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

00:00:0400:00:05
This is Brent of the Brookbush
00:00:0400:00:05
...blank
00:00:0500:00:07
Institute in this video we're bringing
00:00:0700:00:08
you another manual technique. Now if
00:00:0800:00:09
you're watching this video I'm assuming
00:00:0900:00:11
you're watching it for educational
00:00:1100:00:13
purposes and that you are a licensed
00:00:1300:00:15
manual therapists following the laws
00:00:1500:00:17
regarding scope of practice in your
00:00:1700:00:19
state or region. That means athletic
00:00:1900:00:21
trainers, chiropractors, physical
00:00:2100:00:23
therapists, osteopaths, licensed massage
00:00:2300:00:25
therapists you are likely in the clear
00:00:2500:00:28
to do these techniques. Personal trainers
00:00:2800:00:30
this probably does not fall within your
00:00:3000:00:31
scope of practice, although you might be
00:00:3100:00:33
able to use the palpation portion of
00:00:3300:00:35
this video to aid in learning your
00:00:3500:00:38
functional anatomy in an educational
00:00:3800:00:41
setting, supervised by a licensed manual
00:00:4100:00:43
therapist. Now before we place our hands
00:00:4300:00:45
on a patient or client it is important
00:00:4500:00:48
that we assess and have a good rationale
00:00:4800:00:50
for doing so, and of course if we're
00:00:5000:00:52
going to assess then we should be
00:00:5200:00:55
reassessing to ensure that the manual
00:00:5500:00:57
technique we're using is effective and
00:00:5700:00:59
we have a good rationale for continuing
00:00:5900:01:01
to use that technique. In this video
00:01:0100:01:02
we're going to do static manual release
00:01:0200:01:04
of the sternocleidomastoid. I'm going to
00:01:0400:01:06
have my friend Melissa come out, she's
00:01:0600:01:07
going to help me demonstrate. We're going
00:01:0700:01:09
to use the same four step process we've
00:01:0900:01:11
been using for all of our manual release
00:01:1100:01:13
techniques. We're going to talk about how
00:01:1300:01:15
to differentiate this structure from the
00:01:1500:01:17
other structures around it, and it's
00:01:1700:01:19
actually fairly simple. I think this is a
00:01:1900:01:21
structure that most of you would be very
00:01:2100:01:23
visually familiar with. If i just take
00:01:2300:01:27
Melissa's head and turn it away, you can
00:01:2700:01:29
see this line right here is her
00:01:2900:01:31
sternocleidomastoid. There's actually two
00:01:3100:01:34
heads which if I follow just behind this
00:01:3400:01:36
head, I can feel the other one going into
00:01:3600:01:38
the clavicle. This head that you can see
00:01:3800:01:40
goes right into the sternocostal joint.
00:01:4000:01:44
So second step is do we have
00:01:4400:01:45
any structures around the
00:01:4500:01:48
sternocleidomastoid that could be
00:01:4800:01:51
offended, insulted or injured by
00:01:5100:01:53
compression, and the answer to that one
00:01:5300:01:56
is yeah we definitely do in this
00:01:5600:01:58
case. So a lot of people are really
00:01:5800:02:00
scared of this technique and it's
00:02:0000:02:02
because of things like the carotid
00:02:0200:02:03
artery is right behind the
00:02:0300:02:05
sternocleidomastoid. There's a lot of
00:02:0500:02:08
nerves obviously in the neck, and since
00:02:0800:02:10
we're on the front of the neck we have
00:02:1000:02:12
things like your trachea that like
00:02:1200:02:13
people don't really like getting pressed
00:02:1300:02:15
on. So we're probably not going to use
00:02:1500:02:16
anterior
00:02:1600:02:18
to posterior pressure to release the
00:02:1800:02:20
sternocleidomastoid, but there is an
00:02:2000:02:22
answer, there is a different way to
00:02:2200:02:24
release this. So let's skip to step
00:02:2400:02:26
number three, where are the common
00:02:2600:02:29
trigger points. Well it ends up the
00:02:2900:02:30
common trigger points are kind of
00:02:3000:02:31
throughout the sternocleidomastoid,
00:02:3100:02:34
ranging all the way from the mastoid
00:02:3400:02:36
process up here, so I can go just
00:02:3600:02:39
inferior the mastoid process and I can
00:02:3900:02:41
start feeling some increase in tissue
00:02:4100:02:45
density all the way down, and depending
00:02:4500:02:47
on who you're working with and what
00:02:4700:02:50
dysfunction they have, and what history
00:02:5000:02:53
they have, you'll find varied trigger
00:02:5300:02:55
points throughout. So it's going to be
00:02:5500:02:57
important to kind of search the entire
00:02:5700:03:01
muscle rather than finding a trigger
00:03:0100:03:03
point, landing on the first trigger point
00:03:0300:03:05
or increased tissue density nodule that
00:03:0500:03:08
you feel and calling it a day. You
00:03:0800:03:10
need to make sure you search the whole
00:03:1000:03:12
thing, and then of course step number
00:03:1200:03:15
four is how do i get myself and my
00:03:1500:03:18
patient comfortable so that i can hold
00:03:1800:03:21
the technique long enough, and my patient
00:03:2100:03:23
can relax. Since we're talking about the
00:03:2300:03:25
sternocleidomastoid you can
00:03:2500:03:27
probably guess that sitting up is not a
00:03:2700:03:29
great idea, the only way I'm going to get
00:03:2900:03:33
the sternocleidomastoid to relax is with
00:03:3300:03:36
her head supported; and I haven't
00:03:3600:03:38
even had that much luck with that
00:03:3800:03:40
forehead headlock position that we've
00:03:4000:03:42
done another techniques. I've tried
00:03:4200:03:44
because I have somebody in sitting and
00:03:4400:03:45
I'm trying to do a bunch of techniques
00:03:4500:03:48
all in a row, it just never really seems
00:03:4800:03:50
to work out. My suggestion is going to be
00:03:5000:03:52
to put them in supine, so go ahead and lay
00:03:5200:03:54
down,
00:03:5400:03:57
move the table up here a little bit. Now once
00:03:5700:04:00
she lays down her sternocleidomastoid is
00:04:0000:04:03
going to relax, which is a good thing. Now
00:04:0300:04:06
we just have to solve the problem of I
00:04:0600:04:09
can't put an anterior to posterior
00:04:0900:04:11
force of this muscle, that would
00:04:1100:04:14
look a little something like this, that's
00:04:1400:04:17
probably going to get me fired. I don't
00:04:1700:04:19
know about you, but I'd like to keep
00:04:1900:04:20
doing what I'm doing so let's not use
00:04:2000:04:23
anterior to posterior force. Now Travell
00:04:2300:04:25
and Simons describes a very simple way
00:04:2500:04:28
around this, which is a pincer grip. Now a
00:04:2800:04:30
pincer grip is just taking your your 2nd
00:04:3000:04:31
finger here, your index finger and
00:04:3100:04:33
curling up like this and then having
00:04:3300:04:36
your thumb and kind of pinching it in
00:04:3600:04:40
between, and if you have the other hand
00:04:4000:04:42
to kind of put behind the occiput and
00:04:4200:04:44
you kind of mess with contralateral
00:04:4400:04:47
rotation here and put her in a little
00:04:4700:04:49
flexion, her sternocleidomastoid becomes
00:04:4900:04:52
really laxed, I can start up at the
00:04:5200:04:54
mastoid process where I might be able to
00:04:5400:04:56
use a little bit more of like a lateral to
00:04:5600:04:59
medial pressure with my fingertips. But
00:04:5900:05:01
then as I can get a hold of the whole
00:05:0100:05:04
muscle I'm just going to put the muscle
00:05:0400:05:10
inside of that pincer grip, and I'm going
00:05:1000:05:12
to kind of search the tissue by
00:05:1200:05:14
strumming, I'm kind of strumming this
00:05:1400:05:17
way so I need to go from like, since this muscle
00:05:1700:05:19
is long this way, I would strum the
00:05:1900:05:22
muscle medial to lateral and i'm
00:05:2200:05:23
just kind of taking segments down at a
00:05:2300:05:27
time in my little pincer grip. These
00:05:2700:05:29
little short strokes, looking for
00:05:2900:05:33
anything that seems to have an increase
00:05:3300:05:35
in tissue density or something that
00:05:3500:05:37
feels like a nodule. Now notice guys
00:05:3700:05:40
I'm not pushing down far into her neck. I
00:05:4000:05:43
started by palpating the muscle up here
00:05:4300:05:46
really finding it, really knowing what
00:05:4600:05:48
i'm going for which i just fell off
00:05:4800:05:51
inferior and slightly anterior to the
00:05:5100:05:54
mastoid process here, and then I went
00:05:5400:05:58
into my pincer grip this way. I know
00:05:5800:05:59
some of you guys are thinking oh man
00:05:5900:06:02
he's going to kill her, he's just going to
00:06:0200:06:04
pinch off her carotid artery and game
00:06:0400:06:06
over. Well it's not
00:06:0600:06:09
that easy, to have somebody pass out like
00:06:0900:06:10
that she would probably had some
00:06:1000:06:13
symptoms first like nystagmus, or
00:06:1300:06:16
lightheadedness, or her speech would
00:06:1600:06:19
start to slur or something weird.
00:06:1900:06:22
More than that as long as I'm not going
00:06:2200:06:25
in and pinching down real hard,
00:06:2500:06:28
real fast, if I'm being gentle with these
00:06:2800:06:32
tissues and I'm just slowly increasing
00:06:3200:06:36
my pressure, I'll feel a pulse from her
00:06:3600:06:39
carotid artery before I cut off
00:06:3900:06:42
circulation. If it pulses I have the
00:06:4200:06:45
chance to move and chances are if you
00:06:4500:06:46
could do this technique and you're
00:06:4600:06:49
working on this technique you will feel
00:06:4900:06:51
a pulse at some point of time, and you
00:06:5100:06:53
will have to move over a little bit and
00:06:5300:06:58
that's okay, no damage done. I can
00:06:5800:07:00
actually feel her pulse against my thumb
00:07:0000:07:02
on this side, right at the tip
00:07:0200:07:04
of my finger which means i'm not
00:07:0400:07:07
actually squeezing her carotid
00:07:0700:07:10
artery, i'm actually squeezing her SCM
00:07:1000:07:12
more at my second knuckle and
00:07:1200:07:16
my IP of my thumb. So i know where her
00:07:1600:07:21
carotid artery is. I found my densest
00:07:2100:07:24
fascicles here. I'm finding a little bit
00:07:2400:07:26
of a nodule of increased density right
00:07:2600:07:29
here about a centimetre, two centimeters
00:07:2900:07:33
below her mastoid process there, and
00:07:3300:07:35
I'm just going to hold it until it
00:07:3500:07:40
releases, that's it. How bad is this? Not
00:07:4000:07:43
bad at all. It's a little less
00:07:4300:07:45
comfortable if somebody has a trigger
00:07:4500:07:49
point down here, be warned but like I
00:07:4900:07:51
said if you start up here at the mastoid
00:07:5100:07:54
process, you fall off, you get a good idea
00:07:5400:07:57
of where that muscle is and you slowly
00:07:5700:08:00
take out little parts, not take out
00:08:0000:08:02
but slowly strum little sections of that
00:08:0200:08:05
muscle with your thumb and be careful
00:08:0500:08:09
when you feel a pulse, I think you guys
00:08:0900:08:11
will find this technique is not that
00:08:1100:08:13
uncomfortable.
00:08:1300:08:15
If you want you can even add a little
00:08:1500:08:17
stretch to the tissue by going back into
00:08:1700:08:21
contralateral flexion, or back into
00:08:2100:08:24
ipsilateral lateral rotation.
00:08:2700:08:33
This muscle is definitely very related to arthrokinematic
00:08:3300:08:35
inhibition, and you will see an increase
00:08:3500:08:38
in tonicity if somebody's sternal
00:08:3800:08:41
clavicular joint it is really locked up
00:08:4100:08:43
or really hypermobile, so be aware of
00:08:4300:08:45
that as you get down here. It's always
00:08:4500:08:48
worth kind of checking on the how
00:08:4800:08:51
stiff that joint is, kind of in
00:08:5100:08:53
conjunction with this technique. Stay
00:08:5300:08:55
tuned for the close up recap. All right
00:08:5500:08:57
so here we go with our close-up recap of
00:08:5700:09:00
the sternocleidomastoid static manual
00:09:0000:09:03
release. I'll show you guys a real easy way to
00:09:0300:09:04
find the sternocleidomastoid, if I
00:09:0400:09:06
contralaterally rotate Melissa's head
00:09:0600:09:08
here and then have her try to lift her
00:09:0800:09:10
head off the table, you can see that
00:09:1000:09:12
sternocleidomastoid just pops right
00:09:1200:09:16
out and then I can place my pincer grip
00:09:1600:09:18
right over the top of her
00:09:1800:09:19
sternocleidomastoid at her mastoid
00:09:1900:09:23
process, tilt her head back and now
00:09:2300:09:25
we're in a nice relaxed position. I'll
00:09:2500:09:26
keep her in a little contralateral
00:09:2600:09:29
rotation just to keep some slack off
00:09:2900:09:31
this muscle, and then I'm just going to
00:09:3100:09:33
do my little medial to lateral strokes,
00:09:3300:09:38
looking for those densest fascicles,
00:09:3800:09:40
and then once I find an area of
00:09:4000:09:43
increased activity I can move a little bit
00:09:4300:09:47
proximal or a little superior and
00:09:4700:09:50
inferior. Keep in mind you want to
00:09:5000:09:52
be pretty close to where you
00:09:5200:09:54
think that nodule is before you start
00:09:5400:09:56
just kind of rubbing up and down the
00:09:5600:09:57
muscle, because you don't want to take a
00:09:5700:09:58
bunch of skin with you that's going to
00:09:5800:10:01
be really uncomfortable. if I go right
00:10:0100:10:03
here and then I just moved a little superior
00:10:0300:10:05
there and I found a little point of
00:10:0500:10:07
hyperactivity, and I'm just going to keep
00:10:0700:10:09
my pincer grip right where it is until I
00:10:0900:10:13
feel a release. Note I am not laying my hand
00:10:1300:10:16
on top of Melissa's neck, there's no weight
00:10:1600:10:19
from anterior to posterior on her
00:10:1900:10:20
neck that would make her feel like she's
00:10:2000:10:22
being choked, or like I'm putting
00:10:2200:10:25
pressure on her trachea. I can feel the
00:10:2500:10:29
pulse of her carotid artery a little bit
00:10:2900:10:32
on just medial to my thumb,
00:10:3200:10:35
and so for the most part the carotid
00:10:3500:10:36
artery is medial to the
00:10:3600:10:38
sternocleidomastoid. That doesn't mean
00:10:3800:10:41
I'm compressing the carotid artery, it
00:10:4100:10:42
doesn't mean that she's going to pass
00:10:4200:10:44
out. It doesn't mean I'm doing any damage,
00:10:4400:10:45
like I said I can just kind of feel the
00:10:4500:10:48
pulse which is probably a good sign that
00:10:4800:10:50
i shouldn't press any further
00:10:5000:10:52
medialy, I shouldn't press any
00:10:5200:10:54
further anterior to posterior but I'm
00:10:5400:10:57
okay. I can just check the rest of
00:10:5700:10:58
the muscle here, you're
00:10:5800:11:00
sternocleidomastoid does get trigger
00:11:0000:11:01
points throughout its entire length. It's
00:11:0100:11:04
a little hard to identify where the most
00:11:0400:11:09
common point would be, I do find that
00:11:0900:11:12
near the mastoid process some trigger
00:11:1200:11:16
points often get hidden and they are a
00:11:1600:11:19
little easier to get to up here, you
00:11:1900:11:21
have less chance of compressing the
00:11:2100:11:24
carotid artery and the muscles a little
00:11:2400:11:28
easier to grab up here so that helps. If
00:11:2800:11:29
I wanted to I could add a little bit of
00:11:2900:11:31
tension by going back into
00:11:3100:11:33
ipsilateral rotation and contralateral
00:11:3300:11:35
flexion just like so if I thought that
00:11:3500:11:37
would help pin down tissues, or add
00:11:3700:11:40
enough tension to to maybe stimulate a
00:11:4000:11:43
stretch, an autogenic inhibition. So
00:11:4300:11:44
there you have it knowing your
00:11:4400:11:46
functional Anatomy will definitely help
00:11:4600:11:48
your manual technique. It'll help you
00:11:4800:11:50
differentiate structures so that you can
00:11:5000:11:51
place your hands where they need to be,
00:11:5100:11:53
as well as make you aware of these
00:11:5300:11:56
sensitive structures around the tissue
00:11:5600:11:58
that you're trying to target; things like
00:11:5800:12:00
nerves and lymph nodes, and arteries. Make
00:12:0000:12:02
sure that if you're going to place your
00:12:0200:12:03
hands on a patient that you have done an
00:12:0300:12:05
assessment and have a good rationale for
00:12:0500:12:07
placing your hands on that patient, and
00:12:0700:12:09
if you're going to assess make sure you
00:12:0900:12:11
reassess to ensure that your technique
00:12:1100:12:13
was effective and you have a good
00:12:1300:12:15
rationale for using that technique again.
00:12:1500:12:19
Now with manual therapy one-on-one live
00:12:1900:12:22
education is incredibly important, please
00:12:2200:12:24
be looking for opportunities like
00:12:2400:12:27
workshops and mentorships and maybe even
00:12:2700:12:30
classes at your local university that
00:12:3000:12:33
can get you some one on one individual
00:12:3300:12:35
instruction, or at least some live
00:12:3500:12:38
classroom instruction so you've had a
00:12:3800:12:42
chance to be critiqued and mentored by
00:12:4200:12:44
somebody senior to you with some
00:12:4400:12:45
experience in manual
00:12:4500:12:48
therapy techniques; and before you bring
00:12:4800:12:52
this stuff back to your rehab, fitness or
00:12:5200:12:55
performance setting please practice on
00:12:5500:12:58
colleagues. There is no substitute for
00:12:5800:13:01
practice and it is going to take a while
00:13:0100:13:04
to get accustomed to some of the
00:13:0400:13:06
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
00:13:1100:13:13
minutes, you want to have hours of
00:13:1300:13:15
experience under your belt working on
00:13:1500:13:18
various different body sizes and shapes,
00:13:1800:13:20
so that when you do get that first
00:13:2000:13:23
paying client, first paying customer and
00:13:2300:13:24
you're really trying to make a good
00:13:2400:13:28
positive impact, really trying to promote
00:13:2800:13:31
better outcomes, you feel comfortable
00:13:3100:13:33
with that technique. I look forward to
00:13:3300:13:35
hearing about your outcomes and hearing
00:13:3500:13:37
your questions in the comments section