Therapist Notes – Sternocleidomastoid

Therapist Notes include
Anatomy review,
Syndromes and Conditions,
Assessment notes,
Treatment Preparation,
NMT protocols and more…

The sternocleidomastoid muscle is complex in its structure, function, and impact on regulation. In earlier editions of her manual, Travell refers to it as “Amazingly Complex.” Treatment starts with an understanding of the anatomy.

Effective relief starts with an understanding of the anatomy.

About the coloring of the illustrations…

Conditions and Syndromes

Forward-Head Posture.

Habitual craning of the neck without exercise to counter the activity can lead to shortening of the SCM and upper trapezius. This leads to high, tight shoulders. As the scalenes and other anterior neck muscles shorten, forward head posture is strongly supported.

Sternocleidomastoid is usually the largest and most powerful muscle to counter the intrinsic back muscles, like the splenii. It also has a distinct leverage attachment with its high attachment on the lateral cranial base.

Here’s the classic SCM postural problem.

This person tilts their left ear down and turns their head lightly to the right. The thing is, the SCM is still short and tight on the left, where I have drawn a red line. Notice how it doesn’t stand out, even though she has to use it to twist her head like that. On the right, even though the ear is tilted up and back, the SCM still stands out where I have drawn the green line. And yet, she still has that cute head tilt. And that beautiful smile.

The person with this posture complains of SCM symptoms, such as headache around the brow, tinnitus and sinus problems, on the left. I have had clients do the entire interview in this position to accommodate the short SCM. When I ask if the always hold their head like that, they are unaware that do it.


Treatment Preparation

Start with the Atlas

SCM crosses the atlantooccipital joint, and is innervated by a nerve that passes through it. A mobile atlas is key to balancing the tone of the SCMs. This post has a few approaches to atlas mobilization.

This protocol loosens the muscles around the atlas, making it easier to mobilize. It also starts the release of the SCM through treatment of its attachment on the superior nuchal line.

This post reviews an advanced techniques that involves delicate treatment around the anterolateral neck.

Follow-up with gentle stretches to evaluate and integrate treatment of this complex muscle. Start with rotation of the head and follow with extension of the head while it is rotated, as shown in this picture. This helps to identify and release other muscles that may support the shortened SCM.


This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


Weekly Featured Post

Can’t Reach the Pain
Under the Shoulder Blade

This pain and tension under the shoulder blade may be the most common pain pattern that I see. It isn’t always the primary complaint as people have gotten used to the constant ache.

It is usually combined with this pattern in the upper neck, which creates upper neck tension to go with the shoulder blade pain.

Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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