Sternocleidomastoid Syndrome and Trigger Points

Definition of Sternocleidomastoid Syndrome[edit | edit source]

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

Clinically Relevant Anatomy[edit | edit source]

Sternocleidomastoid muscle (highlighted in green) - lateral view

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) head and clavicular (lateral) head, and both of them can develop trigger points. Here are more details about the anatomy of SCM and trigger points in general.

Image: Sternocleidomastoid muscle (highlighted in green) - lateral view [2]

Causes of SCM Syndrome[edit | edit source]

Poor posture (Upper Crossed Pattern), 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 and hyperventilation syndrome[3]

Symptoms[edit | edit source]

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

Aging and SCM Syndrome[edit | edit source]

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 lead to loss of muscle tone and strength of all muscles, including SCM which results in forward-head posture and rounded shoulders. That influence straight off postural and gait changes, decompensations, and kinetic chain pain[4].

Trigger points in SCM[edit | edit source]

Any changes in the SCM muscle can be associated with Trigger Points (TPs) which can be the cause itself or the consequence of the syndrome. If present,TPs are oftentimes found also in the upper Trapezius. If TPs are active within SCM, pain can be referred 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. The 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).

Differential Diagnosis[edit | edit source]

Management / Interventions[edit | edit source]

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[6].
  • 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[7], positional release)
  4. Stretching of both heads separately after TPs treatment
  5. Strengthening of the neck (only isometric neck exercise in any neck strengthening exercises should be done)
  6. Self-massage and daily stretching.

Resources[edit | edit source]

This two minute video is a good summary of the sternocleidomastoid muscle. [8]

References[edit | edit source]

  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. Sternocleidomastoid muscle (highlighted in green) - lateral view image - © Kenhub
  3. 3.0 3.1 Niel-Asher, Simeon. The Concise Book of Trigger Points: a professional and self-help manual. 3rd ed. Chichester: Lotus Publishing, 2014.
  4. 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.
  5. NAMTPT. Symptom Checker. (accessed 16 June 2018).
  6. Sternocleidomastoid Syndrome: Symptoms & Treatment (accessed 15 June 2018).
  7. Niel Asher Continuing Professional Education. Trigger Point Therapy. Muscle Energy Techniques for the SCM and the Scalenes (accessed 30 March 2018)
  8. Sternocleidomastoid muscle video - © Kenhub