Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors (Multifidi) (Cervical Dysfunction)

This course describes static manual release techniques for cervical spine muscles commonly assessed as over-active and prone to trigger point development. Unfortunately, it is easy to be confused by a large number of synonyms for the terms used for these techniques. For example, the techniques described in this course may be considered refinements of neck massage, cervical massage therapy, therapeutic massage, deep tissue massage, sports massage, trigger point massage, static compression techniques, cervical soft tissue mobilization, muscle inhibitory techniques, and manual therapy techniques. Even the term trigger point is referred to by a variety of synonyms including muscle knots, nodules, adhesions, over-active muscle fibers, hypertonic fascicles, and acute points of hyper-contractility, and the trigger point phenomenon is likely part of every reference to short muscles, muscle tightness, muscle spasm, upper back stiffness, neck stiffness, etc. Part of the reason there are so many synonyms is the rich history of scientific inquiry, from multiple disciplines and cultures, that have contributed to our understanding of the techniques described in this course.

This course includes techniques for the suboccipitals, sternocleidomastoid (SCM), scalenes, and cervical extensors (multifidi) muscles. Release techniques for these muscles are commonly included in an integrated program designed to address neck pain, neck stiffness, upper back pain, scapular (shoulder blade) muscle pain, upper arm pain, and potentially radiculopathy ("pinched nerve"). These techniques may also aid in addressing poor posture correlated with the cervical spine, upper thoracic spine, scapula, and shoulder dysfunction, including forward head posture, thoracic kyphosis, and rounded shoulder posture. Last, these techniques may be beneficial when included in an integrated program designed for shoulder dysfunction (e.g. shoulder impingement syndrome), upper arm and elbow dysfunction (e.g. lateral epicondylitis), and lower back pain (lumbar spine dysfunction).

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Suboccipital Muscle Manual Static Release
• Sternocleidomastoid (SCM) Manual Static Release
• Scalenes Manual Static Release
• Deep Cervical Extensor Manual Static Release

Additional Static Manual Release Courses

• Static Manual Release: Upper Trapezius, Levator Scapulae and Splenii
• Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors
• Static Manual Release: Scapular Muscles
• Static Manual Release: Shoulder Muscles
• Static Manual Release: Trunk Muscles
• Static Manual Release: Hip Flexors
• Static Manual Release: Hip Internal Rotators
• Static Manual Release: Hip External Rotators
• Static Manual Release: Tibia External Rotators
• Static Manual Release: Lower Leg Muscles

For a review of muscle fiber dysfunction and trigger point etiology:

• Muscle Fiber Dysfunction and Trigger Points
• Trigger Point Assessment and Palpation

Pre-approved credits for:

• Integrated Manual Therapists (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Massage Therapists
• Occupational Therapists - Advanced
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

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2. Phillip Page, Clare Frank , Robert Lardner , Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
3. Shirley Sahrmann and Associates, Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spine © 2011 Mosby, Inc, an affiliate of Elsevier Inc.
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   • Deep Cervical Flexors
5. Falla, D., Jull, G., & Hodges, P. W. (2004). Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental brain research, 157(1), 43-48. (Delayed onset of DCF with arm movement)
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7. Jull, G., Barrett, C., Magee, R., & Hodges, P. (1999). Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia, 19(3), 179-185. (Decreased activity of deep cervical flexors)
8. Jull, G., Kristjansson, E., & Dall’Alba, P. (2004). Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Manual therapy, 9(2), 89-94
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10. Falla, D., O’Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Manual therapy, 12(2), 139-143
11. Jull, G.A., Falla, D., Vicenzino, B., Hodges, P.W. (2009). The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy. 14: 696-701.
12. Falla, D., O’Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Manual therapy, 12(2), 139-143
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    • Serratus Anterior
15. Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 27: 1739-1742
16. Helgadottir, H., Kristjansson, E., Einarsson, E., Karduna, A., & Jonsson, H. (2011). Altered activity of the serratus anterior during unilateral arm elevation in patients with cervical disorders. Journal of electromyography and kinesiology, 21(6), 947-953.
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    • Suboccipitals
18. Martin-Herrero, C., de Souza Rodrigues, D. P., Alburquerque-Sendin, F., Ortega-Santiago, R., & Fernández-de-Las-Peñas, C. (2012). Myofascial trigger points, pain, disability and quality of sleep in patients with chronic tension-type headache: a pilot study. Revista de neurologia, 55(4), 193-199.
19. Alonso-Blanco, C., Fernández-de-Las-Peñas, C., Fernández-Mayoralas, D. M., de-la-Llave-Rincón, A. I., Pareja, J. A., & Svensson, P. (2011). Prevalence and anatomical localization of muscle referred pain from active trigger points in head and neck musculature in adults and children with chronic tension-type headache. Pain Medicine, 12(10), 1453-1463.
20. Palacios-Ceña, M., Castaldo, M., Wang, K., Catena, A., Torelli, P., Arendt-Nielsen, L., & Fernández-de-Las-Peñas, C. (2017). Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine, 96(13).
21. Palacios-Ceña, M., Wang, K., Castaldo, M., Guillem-Mesado, A., Ordás-Bandera, C., Arendt-Nielsen, L., & Fernández-de-las-Peñas, C. (2018). Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia, 38(2), 237-245.
22. Fernández-de-las-Peñas, C., Alonso-Blanco, C., Cuadrado, M. L., & Pareja, J. A. (2006). Myofascial trigger points in the suboccipital muscles in episodic tension-type headache. Manual therapy, 11(3), 225-230.
23. Fernández-de-las-Penas, C., Ge, H. Y., Alonso-Blanco, C., González-Iglesias, J., & Arendt-Nielsen, L. (2010). Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. Journal of bodywork and movement therapies, 14(4), 391-396.
24. Fernández-de-las-Peñas, C. (2010). New evidence for trigger point involvement in tension-type headaches. Journal of Musculoskeletal Pain, 18(4), 354-360.
25. Fernández-de-las-Penas, C., Fernández-Mayoralas, D. M., Ortega-Santiago, R., Ambite-Quesada, S., Palacios-Cena, D., & Pareja, J. A. (2011). Referred pain from myofascial trigger points in head and neck–shoulder muscles reproduces head pain features in children with chronic tension type headache. The journal of headache and pain, 12(1), 35.
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27. Fernández-de-las-Penas, C., Cuadrado, M. L., Arendt-Nielsen, L., Ge, H. Y., & Pareja, J. A. (2008). Association of cross-sectional area of the rectus capitis posterior minor muscle with active trigger points in chronic tension-type headache: a pilot study. American journal of physical medicine & rehabilitation, 87(3), 197-203.
28. Giamberardino, M. A., Tafuri, E., Savini, A., Fabrizio, A., Affaitati, G., Lerza, R., … & Mezzetti, A. (2007). Contribution of myofascial trigger points to migraine symptoms. The Journal of pain, 8(11), 869-878.
29. Calandre, E. P., Hidalgo, J., García‐Leiva, J. M., & Rico‐Villademoros, F. (2006). Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?. European journal of neurology, 13(3), 244-249.
30. Fernández-de-Las-Peñas, C., Cuadrado, M. L., & Pareja, J. A. (2006). Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia, 26(9), 1061-1070.
31. Ferracini, G. N., Chaves, T. C., Dach, F., Bevilaqua-Grossi, D., Fernández-de-las-Peñas, C., & Speciali, J. G. (2016). Relationship between active trigger points and head/neck posture in patients with migraine. American journal of physical medicine & rehabilitation, 95(11), 831-839.
32. Ferracini, G. N., Florencio, L. L., Dach, F., Chaves, T. C., Palacios-Ceña, M., Fernández-de-las-Peñas, C., … & Speciali, J. G. (2017). Myofascial trigger points and migraine-related disability in women with episodic and chronic migraine. The Clinical journal of pain, 33(2), 109-115.
33. Fernández-de-Las-Peñas, C., Alonso-Blanco, C., & Miangolarra, J. C. (2007). Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Manual therapy, 12(1), 29-33.
34. Lluch, E., Nijs, J., De Kooning, M., Van Dyck, D., Vanderstraeten, R., Struyf, F., & Roussel, N. A. (2015). Prevalence, incidence, localization, and pathophysiology of myofascial trigger points in patients with spinal pain: a systematic literature review. Journal of manipulative and physiological therapeutics, 38(8), 587-600.
35. Fernández-Pérez, A. M., Villaverde-Gutiérrez, C., Mora-Sánchez, A., Alonso-Blanco, C., Sterling, M., & Fernández-de-las-Peñas, C. (2012). Muscle trigger points, pressure pain threshold, and cervical range of motion in patients with high level of disability related to acute whiplash injury. journal of orthopaedic & sports physical therapy, 42(7), 634-641.
36. Castaldo, M., Ge, H. Y., Chiarotto, A., Villafane, J. H., & Arendt-Nielsen, L. (2014). Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Medicine, 15(5), 842-849.
37. Alonso-Blanco, C., Fernández-De-Las-Peñas, C., de-la-Llave-Rincón, A. I., Zarco-Moreno, P., Galán-del-Río, F., & Svensson, P. (2012). Characteristics of referred muscle pain to the head from active trigger points in women with myofascial temporomandibular pain and fibromyalgia syndrome. The journal of headache and pain, 13(8), 625.
38. Castaldo, M., Ge, H. Y., Chiarotto, A., Villafane, J. H., & Arendt-Nielsen, L. (2014). Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Medicine, 15(5), 842-849.
39. Doraisamy, M. A., Kumar, C. P., & Gnanamuthu, C. (2010). Chronic tension type headache and the impact of myofascial trigger point release in the short term relief of headache. Global Journal of Health Science, 2(2), 238.
40. Quinn, C., Chandler, C., & Moraska, A. (2002). Massage therapy and frequency of chronic tension headaches. American journal of public health, 92(10), 1657-1661.
41. Moraska, A. F., Schmiege, S. J., Mann, J. D., Butryn, N., & Krutsch, J. P. (2017). Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. American journal of physical medicine & rehabilitation, 96(9), 639-645.
42. Rizo, A. M. H., Pascual-Vaca, Á. O., Cabello, M. A., Blanco, C. R., Pozo, F. P., & Carrasco, A. L. (2012). Immediate effects of the suboccipital muscle inhibition technique in craniocervical posture and greater occipital nerve mechanosensitivity in subjects with a history of orthodontia use: a randomized trial. Journal of manipulative and physiological therapeutics, 35(6), 446-453.
43. Sedighi, A., Ansari, N. N., & Naghdi, S. (2017). Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. Journal of bodywork and movement therapies, 21(4), 810-814.
44. Fernández-De-Las-Peñas, C., Cleland, J. A., Cuadrado, M. L., & Pareja, J. A. (2008). Predictor variables for identifying patients with chronic tension-type headache who are likely to achieve short-term success with muscle trigger point therapy. Cephalalgia, 28(3), 264-275.
45. Itoh, K., Katsumi, Y., Hirota, S., & Kitakoji, H. (2007). Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complementary Therapies in Medicine, 15(3), 172-179.
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47. Espí López, G. V., & Oliva Pascual-Vaca, A. (2012). Atlanto-Occipital Joint Manipulation and Suboccipital Inhibition Technique in the Osteopathic Treatment of Patients with Tension-Type Headache. European Journal Osteopathy & Clinical Related Research, 2012, vol. 7, num. 1, p. 10-21.
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    • Sternocleidomastoid (SCM) (19, 20, 23, 31 - 33, 35, 44)
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57. (113) Falla, D., Jull, G., Hodges, P., & Vicenzino, B. (2006). An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain. Clinical Neurophysiology, 117(4), 828-837. (SCM and Scalenes)
58. Palazzi, C., Miralles, R., Soto, M. A., Santander, H., Zuñiga, C., & Moya, H. (1996). Body position effects on EMG activity of sternocleidomastoid and masseter muscles in patients with myogenic cranio-cervical-mandibular dysfunction. CRANIO®, 14(3), 200-209.
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60. Fernández‐de‐las‐Peñas, C., Alonso‐Blanco, C., Cuadrado, M. L., Gerwin, R. D., & Pareja, J. A. (2006). Myofascial trigger points and their relationship to headache clinical parameters in chronic tension ‐type headache. Headache: The Journal of Head and Face Pain, 46(8), 1264-1272.
61. Fernández‐de‐las‐Peñas, C., Cuadrado, M. L., & Pareja, J. A. (2007). Myofascial trigger points, neck mobility, and forward head posture in episodic tension‐type headache. Headache: The Journal of Head and Face Pain, 47(5), 662-672.
62. Florencio, L. L., Ferracini, G. N., Chaves, T. C., Palacios-Ceña, M., Ordás-Bandera, C., Speciali, J. G., … & Fernández-de-las-Peñas, C. (2017). Active trigger points in the cervical musculature determine the altered activation of superficial neck and extensor muscles in women with migraine. The Clinical journal of pain, 33(3), 238-245.
63. Tali, D., Menahem, I., Vered, E., & Kalichman, L. (2014). Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: case-control study. Journal of bodywork and movement therapies, 18(4), 569-575.
64. Fernández-de-las-Peñas, C., Alonso-Blanco, C., Alguacil-Diego, I. M., & Miangolarra-Page, J. C. (2006). Myofascial trigger points and postero-anterior joint hypomobility in the mid-cervical spine in subjects presenting with mechanical neck pain: A pilot study. Journal of Manual & Manipulative Therapy, 14(2), 88-94.
65. Muñoz-Muñoz, S., Muñoz-García, M. T., Alburquerque-Sendín, F., Arroyo-Morales, M., & Fernández-de-las-Peñas, C. (2012). Myofascial trigger points , pain, disability, and sleep quality in individuals with mechanical neck pain. Journal of manipulative and physiological therapeutics, 35(8), 608-613.
66. Fernández-de-las-Peñas, C., Galán-del-Río, F., Alonso-Blanco, C., Jiménez-García, R., Arendt-Nielsen, L., & Svensson, P. (2010). Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disoders. The Journal of Pain, 11(12), 1295-1304.
67. Zuñiga, C., Miralles, R., Mena, B., Montt, R., Moran, D., Santander, H., & Moya, H. (1995). Influence of variation in jaw posture on sternocleidomastoid and trapezius electromyographic activity. CRANIO®, 13(3), 157-162.
68. Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., & Florez-Garcia, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.
69. Gerwin, R. D., Shannon, S., Hong, C. Z., Hubbard, D., & Gevirtz, R. (1997). Interrater reliability in myofascial trigger point examination. Pain, 69(1-2), 65-73.
70. Bodes-Pardo, G., Pecos-Martín, D., Gallego-Izquierdo, T., Salom-Moreno, J., Fernández-de-las-Peñas, C., & Ortega-Santiago, R. (2013). Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. Journal of manipulative and physiological therapeutics, 36(7), 403-411.
71. von Stülpnagel, C., Reilich, P., Straube, A., Schäfer, J., Blaschek, A., Lee, S. H., … & Heinen, F. (2009). Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option. Journal of child neurology, 24(4), 406-409.
72. Quinn, C., Chandler, C., & Moraska, A. (2002). Massage therapy and frequency of chronic tension headaches. American journal of public health, 92(10), 1657-1661.
73. Missaghi, B. (2004). Sternocleidomastoid syndrome: a case study. The Journal of the Canadian Chiropractic Association, 48(3), 201.
74. Roth, J. K., Roth, R. S., Weintraub, J. R., & Simons, D. G. (2007). Cervicogenic headache caused by myofascial trigger points in the sternocleidomastoid: a case report. Cephalalgia, 27(4), 375-380.
75. Cantarero-Villanueva, I., Fernández-Lao, C., Fernández-de-las-Peñas, C., López-Barajas, I. B., Del-Moral-Ávila, R., de la-Llave-Rincón, A. I., & Arroyo-Morales, M. (2012). Effectiveness of water physical therapy on pain, pressure pain sensitivity, and myofascial trigger points in breast cancer survivors: a randomized, controlled clinical trial. Pain medicine, 13(11), 1509-1519.
76. Hanten, W. P., Olson, S. L., Butts, N. L., & Nowicki, A. L. (2000). Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical therapy, 80(10), 997-1003.
77. Santander, H., Miralles, R., Pérez, J., Valenzuela, S., Ravera, M. J., Ormeño, G., & Villegas, R. (2000). Effects of head and neck inclination on bilateral sternocleidomastoid EMG activity in healthy subjects and in patients with myogenic cranio-cervical-mandibular dysfunction. CRANIO®, 18(3), 181-191.
78. Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 27: 1739-1742.
79. Graff-Radford, S. B., Reeves, J. L., Baker, R. L., & Chiu, D. (1989). Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity. Pain, 37(1), 1-5.
80. Wilke, J., Vogt, L., Niederer, D., Hübscher, M., Rothmayr, J., Ivkovic, D., … & Banzer, W. (2014). Short-term effects of acupuncture and stretching on myofascial trigger point pain of the neck: a blinded, placebo-controlled RCT. Complementary therapies in medicine, 22(5), 835-841.
81. Fernandez-Lao, C., Cantarero-Villanueva, I., Fernandez-de-las-Penas, C., Del-Moral-Avila, R., Arendt-Nielsen, L., & Arroyo-Morales, M. (2010). Myofascial trigger points in neck and shoulder muscles and widespread pressure pain hypersensitivtiy in patients with postmastectomy pain: evidence of peripheral and central sensitization. The Clinical journal of pain, 26(9), 798-806.
    • Scalenes (35, 54 - 57, 65, 68
82. Fernández-Pérez, A. M., Villaverde-Gutiérrez, C., Mora-Sánchez, A., Alonso-Blanco, C., Sterling, M., & Fernandez-de-las-Penas, C., Gröbli, C., Ortega-Santiago, R., Fischer, C. S., Boesch, D., Froidevaux, P., … & González-Iglesias, J. (2012). Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (manual) and white-collar (office) workers. The Clinical journal of pain, 28(6), 511-518.
83. Jalil, N. A., Awang, M. S., & Omar, M. (2010). Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases. The Malaysian journal of medical sciences: MJMS, 17(1), 60.
84. Treaster, D., Marras, W. S., Burr, D., Sheedy, J. E., & Hart, D. (2006). Myofascial trigger point development from visual and postural stressors during computer work. Journal of electromyography and kinesiology, 16(2), 115-124.
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