Excerpted from Migraine Brains
and Bodies by C. M. Shifflett.
breastbone + kleid-, collarbone + mastoeidês,
(left): Head pain, "sinus" pain, visual disturbances, “sore
throat,” difficulty swallowing, dry cough.
(right): Autonomic and
proprioceptive disturbances; frontal "sinus" headache, ear pain,
nausea, dizziness and car-sickness; reversible
What It Is and What It Does
Sternocleidomastoid (SCM) is the big ropey muscle that runs
from the mastoid process (the rounded bump behind your ear) to the joint
between collarbones and sternum at the base of your throat. This paired
muscle pulls the head forward and down, and acts as a checkrein to prevent
the head from falling backward. Both of these actions are involved in
rolling where you must tuck the head for safety.
What Goes Wrong
SCM is strained or shortened the muscle itself rarely hurts, no matter
how stiff or tight it may be. Problems are referred elsewhere, to
head and neck, ears, eyes, nose and throat. The astonishing laundry-list
of pain and dysfunction includes severe dizziness and other neurological
symptoms. These may be mistakenly diagnosed as migraine, sinus
headache, atypical facial neuralgia, trigeminal neuralgia, arthritis of
the sternoclavicular joint, ataxia, multiple sclerosis (MS), brain
lesions, tumors, and other frightening conditions.
As always, these possibilities should be eliminated
through differential diagnosis. However, because of its intimate relationship
with the brain stem and cranial nerves (accessory nerve, CN XI and the vagus nerve, CN X), the SCM
can produce many neurological disturbances all on its own. One is a
condition known as “postural dizziness” —- just walking around feeling
dizzy and disoriented -— perhaps with a frontal headache
commonly interpreted as “sinus” pain.
A common complaint in beginning Aikido or
Judo is dizziness and nausea while rolling. This may be due to
disorienting unfamiliar movements. It may also be due to a tight SCM, possibly
strained long before arriving at the dojo by poor posture, chest
breathing, or car accidents.
At the dojo SCM is commonly
strained by locks and pins and in rolling. SCM is critical for tucking the
head which may be overdone by beginners. (Holding the head in the same
position at the office will produce a nasty “word processor” headache.)
More advanced students may suffer as well; when taking throws from beginners
they often fling the head back then forward into a side-tucked position.
This motion provides the energy and inertia needed for safety in the coming
fall but it can also strain the SCM, a sort of self-induced whiplash injury.
Avoid the fling, and learn to treat the injury.
Testing and Treating The
SCM is easily tested simply by grasping the body of the muscle. Be sure to
grasp the muscle, not just the skin. In healthy athletic persons, this
muscle will be much larger and deeper than you think. In some it will be
rock hard, unbelievably tight and therefore easy for a novice to confuse
with the more flexible overlying skin. A tense
muscle subjected to a firm but gentle squeeze will be painful, and may
produce the referred pain pattern. A relaxed SCM
will perceive the squeeze as pressure, but will not be painful.
- Look for a tender spot at the mastoid process, the
bump behind the ear. Apply gentle pressure until perception of “pain” or
“tenderness” decreases to “pressure” only.
- Repeat down the muscle until you reach the point
where you can actually grasp the muscle between thumb and index finger.
Using thumb and the side of finger as shown, grasp muscle and squeeze
- Continue working downward to the sternum, feeling
around the inside of the notch for tender points.
- Note that
the clavicular division of the muscle extends out to the medial third of
the collarbone. Look for tender spots there as well.
- Stretch gently to return muscle to its proper
resting length. Use passive stretch, that is, move your head with your
hand; don't try to stretch the muscle by tightening its partner on the
other side. To stretch,
- Sternal division: Turn the head
fully to side of the muscle to be stretched, tipping chin downward towards the
shoulder. (This may seem backwards, but it increases the distance between
sternum and mastoid process.) Hold for just a few seconds and return to neutral
- Clavicular division: Turn head to side
opposite the muscle being treated and raise the chin.
Sternal Division: Lateral surface of
mastoid process / front of manubrium
Clavicular Division: Lateral surface
of mastoid process / upper border of the front of clavicle.
Flexes neck and head forward, bringing chin
to chest. Flexes neck sideways, bringing ear to shoulder.
Stabilizes head (as a “check-rein) when tilting chin upward, or
during talking and chewing. Assists in swallowing.
As an accessory muscle of respiration, SCM lifts upper ribs
in breathing when neck is erect or hyper-extended (not when head is
May entrap entrap its own nerve supply (accessory or CN XI) en route to trapezius causing weakness in trapezius or torticollis of
muscular origin. CN XI motor fibers intermingle with those of the vagus.
Sternal Division. Pain referred upward to cheek and
sinuses, occiput, eye (orbicularis), top of head; pain referred downward
to sternum. Tearing of eye, visual disturbances when viewing parallel
lines. Chronic “sore throat” when swallowing, possibly with a
chronic dry cough.
Clavicular Division: Pain referred
bilaterally across forehead; frontal sinus-like headache, ear ache,
nausea, dizziness, car-sickness, faulty weight perception of held
objects, and hearing loss (reversible).
Whiplash injuries, structural
faults (short leg or small hemi-pelvis), overhead painting,
carpentry, wallpapering; horseback riding, front-row movie seats,
coughing, chest breathing, working for long-periods with head
turned to one side (“word-processor headache”). It is also
irritated / compressed by tight collar or tie.