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Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization)
Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization) is a type of treatment used to improve mobility and reduce pain in the sternocleidomastoid (SCM) muscle. It is a gentle, manual technique that targets the soft tissue along the SCM muscle. During the procedure, the therapist uses their hands to gently release the knotty areas using long, relaxing strokes. The manual release can help to alleviate tension, reduce tightness,
Transcript
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This is Brent of the Brookbush
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...blank
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Institute in this video we're bringing
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you another manual technique. Now if
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you're watching this video I'm assuming
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you're watching it for educational
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purposes and that you are a licensed
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manual therapists following the laws
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regarding scope of practice in your
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state or region. That means athletic
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trainers, chiropractors, physical
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therapists, osteopaths, licensed massage
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therapists you are likely in the clear
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to do these techniques. Personal trainers
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this probably does not fall within your
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scope of practice, although you might be
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able to use the palpation portion of
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this video to aid in learning your
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functional anatomy in an educational
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setting, supervised by a licensed manual
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therapist. Now before we place our hands
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on a patient or client it is important
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that we assess and have a good rationale
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for doing so, and of course if we're
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going to assess then we should be
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reassessing to ensure that the manual
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technique we're using is effective and
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we have a good rationale for continuing
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to use that technique. In this video
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we're going to do static manual release
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of the sternocleidomastoid. I'm going to
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have my friend Melissa come out, she's
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going to help me demonstrate. We're going
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to use the same four step process we've
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been using for all of our manual release
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techniques. We're going to talk about how
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to differentiate this structure from the
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other structures around it, and it's
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actually fairly simple. I think this is a
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structure that most of you would be very
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visually familiar with. If i just take
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Melissa's head and turn it away, you can
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see this line right here is her
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sternocleidomastoid. There's actually two
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heads which if I follow just behind this
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head, I can feel the other one going into
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the clavicle. This head that you can see
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goes right into the sternocostal joint.
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So second step is do we have
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any structures around the
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sternocleidomastoid that could be
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offended, insulted or injured by
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compression, and the answer to that one
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is yeah we definitely do in this
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case. So a lot of people are really
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scared of this technique and it's
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because of things like the carotid
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artery is right behind the
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sternocleidomastoid. There's a lot of
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nerves obviously in the neck, and since
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we're on the front of the neck we have
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things like your trachea that like
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people don't really like getting pressed
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on. So we're probably not going to use
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anterior
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to posterior pressure to release the
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sternocleidomastoid, but there is an
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answer, there is a different way to
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release this. So let's skip to step
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number three, where are the common
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trigger points. Well it ends up the
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common trigger points are kind of
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throughout the sternocleidomastoid,
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ranging all the way from the mastoid
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process up here, so I can go just
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inferior the mastoid process and I can
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start feeling some increase in tissue
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density all the way down, and depending
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on who you're working with and what
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dysfunction they have, and what history
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they have, you'll find varied trigger
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points throughout. So it's going to be
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important to kind of search the entire
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muscle rather than finding a trigger
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point, landing on the first trigger point
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or increased tissue density nodule that
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you feel and calling it a day. You
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need to make sure you search the whole
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thing, and then of course step number
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four is how do i get myself and my
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patient comfortable so that i can hold
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the technique long enough, and my patient
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can relax. Since we're talking about the
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sternocleidomastoid you can
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probably guess that sitting up is not a
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great idea, the only way I'm going to get
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the sternocleidomastoid to relax is with
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her head supported; and I haven't
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even had that much luck with that
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forehead headlock position that we've
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done another techniques. I've tried
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because I have somebody in sitting and
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I'm trying to do a bunch of techniques
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all in a row, it just never really seems
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to work out. My suggestion is going to be
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to put them in supine, so go ahead and lay
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down,
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move the table up here a little bit. Now once
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she lays down her sternocleidomastoid is
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going to relax, which is a good thing. Now
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we just have to solve the problem of I
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can't put an anterior to posterior
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force of this muscle, that would
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look a little something like this, that's
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probably going to get me fired. I don't
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know about you, but I'd like to keep
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doing what I'm doing so let's not use
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anterior to posterior force. Now Travell
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and Simons describes a very simple way
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around this, which is a pincer grip. Now a
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pincer grip is just taking your your 2nd
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finger here, your index finger and
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curling up like this and then having
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your thumb and kind of pinching it in
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between, and if you have the other hand
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to kind of put behind the occiput and
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you kind of mess with contralateral
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rotation here and put her in a little
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flexion, her sternocleidomastoid becomes
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really laxed, I can start up at the
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mastoid process where I might be able to
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use a little bit more of like a lateral to
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medial pressure with my fingertips. But
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then as I can get a hold of the whole
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muscle I'm just going to put the muscle
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inside of that pincer grip, and I'm going
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to kind of search the tissue by
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strumming, I'm kind of strumming this
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way so I need to go from like, since this muscle
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is long this way, I would strum the
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muscle medial to lateral and i'm
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just kind of taking segments down at a
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time in my little pincer grip. These
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little short strokes, looking for
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anything that seems to have an increase
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in tissue density or something that
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feels like a nodule. Now notice guys
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I'm not pushing down far into her neck. I
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started by palpating the muscle up here
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really finding it, really knowing what
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i'm going for which i just fell off
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inferior and slightly anterior to the
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mastoid process here, and then I went
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into my pincer grip this way. I know
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some of you guys are thinking oh man
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he's going to kill her, he's just going to
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pinch off her carotid artery and game
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over. Well it's not
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that easy, to have somebody pass out like
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that she would probably had some
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symptoms first like nystagmus, or
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lightheadedness, or her speech would
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start to slur or something weird.
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More than that as long as I'm not going
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in and pinching down real hard,
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real fast, if I'm being gentle with these
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tissues and I'm just slowly increasing
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my pressure, I'll feel a pulse from her
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carotid artery before I cut off
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circulation. If it pulses I have the
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chance to move and chances are if you
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could do this technique and you're
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working on this technique you will feel
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a pulse at some point of time, and you
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will have to move over a little bit and
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that's okay, no damage done. I can
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actually feel her pulse against my thumb
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on this side, right at the tip
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of my finger which means i'm not
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actually squeezing her carotid
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artery, i'm actually squeezing her SCM
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more at my second knuckle and
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my IP of my thumb. So i know where her
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carotid artery is. I found my densest
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fascicles here. I'm finding a little bit
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of a nodule of increased density right
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here about a centimetre, two centimeters
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below her mastoid process there, and
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I'm just going to hold it until it
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releases, that's it. How bad is this? Not
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bad at all. It's a little less
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comfortable if somebody has a trigger
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point down here, be warned but like I
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said if you start up here at the mastoid
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process, you fall off, you get a good idea
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of where that muscle is and you slowly
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take out little parts, not take out
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but slowly strum little sections of that
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muscle with your thumb and be careful
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when you feel a pulse, I think you guys
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will find this technique is not that
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uncomfortable.
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If you want you can even add a little
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stretch to the tissue by going back into
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contralateral flexion, or back into
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ipsilateral lateral rotation.
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This muscle is definitely very related to arthrokinematic
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inhibition, and you will see an increase
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in tonicity if somebody's sternal
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clavicular joint it is really locked up
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or really hypermobile, so be aware of
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that as you get down here. It's always
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worth kind of checking on the how
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stiff that joint is, kind of in
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conjunction with this technique. Stay
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tuned for the close up recap. All right
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so here we go with our close-up recap of
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the sternocleidomastoid static manual
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release. I'll show you guys a real easy way to
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find the sternocleidomastoid, if I
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contralaterally rotate Melissa's head
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here and then have her try to lift her
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head off the table, you can see that
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sternocleidomastoid just pops right
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out and then I can place my pincer grip
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right over the top of her
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sternocleidomastoid at her mastoid
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process, tilt her head back and now
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we're in a nice relaxed position. I'll
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keep her in a little contralateral
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rotation just to keep some slack off
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this muscle, and then I'm just going to
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do my little medial to lateral strokes,
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looking for those densest fascicles,
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and then once I find an area of
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increased activity I can move a little bit
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proximal or a little superior and
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inferior. Keep in mind you want to
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be pretty close to where you
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think that nodule is before you start
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just kind of rubbing up and down the
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muscle, because you don't want to take a
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bunch of skin with you that's going to
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be really uncomfortable. if I go right
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here and then I just moved a little superior
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there and I found a little point of
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hyperactivity, and I'm just going to keep
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my pincer grip right where it is until I
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feel a release. Note I am not laying my hand
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on top of Melissa's neck, there's no weight
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from anterior to posterior on her
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neck that would make her feel like she's
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being choked, or like I'm putting
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pressure on her trachea. I can feel the
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pulse of her carotid artery a little bit
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on just medial to my thumb,
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and so for the most part the carotid
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artery is medial to the
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sternocleidomastoid. That doesn't mean
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I'm compressing the carotid artery, it
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doesn't mean that she's going to pass
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out. It doesn't mean I'm doing any damage,
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like I said I can just kind of feel the
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pulse which is probably a good sign that
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i shouldn't press any further
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medialy, I shouldn't press any
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further anterior to posterior but I'm
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okay. I can just check the rest of
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the muscle here, you're
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sternocleidomastoid does get trigger
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points throughout its entire length. It's
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a little hard to identify where the most
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common point would be, I do find that
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near the mastoid process some trigger
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points often get hidden and they are a
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little easier to get to up here, you
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have less chance of compressing the
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carotid artery and the muscles a little
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easier to grab up here so that helps. If
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I wanted to I could add a little bit of
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tension by going back into
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ipsilateral rotation and contralateral
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flexion just like so if I thought that
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would help pin down tissues, or add
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enough tension to to maybe stimulate a
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stretch, an autogenic inhibition. So
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there you have it knowing your
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functional Anatomy will definitely help
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your manual technique. It'll help you
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differentiate structures so that you can
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place your hands where they need to be,
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as well as make you aware of these
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sensitive structures around the tissue
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that you're trying to target; things like
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nerves and lymph nodes, and arteries. Make
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sure that if you're going to place your
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hands on a patient that you have done an
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assessment and have a good rationale for
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placing your hands on that patient, and
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if you're going to assess make sure you
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reassess to ensure that your technique
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was effective and you have a good
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rationale for using that technique again.
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Now with manual therapy one-on-one live
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education is incredibly important, please
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be looking for opportunities like
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workshops and mentorships and maybe even
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classes at your local university that
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can get you some one on one individual
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instruction, or at least some live
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classroom instruction so you've had a
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chance to be critiqued and mentored by
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somebody senior to you with some
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experience in manual
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therapy techniques; and before you bring
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this stuff back to your rehab, fitness or
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performance setting please practice on
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colleagues. There is no substitute for
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practice and it is going to take a while
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to get accustomed to some of the
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techniques that we show in these manual
00:13:0600:13:08
technique videos. Don't expect to learn
00:13:0800:13:11
them in two or three or even five
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minutes, you want to have hours of
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experience under your belt working on
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various different body sizes and shapes,
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so that when you do get that first
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paying client, first paying customer and
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you're really trying to make a good
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positive impact, really trying to promote
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better outcomes, you feel comfortable
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with that technique. I look forward to
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hearing about your outcomes and hearing
00:13:3500:13:37
your questions in the comments section
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