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The anterior neck is problematic formany massage therapists. You mayavoid working this region for two rea-sons. First, many endangerment sitesare located in the anterior neck, includ-ing the trachea, thyroid gland, brachialplexus of nerves, and carotid artery.Second, working in this region can beuncomfortable if you are not skilled andfamiliar with it. The contours of the

transverse processes of the vertebraeare rather sharp and having soft tissuepressed against them can be painful.Even with these concerns, however,working the anterior neck can be verybeneficial for the health of your client,especially one who has suffered awhiplash injury. Therefore, learninghow to work the musculature of theanterior neck can be a valuable addition

body mechanicsby joseph e. muscolino, DO | photography by yanik chauvin

palpationof the anterior neck

RESOURCESFor more information go to

www.medlineplus.gov and searchunder “anterior neck.”

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Common carotid artery

Internal jugular vein

Sternocleidomastoid

Clavicle

Subclavianartery

Brachialplexus

1st rib

Scalenes

Longus colli

Longus capitus

Mastoidprocess

FIGURE 1B is adeep anterior view.The right side illus-trates the SCM, sca-lene group and theprevertebral group.The left side has theSCM removed for abetter view of theother muscles

THE MUSCLES OF THE ANTERIOR NECK

Levator Scapulae

Common carotid artery

Internal jugular vein

Thyroidcartilage

Trachea

Sternocleidomastoid

Scalenes

Omohyoid

Hyoid muscles

Mandible

SUPERIOR

INFERIOR

LATERAL

LATERAL

Hyoid bone

Upper trapezius

Thyroidgland

Platysma

FIGURE 1A is asuperficial anteriorview. The platysmais shown on theright and removedon the left. to a massage therapist’s practice. And

the first step to learning how to safelyand effectively work the anterior neck islearning how to identify, locate and pal-pate the muscles of this region.

The anterior neck is home to a num-ber of important muscles, including thesternocleidomastoid (SCM), scalenegroup and the prevertebral group ofmuscles (Figures 1A and 1B).* Func-tionally, the muscles of the anteriorneck are flexors of the neck at the spinaljoints. Consequently, during a typicalwhiplash accident when a person’s headand neck are forcibly thrown back intoextension, the muscles of the anteriorneck are excessively stretched, trigger-ing the muscle spindle stretch reflex.This results in tightness and spasmingof the muscles of the anterior neck.Beyond local pain from the tightness ofthese muscles, tightness of the SCM isassociated with proprioceptive distur-bances of the neck, often resulting indizziness. Tightness of the scalenes canbe associated with compression uponnerves that provide innervation to theupper extremity. Finally, tightness ofthe prevertebral muscles can causereferral pain that is interpreted as a sorethroat. Given the prevalence ofwhiplash injuries, and the variety andextent of signs and symptoms that canresult, there can be tremendous valuein working the anterior neck muscula-ture of our clients!

The Scalene and Prevertebral MusclesWhile most of you are knowledgeableand comfortable working the SCM, thescalenes and prevertebral muscles areless often addressed. We will begin bylocating and palpating the SCM. TheSCM will then be used as a landmark forthe location and palpation of the sca-lene and prevertebral muscle groups.

The SCM has two heads—a sternal

* The hyoid group of muscles is also located in the anterior neck. This article will not address their palpation.Figure 1A courtesy The Muscular System Manual by Joseph Muscolino. Mosby, 2005. Figure 1B courtesy of Joseph Muscolino.

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