at this screen sharing stuff. Obviously, let’s go. All right, so there’s a zygo… I messed it up already. Zygo, what?

Whitney Lowe:

Pophyseal.

Til Luchau:

Zygapophyseal joint and its capsule. These are cervical, so you can see that there’s that joint there that where those overlapping shingles are is surrounded by a joint capsule. It is a tissue, connective tissue, which I’m particularly fond of. As such, it is also richly innervated with various mechanoreceptors and sensory neurons that give a sensation. Do you want to say anything about the sensation there, Whit?

Whitney Lowe:

Well, yeah, I think what you just brought up is really interesting too about the mechanoreceptors and sensation because they do play a critical… I mean when we think about the position of the head and neck giving us all kinds of information about where we are in space, how we are oriented, what’s going on with balance in our body, the incredibly rich amount of information coming from those mechanical receptors and sensory receptors is really crucial to putting us in those different positions and then of course we naturally try to adjust to that from what’s going on with them.

Just an interesting little side note about just an example of that, I can’t remember if you ever mentioned this on the podcast before or not, but my wife has always bugged me about the fact that every time you see me in a photograph or we just stand still for a portrait photograph, my head is always tilted to one side and she always used to say, “Why do you cock your head to the side like this?” Of course, I’m not aware of doing that and I was going to get refitted for my glasses, I don’t know, a year or two ago or something like that. The optometrist mentioned, “Do you know that one of your eye orbits is slightly higher than the other?” I said, “I didn’t realize that, but now that makes sense.” I tilt my head to the left to try to-

Til Luchau:

Seeking horizon.

Whitney Lowe:

Seeking balance and level horizon to keep those at the same level each other, so they’re interacting with my mechanical receptors probably in my cervical region to get that position there to be able to look straight ahead.

Til Luchau:

Fascinating. Did you ask him if he could just make you a pair of glasses that was offset so your head went straight?

Whitney Lowe:

I could, but then I’d look a little off there probably.

Til Luchau:

I don’t want to see that.

Whitney Lowe:

I’ve had 61 years of doing it this way. I’d probably get messed up after a while trying to do it another way.

Til Luchau:

Yeah, you talked about how those mechanical receptors are concentrated around the joint capsules that have a lot to do with proprioception, maybe horizon orientation like you said, and also the joint surfaces are thought to… Should I jump in and say something about degeneration?

Whitney Lowe:

Let’s do. Yeah, let’s do.

Til Luchau:

Okay. The joint surfaces are thought to contribute to pain when they get degenerated or roughened. Joint degeneration brings up some disagreement in the field that to think that’s equated with pain that if you see something rough on an x-ray that that’s necessarily painful. You’ll get clients who come to you and says, “I’ve been told my necks or joints are just degenerated. I’m just going to hurt.” That’s something that I hold it lightly, you could say, that explanation. Just because we have roughened joint surfaces anywhere doesn’t mean we’re necessarily in pain. Those are independent phenomenon.

Whitney Lowe:

That’s pretty much true as a blanket statement applied to other joints as well, wouldn’t you say?

Til Luchau:

Yeah. Well, we don’t see pain on a scan. We see shapes, textures, like that, and they don’t correlate that well with pain actually.

Whitney Lowe:

Yeah.

Til Luchau:

So how about position? Should we go to the position question?

Whitney Lowe:

Yeah, that’s a big one. That’s a nice little can of worms-

Til Luchau:

Head forward position say.

Whitney Lowe:

That’s a good can of worms to open up there.

Til Luchau:

The question that you put in our script that I want to ask you, is there empirical evidence that establishes a direct link between forward head posture and neck pain? I want your answer.

Whitney Lowe:

It depends.

Til Luchau:

Okay. I knew you were going to say that.

Whitney Lowe:

So the stuff that I was reading about, it does not at least to me appear definitive yet. There were some conflicting studies. Some were interesting saying like, “Yeah, there seems to be a correlation in older people and not in younger people,” which I thought was interesting because everybody’s blaming all the younger people for texting on their phones all the time as being a part of this whole thing.

Til Luchau:

It’s because us older people didn’t get to do that. Our necks aren’t adaptable enough and we start to hurt.

Whitney Lowe:

We start to hurt. That could be, yeah.

Til Luchau:

I’m making that up, but who knows.

Whitney Lowe:

Yeah, so in answering your question, I’m going to default to my usual statement around posture and pain, which is again, posture is not necessarily a cause of pain except when it is.

Til Luchau:

It can be, but it’s not necessary.

Whitney Lowe:

I honestly believe in some instances, it can do that even though some of the other folks out there looking at some of this research will say there’s no correlation between posture and pain, but that doesn’t necessarily mean it doesn’t ever happen. That just might mean that the correlation is not strong.

Til Luchau:

Yeah, I’m with you, as you know, in that general point of view that posture doesn’t equal pain. It’s interesting that in the great debates of the last decade, they’re quieting down now, but I think Walt Fritz refers to them in our neck episode too about the pain science wars or something like that. But there was constant debate between, “Is posture relevant to pain? Should our measure just be pain? Should our measure just be posture?” The head forward thing was the one place where there actually at that time…

This probably developed some sense then. There was some empirical evidence that head forward posture does correlate more with TMJ pain. Those are two that you could draw a pretty straight line with through the evidence saying people who have a head forward posture have a higher incidence of TMJ pain. There are probably a number of places like that where we could find pretty clear evidence, but in general, the evidence is pretty weak that our posture produces pain.

Whitney Lowe:

Yeah. Do you want to make a correlation line or thoughts? I’d like to hear your thoughts on that in relation to TMJ pain. What’s the cause-effect relationship?

Til Luchau:

What’s the mechanism?

Whitney Lowe:

Yeah.

Til Luchau:

Well, Collier, influential physical therapist in the ’90s, said it was because the head forward posture would pull backwards on the jaw on the mandible. The tissues become tight from that head forward posture and pull the mandible back into the backside of the condyle on the skull where the TMJ is and it’s the backside of that joint that has a richer concentration of nociceptors.

Whitney Lowe:

Oh, interesting.

Til Luchau:

That was his linear explanation for why that would be. Honestly, I hold that explanation lightly too. It’s plausible, but there’s probably a lot of reasons why people with a head forward posture have a higher incidence of TMJ pain.

Whitney Lowe:

Yeah, yeah.

Til Luchau:

You mentioned too that the big dive into text neck, let’s find the smoking gun in text neck and show that people who text more hurt more. That has been elusive. There have been very few studies rather that found that correlation. There was a big one out of Brazil and there does seem to be big differences between age groups. Young people do great with whatever they’re doing. Maybe by the time you’re my age, you got to be more exacting.

Whitney Lowe:

Yeah, I think so many of these just chronic postural challenges just have cumulative effects that are going to affect people more as they get older.

Til Luchau:

Maybe that’s it.

Whitney Lowe:

Maybe it’s because we also get cranky.

Til Luchau:

We just complain more.

Whitney Lowe:

It’s like a little higher on the priority list for us.

Til Luchau:

Yeah, yeah. Well, actually, some of us do, that’s for sure. I sure do. There’s actually some good evidence too that older people complain less about pain as well.

Whitney Lowe:

I would be curious to know and again this is something that I don’t think has ever been studied, but most of the studies that I had looked at around this whole issue of text neck and the posture and pain problems have been looking at things like biomechanical measurements of this particular position being in forward. But what about just saying something more along physiological lines? In that forward head posture, your muscles and tissues are under a greater load, because they’re trying to offset that head posture. But as you get older, you have less fluid content in your tissues and maybe less capability for them to be resilient to moving in and out of those postures.

Maybe that might be why some more of those people feel some of those kinds of things as they get older. I mean I feel like that’s true. I’ve had nagging back pain most of my life when I do certain activities or when I sit for long periods. But the older I get, the more nagging it gets. I think it seems to me maybe just predicting that that’s something associated with there’s physiological changes of the tissue in addition to things like that.

Til Luchau:

Yeah, physiological changes in the tissue, but also positions. I mean our spinal curves do get deeper with age or at least you can draw that line on the chart and say people who get older do have more head forward position as a function of time perhaps or gravity or who knows what. It’s just something to be aware of. I saw a picture of myself from the side recently and I was like, “Oh, my God. I’ve always had a little bit of that tendency for sure and it’s something to work with.”

Whitney Lowe:

Another interesting analogy about what you’re speaking about earlier in terms of looking at, imaging studies or things that show us what’s going on with our structure and whether or not they’re correlate with pain. I remember an instance back when I was about 18 years old I think it was, and my dad had been having a lot of back pain. He had gone to see a chiropractor for the first time. He got all excited about this, because this person was really helping him with his pain. He said, “You should go see this guy,” that whole evangelical thing. Well, something works for you so everybody else has got to try now. So, it’s like, “Well, I don’t have any real problems.”

Go see him anyway. I think it would be really good for you. This was back in the time when they were doing a lot of x-rays with everybody that came in and he took a side x-ray of my cervical region and came back and said like, “What on earth are you doing to your neck? You’ve got this super cervical curve in there.” I said like, “Well, I’m a small scrawny guy and I spend about an hour or more a day with a 12-pound tenor saxophone wrapped around my neck holding it in that position. That’s probably what’s… yeah. So, that would’ve caused increased compression on my cervical facet joints and things like that, but I wasn’t having any pain, but the structure didn’t look good. The structure certainly looked problematic.

Til Luchau:

I am glad you told that story. Let’s stick with that theme for a minute about what you can see in a momentary view like an x-ray and what people experience, because there’s also very little linkage in that. Like we said with the side joints if they’re rough, people don’t necessarily hurt. It’s also true that which we see on a positional X-ray doesn’t correlate very well with pain. Sorry to the chiropractic profession and not to single them out at all and their very effective ways. People are probably using that information and their manual treatments.

But just because you have a lot of curve in your neck on an x-ray or just because the opposite, which is also the critics of this phenomenon really jump on a military neck as a common diagnosis done from an x-ray that may or may not have anything at all to do with pain. Military neck is the lack of curves, the opposite of what you’re describing. Often, you give it as an explanation for why people have neck pain or why they might need a particular treatment to restore the curve. So, again, maybe, maybe not. I tend to go toward the maybe not side of it. That position doesn’t equal function or doesn’t equal pain.

It was such a radical idea for us when I started learning in the ’80s or before that, people started developing the work, the ’70s to think about how physical form really does influence so much and reflect so much and expresses so much the shapes of our bodies, the movements we make, things like that. Still a lot to it, but when we take it really far, it starts to be a little more questionable. Does a straight neck always hurt? No. Does a kid whose neck look like yours in the x-rays always hurt? Not necessarily. It turns out that position is probably a pretty indirect measure of neck health.

It’s a good position of how it looks. Like me seeing myself from the side going, “Wow, I don’t like how that looks,” that’s a deal. That’s a real deal. If I want to look different, then I’m going to work with how my head forward posture manifests itself. What I’m interested in is pain or even to some extent performance, until you get to really high athletic levels of performance. The position isn’t the direct measure of that.

Whitney Lowe:

I think one of the other ways where position has been misused to some degree is taking and extrapolating biomechanical principles of a malposition to predicting that somebody’s going to have this kind of problem. So, for example, with the military neck, when you lose that cervical lordosis and you stack those vertebra directly on top of each other, you do increase compressive loads on the vertebral discs, because they’re not designed to really be straight stacked on top of each other and that does increase compressive loads. Or if you have an exaggerated cervical lordosis, you will shift the weight-bearing responsibility farther in a posterior direction and put more load on the-

Til Luchau:

Okay. Would you or would you not accept the modification to statement that theoretically we increase the loads? Have there been direct measurements of people’s loads in their discs when they’re straighter or less straight to show differences in loads?

Whitney Lowe:

Yeah, I actually don’t know to be able to quote them. So, I’ll go with theoretically, my understanding is that that has been validated, but I can’t pull those studies off the top of my head.

Til Luchau:

So then that’s how I think of it. Then we have debating series. The other theory that says that well, the straighter things are, the more stacked they are one block over another, so there’s less deviation from the plumb line. There is still less physical force is there too. They’re both theoretical models, which could definitely explain some people’s experience or some pain. But what we end up doing is picking our model as a practitioner or as a client to explain why their neck hurts.

Sometimes just jumping models can be really amazing too. I’m going to tell you my favorite model or of a moment, which really is a movement. So, in my teaching and in my practice and in my own body, my question has evolved over the years to, “Does it move?” Not is it straight or is it curved or is it in the right position? Is it balanced left and right? It’s the question, can I move when it needs to and can it not move? Can I resist movement when it doesn’t need to?

Whitney Lowe:

Yeah. I know you use orient these questions, I hear you orient these questions to practitioners and to the people that you work with a lot too. You would be also interested in the questions like, “How does that feel? How does that movement feel? Does that feel like you can move the way you want to or how are you perceiving that? Is that accurate?”

Til Luchau:

There’s a qualitative question I’ll ask. How does it feel? But there’s a quantitative one I start with and that is, “Does it move?” in a particular situation where it might be helpful to have it move.

Whitney Lowe:

So let me ask you this because this comes up frequently. So, when you are asking the question, “Does it move?”, are you trying to pay attention to does it move? How far? For example, when you say like, “Oh, yeah. Well, I can turn my head to the side, but yeah, just a little bit. But yeah, I can turn it to the side.”

Til Luchau:

Can I lead you and the listeners through a little 60-second exercise that’ll answer that question?

Whitney Lowe:

Yeah, let’s do it. Yeah.

Til Luchau:

All right. So, if we put our hands on our neck, so I’m feeling the back of my own neck right now. You don’t have to see this on the video.

Whitney Lowe:

Thumbs pointing toward the anterior part of your neck or in that direction.

Til Luchau:

But most important part is that my fingers are on the back of my neck and I’m going to feel now what happens in the back of my neck when I nod. It’s a big nod, so that I can feel some movement back there. It’s not just a little bobble, but it’s a big forward and back nod of the head and just feel with your hands what happens in the back of your neck. You’ll feel some of your fingers spreading. At least some of them spread when you look down and they come together when you look up. That’s flexion extension. The vertebrae, the facets are doing something similar. They’re gapping when you look down. They’re coming together when you look up.

So, now get really specific with your touch and see if you can feel or imagine down to the joint level where you can tell what each joint is doing. So, now, if you get really specific with your nodding, can you feel which joints move the first or move the most? So you still got to broad touch. You’re going to do a nod and your hands are going to tell you where’s the first movement at the bony level or the joint level. Again, you might have to imagine this or extrapolate some through the muscles. If you’re used to feeling muscles, you’re going to tune into that, but I’m not going to ask you to feel for bone. For me, it’s right in the middle plus say C3-ish, somewhere in there. That’s pretty common, but that’s the first place or the biggest place that moves when I look down, you could say.

Yeah, okay, so now from the place you found that moves the most, now go down a joint. Let’s say a fingers width or a little more. Can you move in a way that lets that next place move first? Can you start the nod from a lower place than you’re usually doing it? You’re going to notice right away it helps to breathe, it helps to relax, that you can use your eyes as a part of that process. You can look down. You can look up. You can let the breath move into your chest and shoulders as well as just into your lungs. So, when you play with all those big picture factors and you really bring your awareness into that next joint down, often you’ll find that by relaxing you can let the next joint down move even more. Maybe try one more joint. Go even lower in your neck.

So, now I’m down to C4, C5, and the muscles around it start to get a lot denser. But I’m going to just play with and stay comfortable in your arms feeling. I’m going to play with my ability to nod and initiate movement at a lower place than I’m used to by relaxing. So, go ahead and let your arms rest, everybody. So, what I did there, Whitney, was basically, I found the place that was moving the most obviously and then we explored a couple of options. Could I let the next place down and the next join down from that move even sooner in the cycle or easier in the cycle too? So no, quantity doesn’t play into that yet. It’s more like my ability to perceive that in my own body and then my ability to do something different.

Whitney Lowe:

So the biomechanist and kinesiologist in me wants to know these questions that come up as I do that. Are you actually changing the degree of movement between those adjacent cervical vertebra or is this a perception of movement?

Til Luchau:

Well, to answer that, let’s say feel your own body, you and me and everyone listening, after having done that experiment. If you’d nod now after having your hands there, notice if there’s a difference. There may or may not be, but what typically people report is more freedom or a sense of a bigger neck where things get easier or having an upright head posture becomes easier naturally. So, those are the qualitative or perceptive differences that I’m after. I can get around the question by saying my biomechanical inquirer also wonders, but really what really counts for me at the end of the day is how the client feels, the perceptive. That is actually what I’m targeting.

Whitney Lowe:

Yeah, cool. Okay. All right. Okay.

Til Luchau:

So that’s a self-assessment and self-mobilization or awareness enhancing exercise we could do. We call it the cervical wedge technique. We do a version on the table with people too where basically your face up client, your supine client, we’re lifting underneath their neck into each joint, helping them feel that and helping them find movement in each joint there. So, I think in that point we agree, me the practitioner and the client agrees that we both feel movement there joint by joint. So, that probably is both the subjective and the objective lining up a little more than we just did.

Whitney Lowe:

Yeah. So, let me ask another generalized question about treatment things because I hear this question a lot. This comes up. When we talk about cervical facet dysfunctions or problems or think we have pain that’s coming from facet joints, these are really deep. We as manual therapy practitioners always want to get in and do something to that problem area. Since we can’t really get to them and there’s very little we can actually do to them, what are the strategies that you take from a treatment perspective or mostly aimed at indirect methods like you just did here to enhance movement and enhance freedom of proprioception and greater freedom of movement? What are your key strategies from a treatment perspective for that?

Til Luchau:

Okay, let’s start with the premise. We can’t really get to them. They’re so deep that we have to reach through skin, connective tissue, muscle to imagine physically touching those joints. Maybe we never get there. But if I could get you on my table, Whitney, and do this technique, I think you would agree that where there’s a focused sensation, that’s much deeper than me touching the skin. Again, I’m a little hoarse here. I think through that movement, we are touching them. We’re touching them both with perception, but then the movement itself is having a direct mechanical or physical effect. If I can localize movement or get more movement perhaps into a place, we’re having a different mechanical effect on it.

Whitney Lowe:

Yeah, it’s a fascinating means of working these areas, because as you noted and we were talking about this earlier, there are so many sensory receptors in this area and there’s just a lot to work with of very subtle kinds of changes and things like that that can have some, I think, moderately significant, profound effects and impacts for people in doing these kinds of things.

Til Luchau:

People love neck work and they love this down to the deepest structure awakening or awareness building or refinement of people’s perceptive understanding of those. People love this technique, love this way of working with the neck. I mean the wrap ups for that technique and you got more questions I want to hear, but I’m working as many joints as I can feel, as many joints as I have time for. I’m looking for an effortless quality to the movement. It’s not just, “Can you force your neck open and close there?” It’s like, “Can you relax and let the movement happen?”

Whitney Lowe:

Yeah.

Til Luchau:

Then the other piece that I mentioned, but I’ll do even more on the table, is what happens in the rest of your body when you do this? If you tighten your jaw to this, is that different than relaxing your jaw? What do you have to do in your shoulders to allow this movement to happen, your chest, et cetera?

Whitney Lowe:

Yeah. Then would you say that there’s also a continuity when you try to do this approach of looking at not only getting that freedom of movement in those facet joints in the cervical region, but you would also want to carry that through the spine through other areas as well?

Til Luchau:

Absolutely. I mean our episode today focuses on the facet joints, but that’s a pretty artificial focus clinically because everything works together. The whole spine works as a unit. You could feel just probably when you’re doing your own nod to find the different place, you had to relax your shoulders, for example, where you had to breathe into your chest or you had to sit more square in your chair or something like that. So, absolutely, in terms of a session, it’s part of a bigger picture of increasing someone’s overall body awareness and the awareness of what happens in their body when they do look for different movement patterns in their neck.

Whitney Lowe:

Right. Well, that’s a fascinating exploration there with our drill down on those facet joints. Any other key things that you want to zero in on with that?

Til Luchau:

No, thanks for being such a willing guinea pig.

Whitney Lowe:

Yeah, it was cool. I like that. Yeah.

Til Luchau:

There’s a lot of different ways to work with the facet joints. I just shared one of my own favorites. A lot of it depends on really how we think about the body and the role that we have in it. Depends on what your mental or practical model is in terms of how you’re working and we’re evolving in our understanding of what the body is and how it changes and what we’re doing with our hands.

But a lot of it comes back to things like, “Do you think of the body as clay to be molded? You’re going to touch it and work with it in one way. Or is it like a muscle machine that needs to be pumped up into a particular shape and then you’re going to prescribe head and back exercises against the wall? Or is it like a fascial tensegrity network that you’re re-rigging and then you’re going to think about span and stretch and things like that? Or is it a living, breathing, perceiving organism that’s a highly evolved nervous system that’s always adjusting and always adapting that what’s going on around it?” Then you can probably hear my bias in there. That’s the way I go. So, then I’m really working with perception as well as whatever’s happening in the tissues.

Whitney Lowe:

Yeah. Well, I think that’s a fascinating model and perspective on this and I want to thank you again very much for sharing some of those hands-on somatic explorations with us on that. That was really interesting on the neck as well.

Til Luchau:

Appreciate it.

Whitney Lowe:

Yeah.

Til Luchau:

Anything else you want to say in closing? You shared some key features with us as well.

Whitney Lowe:

Yeah, again, I think there’s so much around this that we have yet to learn some more about and it is mechanically and structurally and physiologically and functionally a very complex area. There’s a lot of things that we haven’t really had a chance to dive into in great detail, but it is also, of course, something that so many people come to us for help with. My neck hurts, doing these kinds of things. It’s easy sometimes for people to blame certain simple answers for things when there are certainly more complex processes of how you’re using your body that are playing a role in that.

So, I do just want to put the plug out there for, again, one of the many, many, many reasons why I think manual therapy practitioners are in such a wonderful place to help so many people with these kinds of things, because we do take the time with people and the time is often a big factor to really explore in greater detail what’s going on with somebody’s integrated movement processes throughout their whole body. Instead of just taking piecemeal approaches to doing things, it really does allow us the opportunity to look at them much more holistically and completely in that process.

Til Luchau:

That’s great, holistically and more completely and to invite some of the inside out change in people’s understandings, sensation, experience of their own body. Just something that’s being injected into you or done to you. Even if you’re not involving your clients as much as I was describing just there, the fact that people feel your hands, feel our hands, and feel differently afterwards is an inside-out kind of experience that we really benefit from.

Whitney Lowe:

Yeah. Wonderful. All right. Well, we’ll put a bookmark and a pause in that for today. How about that?

Til Luchau:

Lots more to talk about the neck. Yeah.

Whitney Lowe:

Indeed, revisiting this concept some more in the future here. But at this point today, we’ll keep in mind that Books of Discovery has been a part of massage therapy education for over 20 years where thousands of schools around the world teach with their textbooks, eTextbooks, and digital resources. Books of Discovery likes to say learning adventures start here. They see that same spirit here on The Thinking Practitioner Podcast and are proud to support our work knowing that we share the mission to bring the massage and bodywork community in livening content that advances our profession.

Til Luchau:

Check out their collection of eTextbooks and digital learning resources for pathology, kinesiology, anatomy, and physiology at booksofdiscovery.com, where Thinking Practitioner listeners like you save 15% by entering Thinking at checkout.

Whitney Lowe:

We would like to say a thank you to all of our listeners and to all of our sponsors. You can stop by our sites for the video, show notes, transcripts, and any extras. You can find that over on my site at academyofclinicalmassage.com. Til, for you, where can people find that?

Til Luchau:

advanced-trainings.com.

Whitney Lowe:

If you have comments, questions, or things you’d like to hear us talk about, just record a short voice memo on your phone and you can email it to us at [email protected], or you can look for us on social media. You can find me there under my name, Whitney Lowe. Til, on social, people can find you where?

Til Luchau:

Til Luchau. Rate us on Apple Podcasts please. It does help other people find the show and know about the show. You can hear us on Spotify, Stitcher, Podbean, or wherever else you listen. Please do share the word, tell a friend. Please do write in and tell us how it’s going. Send your voice memo. I can’t wait to hear some of those too. Thanks, everybody, and thank you, Whitney, for today.

Whitney Lowe:

It sounds good. That was a great conversation. We’ll look forward to doing it again soon.

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