This clinical case was submitted to the Journal of Massage Science by Cheri Conklen, LMT, from Phoenix, Arizona. Cheri is a current SOMI student, and her clinical expertise and technical abilities are growing from seminar to seminar 


Cheri’s submission is an excellent illustration of clinical reasoning and the efficiency of Medical Massage therapy. It took Cheri three sessions using the skills and knowledge she’s received from SOMI training to decisively help her patient with a complex combination of somatic abnormalities.

          She correctly identified the initial trigger and addressed it with Medical Massage protocols while eliminating secondary syndromes that had formed in the patient’s body. Besides evaluation skills, Cheri exhibited the ability to combine steps from different Medical Massage protocols to develop an ideal treatment strategy for her patient. 



Dr. Ross Turchaninov, Editor in Chief 






by Cheri Conklen, LMT 

Phoenix, AZ 



The patient, 21 years old, works as a secretary. She has suffered from severe headaches, peripheral vision loss, and nausea for several weeks. She also complains about the significant restriction of ROM in the right shoulder, which locks periodically. Recently pain in the right shoulder increased, and she’s had difficulties getting dressed. She visited different medical facilities, but the treatment didn’t significantly relieve her symptoms.  




The patient has evident discomfort due to severe headaches. Further visual observation revealed significant elevation, medial rotation of the right shoulder, and restrictions in the cervical ROM.  


Applying the Cervical Compression Test ruled out acute pathology of the cervical disks. The Sensory Test was negative in all cervical dermatomes and ruled out the irritation of the peripheral nerves on her neck and upper extremity. The Wartenberg’s Test was negative, ruling out brachial plexus irritation on the anterior neck. 


Palpation indicated severe muscle spasms in the posterior cervical and upper shoulder muscles, with the epicenter of pain and tension in her paravertebral muscles on the level of C5-C6. Active trigger points were registered in the vertical portion of the trapezius, splenius capitis, and levator scapulae muscles on the right.  


Examination of the ROM in the right shoulder joint revealed active abduction only to the level of 90 degrees and very painful medial rotation. All portions of the deltoid and supraspinatus muscles were sensitive during the palpation. 


My clinical reasoning is based on the evaluation results and the nature of this patient’s job. No disk or anterior scalene muscle pathologies triggered her symptoms. Since her job entails so much computer time, she initially developed an acute spasm in her posterior cervical muscles on the C5-C6 level. As a result, her greater occipital nerve was compressed in the suboccipital space, triggering a Tension Headache. Its intensity slowly worsened until her tension headache became a severe Cluster Headache with a visual deficit and autonomic reactions in the form of nausea.

          As a reflex reaction to the acute spasm in the posterior cervical muscles and the presence of the Cluster Headache, she secondarily developed tension in the deltoid and supraspinatus muscles after initial clinical symptoms were fully active. The probability of that was increased by the innervation pattern of the deltoid muscle, which is supported by the axillary nerve originating from C5-C6 of her cervical spine. Finally, the supraspinatus muscle was innervated by the suprascapular nerve, which originates from C5-C6. 




Based on my theory and SOMI’s Medical Massage training, it is evident that control of the patient’s headache was the main priority. 


Using SOMI’s Medical Massage protocol for Chronic Headaches, I concentrated on the C5-C6 level and performed detailed work in the suboccipital space, addressing obliques capitis inferior and superior muscles. Next, I used Scalpotherapy to decompress the cranial aponeurosis. I finished the headache part of the session by working on the patient’s face and using Eye Therapy to eliminate her Cluster Headache. At this point, the patient stated that the headache was gone.  


After I deactivated trigger points in the vertical portion of the trapezius muscles as well as slenius capitis and addressed the levator scapulae at its insertions to the transverse processes of C5-C6, the patient reported a decrease of discomfort in the right shoulder. Despite Wartenberg’s Test being negative, I drained the anterior scalene muscle and passively stretched her anterior neck.  




The patient reported no headache before we started the second session after two days, and her peripheral vision was fully restored. I used the same treatment regime again but now concentrated on the right shoulder using steps from SOMI’s MMM protocol for Rotator Cuff Syndrome. 


I released protective tension in the trapezius muscle, which gave me access to the supraspinatus muscle. I finished my work on the posterior shoulder by addressing her deltoid, teres, and latissimus dorsi muscles. Before passive stretching, I used heated stones to enhance therapy additionally.  


After turning the patient on her back, I released tension in the middle and anterior portions of the deltoid muscle. I finished the decompression of the shoulder joint by working on her pectoral major and minor muscles. Elevation of the right shoulder significantly declined after passive stretching. 





After a third session combining Medical Massage protocols, all clinical symptoms were gone, and functions were restored. 


          Today the patient is free of headaches, her peripheral vision is fine, and her right shoulder is in the proper position with the full range of motion. 




About Author

           Cheri Conklen, LMT studied Massage Therapy at the Sedona School of Massage. She continued her massage education for Lomi Lomi on the island of Maui in Hawaii.

          Her most recent studies have been in Medical Massage with the Science of Massage Institute located in Phoenix, Arizona.

          She currently practices massage in Phoenix and has enjoyed helping people with massage therapy since 2010. Cheri can be reached by e-mail: 

Category: Case Studies