Muscular function, dysfunction, and treatment


Unlike other skeletal muscles in the body, those in the face attach to skin instead of bone. Instead of moving joints they make facial movements which play a major role in how we communicate with other people. Painful overuse injuries are very rare because they have nothing more than the force of gravity to resist. But the link between emotion and facial expression is clear to see and this can mean that good deep massage of the facial muscles is very relaxing. Muscles of the face can be affected in neural conditions such as Bell’s palsy, and friction massage techniques along the nerve’s pathway can be very beneficial. General massage techniques to help keep the muscles in good health are also worthwhile.


The temporomandibular joint (TMJ) is a complex joint with strong muscles which pull the mandible bone up and glide it forward and back when chewing and talking. Even though they may be in almost constant use in some people, normal activity rarely leads to overuse injury. But muscular problems do result from joint misalignment, which may be caused by dental issues. Grinding teeth at night can also lead to overuse muscular problems and, although massage may help alleviate painful symptoms, it will be unlikely to affect the underlying causes of the problem.
The joint and its muscles can also be vulnerable to impact trauma in some violent activities. There can be a strong link between chronic problems around the TMJ and deep emotional issues. If there is no traumatic incident or obvious dental issue associated with the injury, this should be considered carefully before proceeding with deep soft tissue techniques.
The masseter and temporalis muscles, which raise the mandible up to the temporal bone and close the joint, can easily be seen working on the outside of the jaw. These short strong muscles can be treated quite easily and connective tissue and Soft Tissue Release (STR) techniques are particularly effective on them. Inside the joint is a small group of short powerful pterygoid and buccinator muscles, which create the forward and backward chewing action.
To treat these muscles, it is necessary to wear sterilised gloves and work from inside the mouth without any lubricant. Short, strong fascial strokes into and along the muscle borders can be a very effective way of releasing restrictions here. But these can be very painful techniques which should only be done once during a treatment session and should not be attempted on a normal, mobile and unrestricted joint. Because this is a very unusual technique to perform, and as emotional factors may be linked to the condition, this needs to be discussed first. It is important that both client and therapist feel comfortable with the situation before proceeding.


The muscles of the neck have to control the weight of the head, which is very dense and heavy, and they have to do this for very long periods without fatigue. With good postural alignment, the head is well balanced and needs little effort to control and move; but, with poor alignment, much greater stress is put on some of the muscles whilst others get underused.
The muscles also sometimes have to deal with huge loads when sudden movements cause very strong forces of inertia on the head and neck and acute injury (whiplash) is common in these situations. The long thin omohyoid muscles run down the front of the neck and are the only muscles used to assist in opening the jaw through their fascial connections to the mandible bone. Opening the jaw comes mainly from gravity, so this muscle is rarely put under any strain.
Although they get lengthened in people with a forward-head posture, this does not usually cause any problems to the muscle. The sternohyoid muscle runs down from the hyoid bone to the manubrium and depresses the hyoid bone as well as assisting in neck flexion. Deep behind these muscles are the longus capitis and longus colli muscles, which run from the anterior upper cervical vertebra down to the upper thoracic vertebrae and so flex and bend the cervical spine anteriorly.
But people with a forward head posture are already set in this position, so the muscles are underused and therefore injury is unlikely. Deep massage techniques are not possible on the hyoid and colli muscles because they run alongside the windpipe and any compression to this can give the client a choking sensation. The largest muscle in the front and side of the neck is the sternocleidomastoid (SCM), which attaches from the sternum and clavicle to the mastoid process on the skull. Its main action in the upright position should be to rotate the head, with the muscle on the left side turning the head to the right and the muscle on the right side turning it to the left.
But this only happens with a good postural alignment. People who hold their head in a very forward position will not use this muscle at all when rotating the head. This means that the muscle is commonly underused and becomes weak, but does not usually suffer any chronic symptoms from this.
However, bilaterally these muscles have to work powerfully to lift the head when flexing the neck from a supine position. So overuse strain can easily occur in people with weakened SCM muscles who take on an activity involving this movement. The SCM cannot be treated with normal massage strokes that apply a deep pressure into the tissues because these could compress the jugular vein and windpipe beneath it. Instead, a squeezing/pinching technique across the belly of the muscle is very effective without interfering with any underlying structures.
The scalene muscles at the side of the neck attaching from the transverse processes of the cervical vertebrae, down into the first and second ribs. With this wide insertion along the curving ribs these muscles create neck movements through a wide range of sideways directions. With the neck rotated, the client first actively lifts their head a few centimetres. This raises the sternocleidomastoid as it contracts; the therapist can now grasp the muscle between thumb and finger. The client then relaxes, and short strokes are applied along the muscle.
Neuromuscular Technique can be applied by pinching the tissues at the trigger point. A side-lying position with the therapist sitting behind the client is excellent for treating the lateral neck. From here, deep strokes can be applied along the scalenes as well as friction in and around the vertebrae and along the occipital ridge. The therapist can pull back on the shoulder girdle at the same time to add a stretch to the tissues. With a forward head position, the posterior part has to overwork to support the weight of the head and can suffer chronic overuse pain. But the anterior part can become weak through lack of use and shortening, so it becomes vulnerable to trauma with sudden head movements. The attachments of the scalenes to the ribs are significant in respiration since they act as stabilisers, holding up the top of the ribcage, and they work concentrically to pull the ribs up in forced inhalation. They often become chronically short and tight through overuse in people suffering with respiratory conditions.
Although they may not feel any muscle pain here, releasing this tension can help ease some of their symptoms. These muscles can be most effectively treated with massage techniques when the client is in a side-lying position.

Cash, Mel. Advanced Remedial Massage (Kindle Locations 1141-1223). Ebury Publishing. Kindle Edition.

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