To complement the MASSAGE Magazine article, “Massage Strategies for Upper Crossed Syndrome,” by Nicole Nelson, in the November 2011 issue. Article summary: Musculoskeletal clinicians are as divided in their treatment approaches as the Tea party and Democrats are in political ideology. The structural approach vs. functional approach. According to the structuralists, treatment is guided by specific static structures, such as, “The MRI has discovered a tear in your supraspinatus tendon, so let’s cut you open and repair it.” Functionalists recognize pathology as a culmination of all processes, systems and movement, such as, “Your shoulder hurts, let’s examine your posture, how you move, the stability and mobility of the shoulder and the surrounding structures.”

by Dawn Lewis

Misalignment of C1, C2 and the occiput can lead to irritated nerves, localized pain, shoulder and arm pain, headaches or a twist in the dural tube that obstructs the flow of cerebrospinal fluid. To realign the atlantoaxial (AA) and atlantooccipital (AO) joints, and to alleviate pain and irritation, a therapist must take all structures involved into consideration. It is not enough to work the neck muscles—and at times it may simply cause further pain and irritation. The ligaments must be released as well.

One way to allow bones to realign is to release the ligaments attaching the bones to one another. If C2 is misaligned, there is tension placed on many different ligaments. A few of them are: the alar ligaments, connecting the dens of C2 to the occipital condyles; the posterior longitudinal ligament, which extends along the posterior surface of the vertebral bodies; and the ligamentum nuchae, which extends from the occiput to the spinous process of C7.

First, the alar ligaments cross both the AA and AO joints, therefore a misalignment of C2 will doubly effect the alignment of C1 and the occiput. Pain is created by the lack of balanced movement within the joints, as well as by a narrowing of the intervertebral foramen and pressure put on the exiting nerve roots. Next, the dural tube that surrounds the spinal cord attaches to the posterior bodies of C2 and C3.

Thus, a misalignment at C2 twists the dura mater and impedes the flow of cerebrospinal fluid to and from the brain. Because the dural tube is blended with the intracranial periosteum, and its only other lower attachment is at S2, twisting the dural tube can create headaches or hip pain.

Finally, a misalignment of C2 can misalign the rest of the cervical vertebrae through the ligamentum nuchae, but particularly C7. Not only will this cause pain in the entire neck, but irritation of the nerves going into the shoulder and arm, and misalignment of the first rib, which attaches between C7 and T1.

Releasing the alar and posterior longitudinal ligaments, as well as the ligamentum nuchae, allows C2 to move toward alignment and very quickly begins to alleviate the pain and irritation associated with a C2 misalignment. After the ligaments are released and C2 is moving toward balance, loosening the surrounding muscles is much more effective.

Dawn Lewis developed the Spontaneous Muscle Release Technique ( The goal of the Spontaneous Muscle Release Technique is to bring the body back to homeostasis, to balance any area that is out of balance. The Spontaneous Muscle Release Technique is based on passive contraction of tissue.