Sternocleidomastoid Syndrome and Trigger Points

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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 anatomy of SCM [1] and trigger points in general [2].

Pathological Process

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

Definition of Strenocleidomastoid Syndrome

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.

Follow-up 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

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 (initially tight SCM muscle and eventually SCM Syndrome). That influence straight off postural and gait changes, decompensations and kinetic chain pain.

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 dysmetry.

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 of medicine. They may complain of one or more symptoms sequentially, and neck pain and stiffness do not have to be reported as a problem.

Management / Interventions

To begin with, it's important to find the cause of SCM Syndrome. For example, if the syndrome is caused by stress and anxiety, stress-relieving techniques like meditation, relaxation, yoga, light body weight exercises and breathing techniques can usually resolve the problem. If the syndrome is caused by poor posture, physical therapy can help to fix and to improve the posture and giving advice on daily life activities. If the condition is serious and chronic, it requires more time and application of physiotherapy procedures. Most commonly used are: deep stroking massage of SCM and neck, application of warm packs (if there is not presented any inflammation in the region of the neck), TPs treatment using compression technique and pincer-grip (also, dry needling,muscle energy, positional release), stretching of both heads separately (clavicular head stretches through opposite side flexion and extension, while sternal head stretches across opposite rotation), strengthening of the neck (should be used only isometric exercise in any neck strengthening exercise).

Differential Diagnosis

Facial and trigeminal neuralgia. Vestibulocochlear disorders. Active TPs in Levator Scapulae, upper Trapezius and Splenius Capitis. Fibromyalgia. Cervical sprain and strain. Cervical disc disorders.

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