Name: Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization)
Uploaded: 2023-04-26T01:02:06.000Z
Duration: 13 min 49 s

English captions

https://stream.mux.com/W9jDe8pjHb2Nk237cxe01wo6bwXyVgMOlZaR11J02Qovc.m3u8

Learn optimal technique for sternocleidomastoid (SCM) static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based course provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to address SCM trigger points, reduce muscle tension, and reduce neck pain and stiffness. Perfect for clinicians and movement professionals, including physical therapists, massage therapists, athletic trainers, occupational therapists, and chiropractors, seeking to enhance their manual therapy skills for cervical spine health, rehabilitation, and performance.

Manual Techniques for Licensed Therapists

Static Manual Release of the Sternocleidomastoid

Identifying Trigger Points and Comfort Techniques

Using Pincer Grip for Safe Muscle Release

Close-Up Techniques and Muscle Anatomy

Importance of Education and Practice in Manual Therapy

Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization)

This is Brent of the Brookbush Institute in this video we're bringing you another manual technique. Now if you're watching this video I'm assuming you're watching it for educational purposes and that you are a licensed manual therapists following the laws regarding scope of practice in your state or region. That means athletic trainers, chiropractors, physical therapists, osteopaths, licensed massage therapists you are likely in the clear to do these techniques. Personal trainers this probably does not fall within your scope of practice, although you might be able to use the palpation portion of this video to aid in learning your functional anatomy in an educational setting, supervised by a licensed manual therapist. Now before we place our hands on a patient or client it is important that we assess and have a good rationale for doing so, and of course if we're going to assess then we should be reassessing to ensure that the manual technique we're using is effective and we have a good rationale for continuing to use that technique. In this video we're going to do static manual release of the sternocleidomastoid. I'm going to have my friend Melissa come out, she's going to help me demonstrate. We're going to use the same four step process we've been using for all of our manual release techniques. We're going to talk about how to differentiate this structure from the other structures around it, and it's actually fairly simple. I think this is a structure that most of you would be very visually familiar with. If i just take Melissa's head and turn it away, you can see this line right here is her sternocleidomastoid. There's actually two heads which if I follow just behind this head, I can feel the other one going into the clavicle. This head that you can see goes right into the sternocostal joint. So second step is do we have any structures around the sternocleidomastoid that could be offended, insulted or injured by compression, and the answer to that one is yeah we definitely do in this case. So a lot of people are really scared of this technique and it's because of things like the carotid artery is right behind the sternocleidomastoid. There's a lot of nerves obviously in the neck, and since we're on the front of the neck we have things like your trachea that like people don't really like getting pressed on. So we're probably not going to use anterior to posterior pressure to release the sternocleidomastoid, but there is an answer, there is a different way to release this. So let's skip to step number three, where are the common trigger points. Well it ends up the common trigger points are kind of throughout the sternocleidomastoid, ranging all the way from the mastoid process up here, so I can go just inferior the mastoid process and I can start feeling some increase in tissue density all the way down, and depending on who you're working with and what dysfunction they have, and what history they have, you'll find varied trigger points throughout. So it's going to be important to kind of search the entire muscle rather than finding a trigger point, landing on the first trigger point or increased tissue density nodule that you feel and calling it a day. You need to make sure you search the whole thing, and then of course step number four is how do i get myself and my patient comfortable so that i can hold the technique long enough, and my patient can relax. Since we're talking about the sternocleidomastoid you can probably guess that sitting up is not a great idea, the only way I'm going to get the sternocleidomastoid to relax is with her head supported; and I haven't even had that much luck with that forehead headlock position that we've done another techniques. I've tried because I have somebody in sitting and I'm trying to do a bunch of techniques all in a row, it just never really seems to work out. My suggestion is going to be to put them in supine, so go ahead and lay down, move the table up here a little bit. Now once she lays down her sternocleidomastoid is going to relax, which is a good thing. Now we just have to solve the problem of I can't put an anterior to posterior force of this muscle, that would look a little something like this, that's probably going to get me fired. I don't know about you, but I'd like to keep doing what I'm doing so let's not use anterior to posterior force. Now Travell and Simons describes a very simple way around this, which is a pincer grip. Now a pincer grip is just taking your your 2nd finger here, your index finger and curling up like this and then having your thumb and kind of pinching it in between, and if you have the other hand to kind of put behind the occiput and you kind of mess with contralateral rotation here and put her in a little flexion, her sternocleidomastoid becomes really laxed, I can start up at the mastoid process where I might be able to use a little bit more of like a lateral to medial pressure with my fingertips. But then as I can get a hold of the whole muscle I'm just going to put the muscle inside of that pincer grip, and I'm going to kind of search the tissue by strumming, I'm kind of strumming this way so I need to go from like, since this muscle is long this way, I would strum the muscle medial to lateral and i'm just kind of taking segments down at a time in my little pincer grip. These little short strokes, looking for anything that seems to have an increase in tissue density or something that feels like a nodule. Now notice guys I'm not pushing down far into her neck. I started by palpating the muscle up here really finding it, really knowing what i'm going for which i just fell off inferior and slightly anterior to the mastoid process here, and then I went into my pincer grip this way. I know some of you guys are thinking oh man he's going to kill her, he's just going to pinch off her carotid artery and game over. Well it's not that easy, to have somebody pass out like that she would probably had some symptoms first like nystagmus, or lightheadedness, or her speech would start to slur or something weird. More than that as long as I'm not going in and pinching down real hard, real fast, if I'm being gentle with these tissues and I'm just slowly increasing my pressure, I'll feel a pulse from her carotid artery before I cut off circulation. If it pulses I have the chance to move and chances are if you could do this technique and you're working on this technique you will feel a pulse at some point of time, and you will have to move over a little bit and that's okay, no damage done. I can actually feel her pulse against my thumb on this side, right at the tip of my finger which means i'm not actually squeezing her carotid artery, i'm actually squeezing her SCM more at my second knuckle and my IP of my thumb. So i know where her carotid artery is. I found my densest fascicles here. I'm finding a little bit of a nodule of increased density right here about a centimetre, two centimeters below her mastoid process there, and I'm just going to hold it until it releases, that's it. How bad is this? Not bad at all. It's a little less comfortable if somebody has a trigger point down here, be warned but like I said if you start up here at the mastoid process, you fall off, you get a good idea of where that muscle is and you slowly take out little parts, not take out but slowly strum little sections of that muscle with your thumb and be careful when you feel a pulse, I think you guys will find this technique is not that uncomfortable. If you want you can even add a little stretch to the tissue by going back into contralateral flexion, or back into ipsilateral lateral rotation. This muscle is definitely very related to arthrokinematic inhibition, and you will see an increase in tonicity if somebody's sternal clavicular joint it is really locked up or really hypermobile, so be aware of that as you get down here. It's always worth kind of checking on the how stiff that joint is, kind of in conjunction with this technique. Stay tuned for the close up recap. All right so here we go with our close-up recap of the sternocleidomastoid static manual release. I'll show you guys a real easy way to find the sternocleidomastoid, if I contralaterally rotate Melissa's head here and then have her try to lift her head off the table, you can see that sternocleidomastoid just pops right out and then I can place my pincer grip right over the top of her sternocleidomastoid at her mastoid process, tilt her head back and now we're in a nice relaxed position. I'll keep her in a little contralateral rotation just to keep some slack off this muscle, and then I'm just going to do my little medial to lateral strokes, looking for those densest fascicles, and then once I find an area of increased activity I can move a little bit proximal or a little superior and inferior. Keep in mind you want to be pretty close to where you think that nodule is before you start just kind of rubbing up and down the muscle, because you don't want to take a bunch of skin with you that's going to be really uncomfortable. if I go right here and then I just moved a little superior there and I found a little point of hyperactivity, and I'm just going to keep my pincer grip right where it is until I feel a release. Note I am not laying my hand on top of Melissa's neck, there's no weight from anterior to posterior on her neck that would make her feel like she's being choked, or like I'm putting pressure on her trachea. I can feel the pulse of her carotid artery a little bit on just medial to my thumb, and so for the most part the carotid artery is medial to the sternocleidomastoid. That doesn't mean I'm compressing the carotid artery, it doesn't mean that she's going to pass out. It doesn't mean I'm doing any damage, like I said I can just kind of feel the pulse which is probably a good sign that i shouldn't press any further medialy, I shouldn't press any further anterior to posterior but I'm okay. I can just check the rest of the muscle here, you're sternocleidomastoid does get trigger points throughout its entire length. It's a little hard to identify where the most common point would be, I do find that near the mastoid process some trigger points often get hidden and they are a little easier to get to up here, you have less chance of compressing the carotid artery and the muscles a little easier to grab up here so that helps. If I wanted to I could add a little bit of tension by going back into ipsilateral rotation and contralateral flexion just like so if I thought that would help pin down tissues, or add enough tension to to maybe stimulate a stretch, an autogenic inhibition. So there you have it knowing your functional Anatomy will definitely help your manual technique. It'll help you differentiate structures so that you can place your hands where they need to be, as well as make you aware of these sensitive structures around the tissue that you're trying to target; things like nerves and lymph nodes, and arteries. Make sure that if you're going to place your hands on a patient that you have done an assessment and have a good rationale for placing your hands on that patient, and if you're going to assess make sure you reassess to ensure that your technique was effective and you have a good rationale for using that technique again. Now with manual therapy one-on-one live education is incredibly important, please be looking for opportunities like workshops and mentorships and maybe even classes at your local university that can get you some one on one individual instruction, or at least some live classroom instruction so you've had a chance to be critiqued and mentored by somebody senior to you with some experience in manual therapy techniques; and before you bring this stuff back to your rehab, fitness or performance setting please practice on colleagues. There is no substitute for practice and it is going to take a while to get accustomed to some of the techniques that we show in these manual technique videos. Don't expect to learn them in two or three or even five minutes, you want to have hours of experience under your belt working on various different body sizes and shapes, so that when you do get that first paying client, first paying customer and you're really trying to make a good positive impact, really trying to promote better outcomes, you feel comfortable with that technique. I look forward to hearing about your outcomes and hearing your questions in the comments section of this video. I'll talk with you soon.

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Manual release techniques for the commonly overactive muscles of the cervical spine. Soft tissue release techniques for the suboccipitals, sternocleidomastoid (SCM), scalenes, and cervical extensors (multifidi). Advanced soft tissue, massage, trigger point palpation, and mobilization techniques to inhibit antagonists. The reliability and validity of manual release techniques for forward head, shoulders elevate, neck pain, shoulder pain, headache, and upper body dysfunction.

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

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.

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).

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.

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.

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

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.

This technique is most comfortable with the patient lying supine and the practitioner sitting at the head of the table.

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.

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).

The practitioner can 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 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.

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.

Once a taut band is located, the length of the band is explored for a dense nodule, and consistent pressure is applied.

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.

Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization)

Infraspinatus and Teres Minor Static Manual Release (Soft Tissue Mobilization)

Rhomboid Static Manual Release (Soft Tissue Mobilization)

Pectoralis Major and Subclavius Static Manual Release (Soft Tissue Mobilization)

Erector Spinae and Multifidus Static Manual Release

Levator Scapulae Static Manual Release (Soft Tissue Mobilization)

Splenius Cervicis and Splenius Capitis Static Manual Release (Soft Tissue Mobilization)

Deep Cervical Extensor Static Manual Release (Soft Tissue Mobilization)

Scalene Static Manual Release (Soft Tissue Mobilization)

Suboccipital Manual Static Release (Soft Tissue Mobilization)

Quadratus Lumborum Manual Static Release

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