Sternocleidomastoid Trigger Points and Referred Pain Patterns

Before reading about sternocleidomastoid trigger points, you may want to find out more about the sternocleidomastoid muscle.

Sternocleidomastoid Trigger Point Causes and Symptoms

image by Rob Swatski

There is rarely pain present in the sternocleidomastoids themselves but they have the potential to refer a large amount of pain to areas of the head, face, throat, and sternum (see trigger point images below). Each head of the SCM, the clavicular and sternal, can have its own trigger points and so each must be treated separately, but each tend to refer pain upwards to the head, face, and jaws. The SCM may become tight and cause painful stiffness in the neck forcing the head to tilt to one side. This may indicate the presence of trigger points, which may be responsible for frequent headaches or ear pain (mistaken for an ear infection).

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Headaches of a myofasical origin are referred to as myogenic headaches. Myogenic headaches are also referred to as tension headaches or muscle contraction headaches. The pain from these types of headaches is most often felt in the lower back portion of the head, termed the occipital area. Trigger points in the trapezius muscle and various muscles of mastication can also contribute to myogenic headaches so should be treated concurrently. Other muscles that may be involved in myogenic headache pain are the temporalis, suboccipitals, occipitalis, orbicularis oculi, and masseter muscles.

Sternocleidomastoid trigger points may be associated with trigger points in the jaw muscles that cause jaw and teeth pain. SCM triggered headaches along with jaw and teeth pain, for example, may mean that the SCM has generated secondary trigger points in the masseter muscles, which are causing the jaw and teeth pain.

Trigger Points of Pain: Wall Charts (Set of 2)
Quickly locate trigger points with these Trigger Point Wall Charts from Travell and Simons

Dizziness or balance problems, nausea, fainting, lacrimation (excess tear production,) blurred vision, eyelid jerking or droopy eyelid and visual disturbances have all been claimed to be a possible result of trigger points along the sternocleidomastoid. A host of other systemic symptoms such as cold sweat on the forehead, distorted weight perception, excess mucus in sinuses, nasal cavities and throat, and chronic cough have also been attributed to them. According to Travell and Simons, impaired hearing was reported in some patients due to trigger points in the clavicular branch on the same side. 1Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. “Chp. 8: Masseter Muscle.” Travell & Simons’ Myofascial Pain and Dysfunction: the Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 329. Print.,2Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.,3Babak, Missaghi. “Sternocleidomastoid syndrome: a case study.” J Can Chiropr Assoc. 2004 September; 48(3): 201–205. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769463/. Webcite.

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Trigger points in the sternocleidomastoid can be activated by a tight or tense pectoralis major muscle as the clavicular head of the pec major pulls down on and forward on the clavicle which puts tension on the clavicular branch of the SCM. Any alteration in gait can cause problems in the SCM as well as the levator scapulae and scalenes as these muscles are active when trying to adjust to the gait alterations. Many other scenarios, of course, exist for the development of sternocleidomastoid trigger points. For more information refer to the resources at the bottom of the page.

Trigger Points of the Clavicular Branch

Trigger points in the clavicular branch of the SCM may cause deep ear-ache symptoms, toothaches of the back molars, pain behind the ear, and frontal head pain.

Sternocleidomastoid Trigger Points clavicular branch
Clavicular Branch Trigger Points

Trigger Points of the Sternal Branch

Trigger points in the sternal branch of the SCM can cause deep pain around the eyes, headaches behind the ear, at the top of the head, and over the eye. They may cause pain in the pharynx (throat) and the tongue when swallowing, giving you a “sore throat.” They may also contribute to temporomandibular joint (jaw) pain along with the muscles of mastication. It is also possible for the pain to be referred downward to the top of the sternum.

Sternocleidomastoid trigger points sternal branch
Sternal Branch Trigger Points

Sternocleidomastoid Trigger Point Treatment

SCM trigger points are easily self-treated and require only the fingers and thumb. Looking in the mirror may help visualize the two branches. To do so, slightly tuck the chin. You should be able to see one or both other the branches’ origins on the sternum, with an indentation between them.

Sternocleidomastoid muscle branches
SCM Sternal and Clavicular Branches

The sternal branch is the prominent branch closest to the front of the neck and the clavicular branch is behind. If you cannot visualize both of them place a few fingers on the one you can see and roll backward and forwards until you encounter a trough-like area or indentation. This should allow you to locate the other branch. Once you have located a branch, squeeze it between the thumb and forefingers, massaging the kneading the muscle from top to bottom. Cover both branches, looking for particularly painful areas to concentrate on.

Only use as much pressure as you can tolerate. Each session should not last more than two minutes per side. Massaging the sternocleidomastoid may be extremely painful at first and may even bring on the referred pain symptoms, such as a headache. But the pain should get better quickly upon subsequent sessions and referred pain symptoms should begin to subside almost immediately. After the symptoms have gone away continue daily massage sessions for several days longer.

Be careful of the carotid artery which is located high up under the chin alongside the windpipe. This artery corresponds to the carotid pulse so if you can feel the pulse you are too close to the artery. The image below shows the internal and external carotid artery’s location relative to the sternocleidomastoid and other neck muscles, as well as the head anatomy. Massage of the SCM should be perfectly safe but as with any self-treatment procedure, there are always risks. Consult your physician with any concerns you have.

Internal and External Carotid
  Artery’s Location Relative the
  Sternocleidomastoid -image by
  Patrick J. Lynch

Although the fingers are the best tools for massaging the sternocleidomastoid, you can also use a massage ball. There are many effective tools and informational resources available for personal use.

Self Stretch for the Sternocleidomastoid

The sternocleidomastoid can be stretched along with the trapezius muscle. To stretch the right trapezius and progress to a stretch of the SCM, from a seated position allow the head to fall to the left and then bend to the left a bit more. Keep the right hand tucked under the right hip so that the right shoulder does not rise during the stretch. While keeping the left side bend, allow the head to fall forward into flexion. Now turn the face to the left and use left hand to pull on the right side of the head to stretch the trapezius further. To stretch the sternocleidomastoid rotate the head to the right and then tuck the chin. A stretch should be felt in the SCM on the opposite side.

Sternocleidomastoid Stretch with Massage Ball Video

Strengthening the Sternocleidomastoids

There is actually no need to think about strengthening individual muscles of the neck. If the neck is exercised against resistance using all of its basic movements then all of the muscles will be appropriately worked and the SCMs will be heavily involved with forward flexion or rotary movements.

However for purposes of explanation, applying resistance to the front of the forehead to apply force posteriorly (toward the back of the head) and attempting to push the head forward against this resistance will work the sternocleidomastoids. This corresponds to the SCM’s function in flexion of the neck. Placing the resistance against one side of the jaw to apply a rotational force and then attempting to turn the head toward this resistant force will work the SCM on the opposite side, corresponding to its role in rotating the head and neck.

Body Back Buddy Self Massage Tool with Usage Poster - Back, Neck, Shoulder, Leg & Feet Trigger Point Therapy & Deep Tissue Massager by Body Back Company (Full-Sized Purple)
Body Back Buddy Self Massage Tool with Usage Poster

The hand or other means of resistance can be used. Such as a weighted forehead strap, to work neck flexion. Also, a cushion can be placed against a wall and then leaned against with the forehead so that some of the body’s weight must be supported, thus working neck flexion. This is more technically known as cervical flexion. The opposite movement, when the neck and head goes back, is cervical extension. This exercise can be graduated to the ground. For rotation work only very light resistance should be used and there is little need for external resistance other than the hand. However, a partner can provide the resistance as well.

The most important point to remember in any neck strengthening exercise is that only isometric exercise should be used. Never actively forward or laterally flex, extend, or rotate the neck against resistance. No neck curls! This is a highly injurious activity and absolutely unnecessary for neck strengthening. The type of cervical injury that can be sustained during these types of exercises, even from just one incident, may never fully resolve. So no movement. Isometric only is the way to go.

The neck muscles and especially the sternocleidomastoid hypertrophy very easily for most trainees with just this kind of isometric work. So if your goal is to do reasonable strengthening of the neck and to have your neck look thicker it does not take a lot to achieve this for most.

Sources   [ + ]

1. Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. “Chp. 8: Masseter Muscle.” Travell & Simons’ Myofascial Pain and Dysfunction: the Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 329. Print.
2. Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.
3. Babak, Missaghi. “Sternocleidomastoid syndrome: a case study.” J Can Chiropr Assoc. 2004 September; 48(3): 201–205. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769463/. Webcite.