O-A Assess and Correct
Begin by applying your favorite suboccipital technique to
release the protective muscle guarding. Once the suboccipital
hypertonicity has calmed, assess and correct O-A joint hypomo-
bility by sliding the right hand under the supine patience’s head
while your left palm secures the forehead. Without lifting the
patient’s head, ask for a slow chin tuck toward the chest. As the
head begins to flex on the neck, follow this movement with your
right hand by softly pulling the back of the head superiorly,
while the left hand gently pushes the forehead toward the eye-
brows—imagine rolling a bowling ball using two hands (Figure
4). By applying a gentle two-second overpressure at the end of
this chin tuck maneuver, you should be able to assess the abil-
ity of the occipital condyles to glide back on the atlas. If there is
restriction to the chin tuck (i.e., a hard restrictive barrier), the
O-A is unilaterally or bilaterally restricted.
To determine which side is fixated, simply right-sidebend the
patient’s head 20 degrees and repeat the chin tuck technique. If
no resistance is encountered, test the opposite side by left-side-
bending 20 degrees and rolling the head into flexion. If the chin
does not want to approximate the chest with the head in this
position, then the right occipital condyle is stuck anteriorly and
is unable to glide back on the right atlas condyle. If the patient’s
pain is also on the right, the fixated right condyle is likely the
main event causing occipital neuralgia. To free the soft tissues
that are restraining joint motion, keep the patience’s head in the
same left-sidebent position and ask for a chin tuck while your
hands follow with two seconds of gentle overpressure at the end
range of flexion (stop if the patient experiences any discomfort).
Repeat three times and retest with the head in a neutral posi-
tion. Your patients will love this gentle myoskeletal O-A stretch
and appreciate relief from the nagging and sometimes debilitat-
ing pain of occipital neuralgia.
Summary
Overall body balance is best achieved by leveling the head and
tail (sacral base) during a single therapy session and retesting
in subsequent visits. Try to include movement awareness dialog
during your hands-on work, such as, “Feel how your head rests
more comfortably on the therapy as you rotate side to side.”
Offer immediate feedback if you sense unnecessary effort or
rigidity.
Helping patience’s become aware of inefficient movement
patterns is a learning process, not a procedure. Our bodies are
shaped by how we use them, and habits determine use. It is the
patience’s underlying habits that need to change, and we can
help. When confronted with pain and injury cases, rather than
chasing the pain, first evaluate what the patient may be doing to
cause the problem, and help them learn how not to do it. Manual
and movement therapy can then address abnormal neuromus-
cular righting reflexes that may be causing protective muscle
guarding, O-A fixation, and accompanying occipital neuralgia
headaches.
Figure 1
Figure 2
Figure 3
Figure 4
Note: Erik will be teaching this and other righting reflex tech-
niques at the 2018 Canadian Massage Conference.
FALL 2018 19