Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization)

Differentiation

1. The sternocleidomastoid (SCM) is a superficial muscle of the anterolateral portions of the neck. This muscle runs from the mastoid process to the manubrium of the sternum and head of the clavicle.
2. The muscle is easy to visualize when contracting. Ask the patient to flex, ipsilaterally flex, and contralaterally rotate the head, while gently resisting the skull just posterior and superior to the ear. Or, in supine, the SCM can be easily visualized by asking the patient to contralaterally rotate the head, and then lift the head of the table (flexion).
3. Getting a pincer grip on the SCM requires that the practitioner first locate the SCM, and then passively flex, ipsilaterally flex, and contralaterally rotate the head to add slack to the muscle. Once there is slack in the SCM the practitioner should be able to place an IP and thumb on either side of the SCM.
4. Special care should be taken to avoid the carotid artery; remember, if your pressing or pinching on something that "pulses" you should likely adjust your hand placement.

Potentially Sensitive Tissues

• The carotid arteries are deep to the SCM. Although momentarily compressing or abutting these vessels while investigating the area for SCM trigger points is unlikely to pose any harm, obstructing or repeatedly abrading these tissues may be an issue. Watch your patient closely for symptoms associated with rapid drops in blood pressure (cold sweats, nausea, loss of consciousness), and perhaps vertebrobasilar insufficiency (VBI) signs to be safe.

Trigger Points

• Trigger points in the SCM are common, and trigger point sites occur throughout the muscle. it is recommended that the entire muscle is investigated from the mastoid process to the sternum/clavicle.

Release Technique:

1. This technique is most comfortable with the patient lying supine and the practitioner sitting at the head of the table.
2. The practitioner slides the hand opposite the side of the treatment under the patient's head. This hand will be used to control the head and cervical spine.
3. The practitioner should then locate the SCM with the other hand, if necessary the practitioner can ask the patient to contralaterally rotate the head, and then lift the head of the table (flexion).
4. The practitioner can then passively flex, ipsilaterally flex, and contralaterally rotate the head to add slack to the muscle.
5. Once there is slack in the SCM the practitioner should be able to use a pincer grip (between thumb and flex index finger) to place an IP and thumb on either side.
   • Be careful, and explore tissues slowly. If a pulse is noticed, and current hand placement seems to press into that pulse, it is advised that the hand position is adjusted. Further, quick careless "pinching" of tissue could result in obstructing the carotid artery, in which case no pulse would result and potential harm could come to the patient.
6. Once a pincer grip on the SCM has been safely established, the practitioner can "pull-through" the fibers from posterior to anterior, to "strum" for taut bands.
7. Once a taut band is located, the length of the band is explored for a dense nodule, and consistent pressure is applied.
8. The practitioner may move the head to control the amount of tension within the muscle to aid in pinning and compressing the nodule and achieving a release.
9. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).