Massage Malady #5: Cervical Sadism

If you’ve read my writing or watched my videos, you know that I love the neck. I fearlessly grasp sternocleidomastoid, I’ll draw the scalenes in as I work the traps, and I’ll happily give the local fascia a stretch with a slow, soft fist. I know there’s a lot of nervous, vascular, and lymphatic tissue present, but the neck is a robust structure full of feel-good muscle, begging to be explored. If you deal with it mindfully, you can really offer the client a new experience of a structure that has previously only caused them pain, or that they think of as the place where they “hold their stress.”

But… there are limits. That brings us to today’s massage malady: “Cervical Sadism.”

cervical-sadism

This is rarely seen with actual massage techniques: People tend to respect the anterior and lateral neck’s potential vulnerability by being careful with it, or even avoiding it altogether! While that’s not great, at least it’s erring on the side of caution. Conversely, this particular problem is characterized by a blithe disregard for the neck’s normal range of motion.

I see this frequently with therapists who have a structural agenda: If something is “out of balance,” or isn’t as mobile as they’d like, or is crooked, they want to fix it. While I can agree with that goal in the case of something clearly dysfunctional (a frozen shoulder, for instance), many of our individual weirdnesses constitute our bodies’ hard-won compromises with gravity and our activities of daily living. My flat, out-turned feet are just part of me now, and they don’t cause me pain (except for emotional pain when I’m shopping for shoes).

In much the same way, my lack of neck mobility seems to be an adaptation that works just fine. I can only side-bend by about 45 degrees, and I can only rotate by about 75, but that suits my purposes. And yet, for some reason, about 90% of the massage therapists that I’ve been to have taken this as a challenge. “We’ve got to get that neck working,” they seem to say, and they proceed to take me waaaay out of my comfort zone. I used to sit silently and accept these rough ministrations (“well, they’re the expert”), until I noticed a direct correlation with headache and neck pain afterward. I don’t usually have those!

I’ve seen a number of online posts by massage therapists wondering about their clients’ post-massage neck pain or headache. Upon further investigation, they had incorporated neck stretching just as a part of their normal routine. This is fairly common in massage school curricula. Done with your neck massage? Time to get that client’s ear down to their shoulder. I recently received a message from a reader in massage school who experienced a vasovagal response (lightheadedness, dizzyness) while receiving neck stretches. Her therapist had tucked her chin downward before bringing the cervical spine into flexion. This extreme position managed to reduce blood flow in one of her major cervical blood vessels, in much the same way that a headlock would. While I haven’t almost passed out during similar stretches, I can’t say that I enjoyed the experience!

Basically, I ask that we work confidently with the neck, but that we also treat it with the respect that it deserves. As the conduit for the spine, the carotid and vertebral arteries, and the holy vagus nerve, stretching it is not the same as stretching a stubborn hamstring. If you feel that cervical stretches are important to your clients and their goals, go slowly, communicate, and keep track of their comfort. Consider simply taking them to their comfortable end-range, rather than trying to set a new high score.

My personal method is to forgo typical neck stretches altogether and, instead, create fascial traction as I work. I do this by spreading tissue in the opposite direction as I glide up the neck. It keeps their neck in a comfortable position, but they still feel a deep sense of stretch. I’ll demo this in a video soon, as well as a fascial stretch that clients can do for self-care.

So, what do you think? Have you had an MT stretch your neck too far? Can I take your neck stretches when I pry them from your warm, therapeutic hands? Let’s talk about it in the comments!

3 thoughts on “Massage Malady #5: Cervical Sadism

  1. Yes, I’ve had that experience twice, by the same MT. It didn’t hurt but I suddenly had the feeling I was about to black out and I had to tell her to STOP what she was doing immediately. I don’t recall if she had my neck flexed or extended but it was very scary and I’ve had a tendency to guard my neck ever since while I’m getting a massage…

    1. Oh cripes! I wonder how widespread this phenomenon is. While it is likely harmless (the vasovagal response is basically a preliminary safety mechanism meant to prevent actual harm), it certainly sounds unpleasant. Thanks for relating that, and do keep your massage therapists in line!

  2. Yes, I had an MT in a CE class doing some of her “medical massage” techniques instead of the things the instructor was encouraging us to explore. She was stretching it quite a bit beyond what I felt comfortable with, and with a bit of velocity. I told her I was kind of scared (felt too close to chiropractic work to me as well) and she said “Oh, there’s no reason to be afraid.” She backed off some then, otherwise, I would have said “Your turn!” But not with her moves.

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