The Sternocleidomastoid (or SCM) is a muscle in the neck region that runs obliquely along the side of the neck in an inferomedial and anterior direction. This muscle flexes and rotates the head. It also acts as an accessory muscle for inspiration.
The muscle has two heads: (1) The sternal head and (2) the clavicular head, and its name is derived from its three attachment sites: the sternum (sterno), the clavicle (cleido), and the mastoid process (mastoid).
In figure 1.1, the SCM is the muscle illustrated on the left side of the image (the client’s right)
- Inferior Attachment Site:
- The Sternal Head attaches to the anterior surface of the manubrium of the sternum.
- The Clavicular Head attaches to superior surface of the medial 1/3 of the clavicle.
- Superior Attachment Site:
- Both heads of the SCM attach to the Mastoid Process, and the lateral half of the Superior Nuchal Line.
(Acting bilaterally) the SCM flexes the neck.
(Acting Unilaterally) it flexes, ipsilaterally side flexes, and contrilaterally rotates the neck
Caution: make sure to assess the structures carefully in the neck region prior to performing the following techniques. Also, ensure that the tissue has been adequately warmed up before performing any deep techniques.
1. MYOTONIC RELEASE
- Objective: To reduce and eliminate contractures and adhesions found in your client’s SCM muscle. Contractures and adhesions in the SCM can result from chronic repetitive strain injuries, overuse injuries, whiplash, and other injuries to the muscles or other structures in the neck region.
- Positioning: Have your client lying supine, in a relaxed state. Stand at the head of the table, and passively bring your client’s head into a position of flexion, ipsilateral side flexion, and contrilateral rotation. This will place the SCM in a maximally shortened position.
- Technique: First, ask your client to help support the weight of his head for a second or two. This action will activate the SCM, allowing you to locate the muscle visually. (figure 2.1).
- Once you have visually located the muscle, squeeze the inferior end of the muscle by placing it between your index finger and your middle finger. (see Figure 2.2) Begin to strip superiorly along the length of the muscle, slowly moving towards its attachment site on the mastoid process, all the while, maintaining your squeeze pressure on the muscle.
- As you strip superiorly along the muscle, slowly move your client’s neck into contrilateral side flexion, ipsilateral rotation, and slight extension. This motion will lengthen the SCM while the strip is being performed. At the end of the myotonic strip technique, your contact hand should be on the superior end of the muscle at the mastoid process. (Figure 2.3). Hold your contact at the end of the movement for approximately 3-5 seconds. Repeat this stroke for a total of 3-4 passes.
This myotonic technique is an extremely effective technique in addressing contractures, adhesions, and trigger points in your clients’ SCM muscle. In addition, this technique simultaneously adds a range of motion element to the joints in the C/Spine, as well as a stretch element to the SCM muscle itself.
2. ISCHEMIC COMPRESSION
- Objective: To release trigger points (hyperirritable bands within the muscle belly) in the sternal head of the SCM. Trigger points can occur in muscles due to injury (to the muscle itself or to other structures in the neck region), or due to overuse. They are a source of local as well as referred pain, and they reduce the flexibility, strength, and overall functionality of the muscle.
- Positioning: Ask your client to lie supine on the table, fully relaxed. To perform this ischemic compression to the SCM, you should be standing (or seated) at the head of the massage table.
- Technique: First, locate the trigger point. To locate a trigger point in the SCM, palpate the muscle to feel for a taut band or a twitch response in the muscle belly. (A common location of SCM trigger points is in the mid to inferior region of the muscle belly of the sternal head). Once you have located the trigger point, apply an ischemic compression by gradually squeezing the trigger point between your thumb and index finger. The client may feel referred pain around the cheek and into the maxilla, over the supraorbital ridge above the eye, and deep within the orbit of the eye (see figure 3.1). Keep in communication with your client, checking to ensure that you are staying within the limits of his pain tolerance. Hold this technique for approximately 20 seconds to 1 minute, until your client tells you the pain has diminished, or until you feel the muscle fibres begin to relax under your pressure. Once you feel this release, gradually release your pressure. Once you have released your pressure, apply a few effleurage strokes to flush out the area, and then follow up with a passive stretch to the muscle.
3. PASSIVE STRETCH:
- Objective: to lengthen the SCM muscle. This will help reduce pain from trigger points and muscle tension. As well, it will improve the flexibility, strength, and overall functionality of the muscle by reducing contractures and adhesions, and by helping to functionally realign scar tissue that has been treated with friction techniques.
- Positioning: As with many techniques for the SCM, the best positioning for a stretch to your client’s SCM is to have him once again, lying supine with his head in a neutral position, and his neck muscles fully relaxed. As the therapist, you will begin your technique standing at the head of the table supporting the clients head and neck with both hands.
- Technique: To stretch the SCM muscle, slowly bring your clients head from the neutral position into a position of ipsilateral rotation, contrilateral side flexion, and slight extension. Make sure to perform this stretch in a gentle, sustained manner, and within your client’s pain tolerance. If your client feels pain, then you have gone too far with the stretch. Also check in with your client during the stretch to ensure that he is breathing properly. Hold this stretch for approximately 30 seconds, and then gradually release the stretch by returning your client’s head back into a neutral position. Repeat this stretch a total of 3 times.
In figure 4.1, The therapist is highlighting the SCM muscle in its stretched position.
The techniques highlighted in this article are courtesy of The Massage Students Video Guide – Video 1: The Torso, By: www.RMTstudents.com, The #1 Online Study Centre for Massage Students.
Dwayne Gray, RMT, is president of RMTstudents.com Inc. He is a 2003 Graduate of the 2,200-hour Massage Therapy program at ICT Kikkawa College in Toronto. Dwayne has certified in Active Release Techniques, Hot Stone Massage, Ultrasound Therapy, TENS, and IFC Therapy. He has owned a successful sports injury clinic in Burlington, Ontario, managed the world’s largest team of Registered Massage Therapists under one roof (50) with the Brydson Group, in Toronto, and now independently performs injury rehab treatments in Pickering, ON, while continuing to work to build RMTstudents.com for massage students. He can be contacted through www.RMTstudents.com.