Sternocleidomastoid Sydrome and Trigger Points

Original Editor - Milijana Delevic

Lead Editors  

Clinically Relevant Anatomy

Sternocleidomastoid is the most superficial and largest muscle in the front portion of the neck. It is also known as SCM or Sternomastoid or Sterno muscle. The name has the origin of the Latin words: sternon = chest; cleido=clavicle and the Greek words: mastos= breast and eidos=shape, form.

It is built of two heads, sternal (medial) and clavicular (lateral), and both of them can develop trigger points of interest for physical therapy. Here are some more details about the anatomy of SCM and trigger points in general.

Pathological Process

When SCM gets irritated for different reasons, can directly lead to a condition called Sternocleidomastoid Syndrome.

Definition of Sternocleidomastoid Syndrome

An acute or chronic condition of neck stiffness with decreased mobility (especially rotation), sometimes followed by aches and pains in neck and/or pains in body areas distant from the neck (eyes, temples, throat, ears, nose, shoulders...), nausea, tinnitus, vertigo, torticollis[1].

Following symptoms

- frequent headaches, ptosis, unexplained lacrimation and eye reddening, sinusitis and sore throat, ipsilateral ear popping sounds, balance problems, postural dizziness, lowered spatial awareness

Causes of SCM Syndrome

- poor posture (Upper Crossed Pattern), inadequate work posture and ergonomics, aging, pillow height, frequent sleeping on a stomach, neck trauma (whiplash), certain occupations (violinists), weightlifting, incorrect swimming styles, too abrupt performing of sit-ups, anxiety, stress, hyperventilation syndrome[2]

Aging and SCM Syndrome

Physiologically, our body tries to keep the eyes and ears at the same level over the years. The head is heavy (approximately 5,5 kg) and aging helps losing muscle tone and strength of all muscles, including SCM which results in forward-head posture and rounded shoulders. Rounded shoulders often have their roots in a short sternocleidomastoid. That influence straight off postural and gait changes, decompensations, and kinetic chain pain[3].

Trigger points in SCM

Any changes in the SCM muscle can be associated with Trigger Points (TPs) whom can be the cause itself or the consequence of the syndrome. If present,TPs are oftentimes found as well in the upper Trapezius. If TP is active within SCM, it can broadcast the referral pain often away from the SCM muscle.

  1. In the sternal head of SCM, there are usually 4 TPs which can give issues as ptosis, blurred vision, sinus headaches and referred pain pattern is more superficial and gives a pain in occiput, throat, eye, sinus, cheek, eyebrow.
  2. In the clavicular head of SCM rest 3 TPs which can give issues with pain in forehead, ear and mastoid zone, nausea, vertigo, ataxia, dizziness. Often, there is a triad of concomitant symptoms like dizziness, frontal headache, and dysmetria (lack of coordination of movement).

Clinical Presentation

People with SCM Syndrome often suffer from very different symptoms, because of which they often lose a lot of time visiting various specialists in medicine. They may complain of one or more symptoms sequentially, and neck pain and stiffness do not have to be reported as a problem.

Differential Diagnosis

Atypical cervical neuralgia, Meniere’s disease. Tic douloureux. Congenital and spasmodic torticollis. Vascular headache. Arthritis of the sternoclavicular (S/C) joint[4].Trigeminal neuralgia. Facial neuralgia. Vestibulocochlear problems. Lymphadenopathy. Active TPs in Levator Scapulae, upper Trapezius and Splenius Capitis[2]. Fibromyalgia. Cervical sprain and strain. Cervical disc disorders.

Management / Interventions

To begin with, it's important to find the cause of SCM Syndrome.

  • If the syndrome is caused by stress and anxiety, stress-relieving techniques can usually resolve the problem: meditation, relaxation, yoga, light bodyweight exercises, breathing techniques.
  • If the syndrome is caused by poor posture, physical therapy can help to fix and improve the posture and to give advice on daily life activities[5].
  • If the condition is serious and chronic, it requires more time and application of physiotherapy procedures. Most commonly used are:
  1. deep stroking massage of SCM and neck,
  2. application of warm packs (if there is not presented any inflammation in the region of the neck),
  3. TPs treatment using ischemic compression technique (ICT) and pincer-grip (also, dry needling, muscle energy for SCM[6], positional release),
  4. stretching of both heads separately after TPs treatment,
  5. strengthening of the neck (should be used only isometric exercise in any neck strengthening exercise),
  6. self-massage and daily stretching.

References

  1. Weeks VD, Travell J. Postural vertigo due to trigger areas in the sternocleidomastoid muscle. The Journal of pediatrics. 1955 Sep 1;47(3):315-27.
  2. 2.0 2.1 Niel-Asher, Simeon. The Concise Book of Trigger Points: a professional and self-help manual. 3rd ed. Chichester: Lotus Publishing, 2014.
  3. Chaitow L, Gilbert C, Bradley D. What are breathing pattern disorders. Recognizing and treating breathing disorders: a multidisciplinary approach. London, Churchill Livingstone. 2014 Jul 7:1-0.
  4. NAMTPT. Symptom Checker. Sternocleidomastoid.www.myofascialtherapy.org/symptom-checker/symptomcheck/symptom_upper_sternocleidomastoid.html (accessed 16 June 2018).
  5. Study.com. Sternocleidomastoid Syndrome: Symptoms & Treatment www.study.com/academy/lesson/sternocleidomastoid-syndrome-symptoms-treatment.html (accessed 15 June 2018).
  6. Niel Asher Continuing Professional Education. Trigger Point Therapy. Muscle Energy Techniques for the SCM and the Scalenes www.nielasher.com/blogs/video-blog/trigger-point-therapy-muscle-energy-techniques-for-the-scm-and-the-scalenes (accessed 30 March 2018)