When you’re dealing with neck pain sufferers, try asking this question: Do you ever wake up with a crick in the neck? The feeling that you can’t quite turn your head because you slept wrong? I think you’ll find this problem is fairly widespread, especially with clients who have other neck and posture-related complaints. They might not mention it because they consider it their “normal”—no, they can’t look over their shoulder most days, but isn’t that true for everyone?

For those lucky readers who have never experienced this cervical quirk, a “crick” is a condition related to spasm of the neck muscles, usually discovered upon waking, that tends to last hours or full days. The crick sufferer will find it difficult to look over one shoulder or the other, often feeling as if there is a hard barrier preventing them from doing so. It hurts, it’s inconvenient, and it can make the next night’s sleep even worse. Being able to help with this issue can be a real boon, even for clients who have learned to live with it.

The Crick Culprit

If a client’s neck rotation ends suddenly and can’t be stretched, is it a bone that’s out of place? Is it a nerve issue? In my clinical experience, there seems to be one major player here, and it’s actually a muscle: the levator scapulae.
When palpating an active neck crick, you’ll often find that this muscle stays in a state of partial contraction, becoming more rigid as the client rotates toward the point of complete restriction. As this happens, other neck muscles, such as the trapezius, scalenes, and erectors, will also contract in a guarding response, preventing further movement.
What causes the levator scapulae to suddenly lead this brigade of rotation prevention? Clients will often report the feeling that they “slept wrong,” or say, “I think I need a new pillow.” While these things may be true, I find that people prone to cricks often have other conditions that predispose them to spasm. These often include forward-head posture, rounded shoulders, upper back pain, and even jaw tightness and dysfunction.
So what caused the crick? If you ask me, it’s not about one problem that needs solving, but a constellation of related symptoms that could all use some contact and consideration. But for now, what to do with that irritated levator scapulae?
Note: If the onset of neck stiffness is accompanied by fever, severe headache, or other unexplained symptoms, refer clients to their physician for evaluation.

Relieving Levator

Before we begin, figure out which side of the neck is involved. Have the client turn toward the point of restriction, and then ask them to point out exactly where they’re experiencing pain or that feeling of being “locked up.” If there is too much spasm, or both sides seem to be involved, feel free to work with both sides.
Start with your client lying supine and you seated at the head of the table, toward the affected side. Slowly and gently warm up the neck and shoulder, making sure to keep the client well within their comfortable range of motion. Then, try this sequence:
1. Using fingertips or a soft fist, sink into the tissue of their upper shoulder, targeting the superior angle of the scapula. This hand will remain here for the duration of the technique.
2. Using the fingertips of your other hand, compress the tissue along the side of their neck near C5.
3. Draw the fingertips of your superior hand up to about the level of C4, then compress and hold.
4. Continue this process, superiorly moving your fingertip contact and applying sustained pressure at the level of each vertebra.
5. Gradually remove both contacts, then proceed to work with related muscles.
As you may have noticed, this has a lot in common with the myofascial stretch concept we discussed in the last issue (May/June 2019, page 96). We’re restraining the fascia near the tendinous insertion of the levator scapulae, and then applying pressure at various points along the body of the muscle, creating fascial stretch in a way that is comfortable for this distressed muscle. In doing so, we’re accomplishing something important: we’re proving to the client’s nervous system that painless stretch is possible.
This can potentially stop that cycle of pain and spasm that keeps this crick going. Want to reinforce that idea even further? Repeat this process with the neck in a different position, or ask the client to gently and slowly move their neck (in a comfortable way!) while you maintain the two points of compression. Follow it up with plenty of work with other neck muscles, the trapezius, and the pecs, and many clients will stand up with a considerable improvement in their range of motion.
Going forward, consider including work specifically for the levator scapulae in more sessions. This issue is more common than we think, and a little focused attention can make a big difference.