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, with lasting results, can be complex and require self-care follow-up.

Start by Understanding the Anatomy.
About the coloring of the illustrations…

Start by Understanding the Anatomy.
About the coloring of the illustrations…

This muscle muscle crosses a number of joints and has complex nerve relationships. Learn more in this post about sternocleidomastoid.

Conditions and Syndromes

Forward-Head Posture.

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

The 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 SCM is short and tight on the left. It lays closer to the neck than the SCM on the right. The right ear is tilted up and back. This imbalance is often created by habitually pulling the head forward and looking away from the tight SCM. For instance, she may lay back and pull her head forward and to the right to watch TV or play with her phone in her right hand. The person with this posture also tends to sleep on their stomach with their head turned to the right.

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 they always hold their head like that, they are unaware that do it.

When both SCMs and other extrinsic neck muscles stand out, it indicates a weakness in the intrinsic neck muscles. Regular exercises to strengthen the neck is indicated.


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 a 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 the treatment of its attachment to 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 the treatment of this complex muscle. Start with the rotation of the head. Follow with the extension of the head while in the rotated position, as shown in this picture. This stretching position 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

Is the pain from
degenerative discs or
trigger points in the muscle?

This post discusses the differences in pain from disc problems and pain from trigger points. Who should you see to help with your 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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*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read, more accessible, and
to include more patterns with better self-care. In the meanwhile, there will be inconsistency in formatting, content, and readability until we get the old posts updated. Please excuse our mess.