Listen to the word as you say it: sternocleidomastoid. Even its name is special; six syllables rhyming with themselves in a three-beat cadence that rolls off the tongue like no other anatomical name.
And whether you hear this unique muscle’s name as a rapper’s multisyllabic rhyme, a poet’s lyrical trochee, or simply as a mouthful of Latin jargon, your hands-on work with the sternocleidomastoids (less poetically known as the SCMs) can be a crucial part of addressing many client complaints, including cervical pain and stiffness, the effects of whiplash (Image 1), jaw issues, and several other primary indications as listed on page 110. In addition to that list, hands-on work with the SCMs has also been said to help with a host of other less-obviously related conditions, such as facial, sinus, and nasal pain; vertigo, dizziness, and car sickness; tinnitus and hearing loss; upper-chest soreness; persistent coughs; swallowing difficulties and throat pain; and more.1
Not only is the SCM implicated in an extraordinarily large number of client complaints, it is also involved in many (if not all) head and neck movements. Connecting the cranium to the shoulder girdle and axial skeleton by wrapping diagonally around the neck, the SCMs lift the sternum and clavicles; turn, bend, and flex the cervical spine; and extend, rotate, and tilt the head.
No other neck muscles seem quite as sensitive as the SCMs, probably due to the many nerves associated with them and their enveloping connective tissues—the outer (or investing) layers of the deep cervical fascia (Image 2). This multilayered fibrous membrane also encloses the trapezius, as well as the muscles of mastication (masseter, pterygoids, temporalis), and is perforated by, enfolds, and interfaces with numerous sensory and motor nerves (Image 3). For example, the deep cervical fascia of the SCM’s inner interface forms part of the carotid sheath, which surrounds the vagus nerve (Image 2), the main parasympathetic trunk. The SCM’s inner fascia also gives rise to the prevertebral fascia, which extends across the anterior surfaces of the cervical vertebrae.2 Injury to the prevertebral fascia and its associated sympathetic ganglia is thought to be a physical cause of the dizziness, anxiety, and other sympathetic autonomic disturbances sometimes seen after hyperextension whiplash injuries.3
And although pain (especially chronic pain) can have many aspects in addition to any tissue-based contributors, the SCM’s fascial layers seem to be involved in many cases of chronic neck pain. In a recent randomized clinical trial comparing the cervical fascia in people with and without chronic neck pain, the fascia of the SCM (and medial scalene) was, on average, significantly thicker and stiffer in those with pain. Fascia-oriented manual therapy was seen to improve both these measures; tissue thickness, stiffness, and reported pain all decreased as a result of hands-on fascial work.4
SCM Differentiation Technique
In the Advanced Myofascial Techniques series taught by the Advanced-Trainings.com faculty, we use the SCM Differentiation Technique in our “cold” whiplash protocol, which is most appropriate only after any initial autonomic reactivity and muscle spasm have diminished (usually several weeks or more after the initial injury, though sometimes longer). It can be used cautiously and very gently with mild “hot” whiplash, but only when there is an absence of muscular spasm so as to avoid aggravating the already irritated condition. This technique is also useful any time we want to increase the client’s ability to move the neck and head without undue contraction or dominance by the SCM, since the technique’s purpose is to gently differentiate the outer layers of the neck and simultaneously teach new, easier movement possibilities.
Start with your client side-lying, without a pillow if that’s comfortable, as this allows you to work the upper SCM in a slightly lengthened (eccentric) state (Images 4 and 5). Because the technique does not involve sliding on the skin, too much oil or lubricant will make this technique difficult to perform. Follow the video link and the instructions on page 109, and pay special attention to gentleness, patience, and increasing client awareness, rather than just on tissue effects alone. Finish by repeating the technique in a seated position to help the client apply a new awareness to an upright posture. Performed correctly, this technique will leave your client enjoying lighter, easier, and more comfortable movement.
Key Points: SCM Differentiation Technique
Indications
• Neck pain or stiffness.
• “Cold” whiplash (3–6 weeks or more since injury; no muscular spasms).
• Positional or postural issues, such as head-forward position or torticollis.
• Headaches: both tension-type and migraines.
• Jaw pain, tension, and temporomandibular joint dysfunction.
• Other indications, as described in the text.
Purpose
• Increase elasticity and layer differentiation of the deep cervical fascia, especially under (medial to) the SCM.
• Reduce and reeducate SCM tonus by refining proprioceptive coordination of SCM engagement in movement initiation.
Instructions
• After other preparatory work, use gentle, specific, and static (not sliding) pressure medial and deep to the SCM.
• Cue active client movements, as described below.
• Monitor the client’s comfort and ability to fully relax, and modulate pressure and pace accordingly.
Movements
• While maintaining SCM relaxation, the client slowly looks left and right with just the eyes.
• Once the ability to move the eyes with relatively relaxed SCM is established, add slow, gentle neck rotation, looking for ways to move the head without overcontracting the SCM.
• Possible cues: “Let the back of your head turn as much as the front,” “Leave your head heavy,” “Use your eyes instead of your muscles to start the movement,” etc.
• Repeat with the client sitting or standing.
Homework
• Practice head rotation with relaxed SCM when side-lying, seated, and standing, with special attention to initiation of movement without overcontraction of the SCM.
For More Learning
• “Neck, Jaw & Head” and “Whiplash” in the Advanced Myofascial Techniques series of workshops and video courses.
• Advanced Myofascial Techniques, Volume 2, chapters 8–10 (Handspring, 2016).
Notes
1. C. M. Shifflett, Migraine Brains and Bodies (Berkeley: North Atlantic Books, 2011).
2. Yvonne Chan and John C. Goddard, K. J. Lee’s Essential Otolaryngology, 10th ed. (New York: McGraw-Hill, 2012): 559–60.
3. Topical Issues in Pain 3: Sympathetic Nervous System and Pain, Pain Management, Clinical Effectiveness, ed. Louis Gifford (Bloomington, IN: AuthorHouse UK, 2013): 34.
4. A. Stecco et al., “Ultrasonography in Myofascial Neck Pain: Randomized Clinical Trial for Diagnosis and Follow-Up,” Surgical and Radiologic Anatomy 36, no. 3 (April 2014): 243–53.
Til Luchau is a Certified Advanced Rolfer, the author of Advanced Myofascial Techniques (Handspring Publishing, 2016), and a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout North America and abroad. Contact him via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.