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Massage Today
November, 2013, Vol. 13, Issue 11

The Sternocleidomastoid Muscle and Cervicogenic Headaches

By David Kent, LMT, NCTMB

There are many types of headaches with a long list of triggers from hormones to food, drinks, sleep deficiency, dehydration, and emotional and physical stress. A cervicogenic headache (CeH) is characterized as unilateral head pain with a cervical source.

Symptoms include a dull ache with restricted cervical range of motion. Contributing factors often include poor posture, sedentary lifestyle, prior neck injuries, and improper computer and workplace ergonomics.

While many muscles can be involved in a cervicogenic headache, I want to share information on the sternocleidomastoid muscle and ways to educate clients of its referred pain, as it can directly affect whether the client reschedules, upgrades to a package of treatments or refers friends, family and co-workers.

Physicians, depending on their specialty, can be a great referral source for clients suffering with cervicogenic headaches. Doctors are familiar with myofascial trigger points and referred pain. A cervicoengic headache can also be caused by the bones, discs and or joints in the neck.

Clients rarely report pain in the front of their neck when experiencing a cervicogenic headache unless recently involved in a motor vehicle accident or other physical trauma. Educate clients about the sternocleidomastoid muscle, integrating three learner styles; visual, auditory and kinesthetic.

Take postural analysis photos with your smartphone, iPhone or iPad to show the position of their head and how the sternocleidomastoid muscle is involved. Use skeletal, muscular and trigger-point charts to show the structural and myofascial patterns.

sternocleidomastoid 1 - Copyright – Stock Photo / Register Mark Provide auditory support for each visual by explaining the details in each photo and image. For example, in posture photos, discuss a high shoulder or forward head posture. On trigger-point charts, explain that the "X" indicates the common location of trigger points and the red color indicates the referral areas patients report pain, tension, burning, tingling, numbness and headache (Photos 1-2).

Now, when you palpate (kinesthetic) an active trigger point in the sternocleidomastoid muscle and it refers pain to the patient's head, they realize why and what is taking place. Without pretreatment education, the patient might think you are pressing on a nerve versus treating an active trigger point.

Use intake forms to screen clients and identify contraindications. Watch for procedures like coronary bypass, stints, angioplasty or a carotid endarterectomy, a surgical procedure for cleaning out the carotid artery to restore blood flow to the brain. Other red flags include blood thinners and carotid sinus hypersensitivity (CSH); even if a client states they have previously received massage, I will not proceed without a prescription for treatment from their physician.

Practice palpating and treating the sternocleidomastoid muscle on your own neck. The name of this muscle reveals its attachments to the sternum, clavicle and mastoid process. To palpate the right SCM, begin in a supine position, shorten the muscle by turning your head to the left, lateral flexion of the cervical spine and place support under your head. Practice muscle testing the right sternocleidomastoid by lifting your head from the support and palpating the outline of the muscle. Relax the muscle prior to treatment, by placing your head back on the support and then using pincher compression to treat each division, checking for active trigger points.

sternocleidomastoid 2 - Copyright – Stock Photo / Register Mark In Myofascial Pain and Dysfunction, The Trigger Point Manual, Drs. Travell and Simons documented numerous active trigger points in the sternocleidomastoid muscle. They found the sternal division refers pain into the forehead, behind the eye, the anterior cervical region and can produce throat pain, discomfort or tightness (Photo 1); while active trigger points in the clavicular division can refer pain to the forehead, behind and/or into the ears (Photo 2).

Recently, the Journal of Manipulative and Physiological Therapeutics published a pilot randomized clinical trial titled, "Manual Treatment for Cervicogenic Headache and Active Trigger Points in the Sternocleidomastoid Muscle." The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity, and increasing motor performance of the deep cervical flexors, pressure pain thresholds (PPT) and active cervical range of motion (CROM) in individuals with CeH showing active trigger points in this muscle. Studies including greater sample sizes and examining long-term effects are needed.

Active trigger points in the sternocleidomastoid muscle may be a contributing factor to a client's cervicogenic headaches. Providing education to the general public, local doctors, healthcare providers and clients is essential to building your practice.

Click here for previous articles by David Kent, LMT, NCTMB.


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