My experience with whiplash begins with my own story. I was in a significant car accident almost 30 years ago, and within two years of that accident I was suffering substantially with whiplash-originated headaches, as well as neck and upper-back pain.
I tried different techniques, both inside and outside the massage field, for pain relief. I experienced limited success or relief. I am happy to say that whiplash and neck pain plague me no more because of how I learned to work with an overlooked muscle and tissue: the platysma.
After my experience, both on and off the massage table, I have spent countless hours studying and honing my massage approach to whiplash. As a CE provider and educator in advanced pain management applications, I would like to share my observations with you about this area of the neck in relationship to injury.
What a Client with Anterior Neck Surgery Taught Me About the Platysma
At the time of my own whiplash syndrome struggle, I had a new client schedule with a complaint of neck pain. Through her health history evaluation and interview, she explained that she was five years postsurgical from thyroid removal surgery with an external scar across her throat about five inches long horizontally. This client stated she had not experienced neck issues prior to surgery and that her pain began directly after her thyroid surgery.
This referral pain was also the identical pain that I had, not from surgery, but from a sustained whiplash injury.
I spent a good portion of that massage working her scar in conjunction with other neck musculature, observing where she told me the pain referred to, and feeling change occur all through the posterior cervical spine, occipital ridge, and reduced tone of the bilateral SCM and trapezius muscles.
The client left with significantly reduced pain and increased range of motion.
Of course, the minute she walked out the door, I grabbed the tissue on the front of my neck and started gentle traction and skin rolling. I experienced the same referral sensations and relief that my client had. The pain in my cervical neck began to subside for the first time in three years. But even more impressively, the ache in my upper back eased to a certain degree as well.
This was a profound moment for me. The response was undeniable, and I wanted to understand what had occurred so that I could reproduce the results and (hopefully) be pain-free. What I found interesting at the time was that the tissue I was working on had responded similarly to a whiplash and surgery. Could that potentially mean I had also scar tissue in my anterior neck without an external scar?
With that in mind, my research led me to the only viable muscle and tissue in the front of the neck, which was the platysma.
The skin and scar were visibly bound centrally on the surgical site, directly over the trachea. After an overall assessment of the neck muscular, with her permission and using care, I gently picked up the scar and started some tissue traction and skin rolling. The client stated that whatever I was touching was reproducing the exact posterior neck pain and headaches that she was complaining of. It was referral pain, but not one that followed trigger-point patterns.
Anatomical Considerations of the Platysma
The platysma muscle was the logical choice for muscle that existed in that specific location of this client’s scar and the tissue I was working for my own neck. While in a cadaver lab training, I remember observing this flap of thin tissue or muscle lying over the neck of a cadaver and being told it was simply a “neck covering” with minor involvement with facial expression.
It obviously had more input than that if it changed my client’s neck and mine as well. I decided to research origin and insertion to understand the function of the muscle better. The platysma, as defined1 by the National Center for Biotechnology Information:
Origin: The muscle has a broad origin with fibers arising from the fascia of the upper thorax including the clavicle, acromial region, pectoralis major and deltoid muscles.
Insertion: The muscle inserts on the mandible, the cheek skin, the commissure of the mouth, the orbicularis oris muscle, to the posterior border of the depressor anguli oris muscle, and in some cases as high as the orbicularis oculi muscle. This muscle only has a small bony insertion, which is on the anterior third of the mandible.
Based on the definition, I found it interesting that its origin was fibers of fascia and not a boney insertion site. I also found it interesting that it only had a bone insertion at the chin—most of this muscle integrates into fascia, which could dynamically change many structures at one time.
What that also meant was that this muscle could automatically have a minor capacity, if given the ability, to pull the chin downward (I to O) and possibly push the neck posteriorly if it were bound into a broad piece of fascia with additional adhesions due to injury. It wouldn’t take very much pressure to impact the posterior neck and start creating pain and inflammation cycles just from improper neck positioning.
Using myself as a guinea pig, I decided to skin roll as much of the platysma as was possible and perform deeper friction at the point of the chin to see what it would do. The pain and pressure that had been in my posterior neck receded substantially and the work I did with the chin attachment seemed to lift my occipital ridge pain.
The upper-back pain lifted even more, and I thought that perhaps where the muscle arises from the fascia upper body, specifically the pectoralis major, then the tension of the pecs had changed and therefore changed the back.
Scar Tissue Adhesions and Pain Management
I asked myself this question: With the training I had received regarding the neck and pain management, and the whiplash pain that I had personally experienced, how could this thin muscle be potentially overpowering the sternocleidomastoid, trapezius, and other auxiliary muscles of the cervical neck and spine?
Conversationally, perhaps it’s not what the platysma muscle does as a muscle. Perhaps the uniqueness lies in what this tissue transitions into after a whiplash injury that potentially redefines its role and therefore creates the ability to create pain issues.
With strain or surgical injury, this muscle may be potentially transitioning into a restrictive quality where it acts more like the fascia it travels along and attaches to. Once this tissue heals with scar tissue adhesions or binding of fascia, it could push the neck posteriorly, creating more of a military-neck position and a loss of the natural cervical curve.
One explanation could be that in response to the binding and restrictive qualities anteriorly, the muscles of the neck must work harder for head placement, entering into fatigue and spasm cycles. The most natural outcome for these pain cycles would be the trigger-point referral patterns of the sternocleidomastoid and upper trapezius muscles.
The neck could simply be fighting itself and be stuck in a pain-spasm-pain cycle, starting with adhesions and fascial adhering in the platysma from damage to this tissue due to trauma. And this cycle could last for years without resolve.
The Platysma: Small but Mighty
While I can’t take a slice of muscle or tissue and place it under a microscope to show beginning and ending change, I have observed hundreds of clients whose range of motion has increased, and pain decreased with the platysma approach.
I have used this tool frequently as a treatment application at the table and teach this concept in CE courses as part of the neck and whiplash techniques class. Other professionals have experienced the same success with the platysma that I have.
“Learning to work on the platysma has created a higher level of neck treatment success for my clients and for myself [as] a massage therapist,” shares Gennifer Brinker, a PPS-certified therapist practicing in Idaho Falls, Idaho. “For 18 years, I have specialized in injury recovery and pain management and have found that I rely on this technique with over half my clientele. When the neck musculature will not respond to traditional work, I have found this tool creates the lasting change and recovery I am looking for in the tissues.”
Brinker says she finds this work the most helpful when utilizing it with clients who have a history of some form of whiplash response, whether from a car accident, an impact in sports, surgical procedures to the neck, or even head trauma with additional neck strain.
“The platysma work is integral to returning the neck to its neutral and natural position, achieving true change, and keeping the tissues healthy,” Brinker added.
Mirelă Crăciunescu, a PPS-certified therapist practicing in Buzău, Romania, says, “When I cannot release the neck pain with other techniques, I use the platysma muscle, which is becoming something I do often now with at least 50% of clients. Even [with] my clients who have not had whiplash from a car accident, the platysma responds to neck injury in a way that until it is worked with, will not let the neck muscles relax and change. There is an order to this approach and working with the platysma, first, and the other muscles of the neck afterward, allows the massage therapy to work for the neck better.”
The platysma muscle may be a small muscle, but it is mighty in how it is potentially converting itself into a more profound tissue after injury. I believe this muscle and the corresponding fascia it adheres to could be further researched as a successful component in the treatment of post-whiplash, cervical neck pain, headache and dysfunction.
Footnote
1. Hoerter, J, Patel, Bhupendra, C. “Anatomy, Head and Neck, Platysma.” StatPearls. National Center for Biotechnology Information. ncbi.nlm.nih.gov/books/NBK545294, accessed online July 2021.
About the Author
Amy Bradley Radford, LMT, BCTMB, has been a massage therapist and educator for more than 25 years. She is the owner of Massage Business Methods and the developer of PPS (Pain Patterns and Solutions) Seminars CE courses and a National Certification Board for Therapeutic Massage & Bodywork-approved CE provider. Her articles for this publication include “Start a Massage Practice. The MT’s Guide to Budgeting for Startup Costs & Monthly Expenses” and “The Client’s Body Does the Healing (The MT Provides the Opportunity)” (both, massagemag.com).
Source link