Takeaway: Guiding clients toward discovering solutions for themselves is far more valuable than simply giving them the answers.

“I’m feeling a lot of pressure in the back of my head,” Mrs. E. said. “It’s like a headache, but maybe more accurately, a sense of constant pressure in my head and tightness in my upper back,” she added.

“Does any position or activity make it worse or better?” I asked.

“It does seem to be worse if I slump,” she said. “My physical therapist gave me some exercises to strengthen muscles that keep me in better alignment, but it’s a constant struggle.”

I began to explore her cervical spine from C3 to the occiput, which felt very compressed and congested. I gently and methodically lengthened the tissue, using upward flexing motions with my fingers.

The tissue softened slightly, but I still felt a lot of compression and tightness. 

Having her stand again to sense her cervical spine in that position, I asked if she felt a lessening of the pressure in her occipital area. 

“I think it is a little bit better,” she said.  

After that underwhelming response, I expanded the search. Having her sidelying, I began to explore a possible scapular connection. While passively guiding the scapula through a range of motion, it did not move freely in retraction, elevation, and depression, with retraction being the most involved.  

“That’s so strange,” she said. “I can’t seem to let you move my shoulder. I know I’m resisting you, but I cannot let go. How do I do that?” she asked. 

“It’s important that you let your nervous system figure that out, rather than me telling you what to do,” I said. 

After a few minutes of this exploration, she discovered how to let me retract her scapula with ease and freedom. We did this same approach to scapular protraction, elevation, and depression, all of which responded quickly. I then had her return to the supine position to assess her upper cervical area. Finding it significantly more relaxed, I asked her to stand and see what she noticed. 

“That’s remarkable,” she said. “I have to admit, I don’t understand why what you did worked. I have a pretty good knowledge of anatomy. Would you mind sharing your process with me?”

“Not at all,” I said. “When working directly on your upper cervical spine only produced marginal results, my sense was that there were other factors at play.”

“Like my shoulder area?” she asked.

“Yes, and when I passively moved your scapula, there was a guardedness to the movements.” 

“When that first movement got better, I assumed all the others would release as well. The other motions were less difficult, and I figured out how to let go faster, but that was still a surprise,” she said.

“It’s wishful thinking that muscles that have adjusted to an imbalance will immediately release,” I said. “You can’t change an outcome unless you change the system that created it.”

“What’s the connection to the neck?” she asked. 

“Taking your scapula posteriorly challenged the serratus anterior to let go, which was the first movement we explored. The connection to your neck is that the serratus anterior can pull the scapula anteriorly, which is part of what happens when you slump. This position also pulls your upper ribs forward, which activates another muscle called the serratus posterior superior. Recent studies have shown that this muscle’s primary function is to monitor the position of the upper ribs. It’s a great example of how the primary function of some muscles is to monitor movement and anatomical position, even though most muscles are designed to create movement. Let’s explore,” I said, gesturing for her to stand again. 

“If you let your shoulders slump forward, what do you feel in your neck?” 

“I feel tension in the back of my head,” she said. “If I bring my shoulders back, I feel the neck relax. I’m not forcing my shoulders backward; they just seem to go there.”

“And the easier it is to be in that position, the more likely you will stay there,” I said.