Dealing with Headaches: The Sternocleidomastoids

You might be intimidated by the name, but you needn’t be. The sternocleidomastoids (pronounced STERNO-CLYDE-OH-MAST-OYDS), or SCMs, are muscles that contribute to headaches, especially migraines. Located on the sides of the neck, they are the fleshy muscles that extend from the ear down to the sternum (breastbone) and clavicle (collarbone). 

There are two branches of the SCMs. Both branches attach just below the ear at the top, but the clavicular branch descends and attaches to the clavicle, while the sternal branch attaches to the sternum. 

Side View

Front View

There are better (and more to scale) drawings in The Trigger Point Therapy Workbook.  See pages 51-55 for more information.  

The sternal branch refers pain to 

• the top of the head 
• above the eye  
• front of the ear 
• the side of the head 
• the chin 
• upper neck 
• lower neck.  
• deep eye 
• tongue (when swallowing) 
• jaw (can mimic TMJ) 

(Note:  You don't have to have pain in all of these places in order for the SCM to be the problem...)

Trigger points in the sternal branch can also cause 

• dimmed, blurred, or double vision 
• red eyes
• excessive tears
• runny nose
• drooping eyelid
• twitching eye
• the print to appear as if it is jumping all over the page

And it can mimic trigeminal neuralgia (face pain).


The clavicular branch causes 

• frontal headache
• pain in the ear 
• pain behind the ear. 

It also can refer pain to the opposite side of the forehead, which is kind of unusual; most pain referral is to the same side of the body.

In addition, trigger points in the clavicular branch can cause 

• deep earache 
• toothache 
• dizziness
• nausea 
• fainting 
• unilateral deafness or hearing loss. 

The range of symptoms of the SCMs is really quite incredible. Besides headaches, they can cause: 

• disturbed weight perception 
• cold sweat on forehead 
• excess mucus in sinuses, nose, and throat
• chronic cough 

The SCMs are fairly easy to work. And you can work them practically anywhere.  


Massage these trigger points between your fingers and your thumb. This is one area where using a tool will not work. If you grab the flesh just below your ear, and begin to squeeze, you may be able to discern the two different branches of SCMs. Trigger points can be found anywhere up and down the two branches of the muscle.  Work your way down both branches.  Be sure to work both sides of your neck.  

Massaging the sternocleidomastoids near the top of the muscle.  

Moving further down.  

Working with the opposite hand.  

Following the sternal branch down.  

What I've been doing - Part 2

(continued from the last post...) 

I was so glad that I had taken the time to work my shoulder, upper arm, upper back, and pec muscles before going to the Emergency Room (ER). At the ER, they decided to do a CT scan. The technician had me lie down on the bed (trolley?) and asked me if I could bring my arm over my head and rest it on a pillow above me on the bed. I hardly thought that was possible, but he assured me that he would help me and convinced me to try. The ER doctor had confirmed that my shoulder did not appear to be injured. The technician said he would brace my arm as we inched it up and over to where it needed to go.  He carefully placed a hand over each side of my elbow joint. His hands overlapped my lower and upper arms, and kept the angle locked. Each movement was not of separate parts of the arm, but the arm moved as if it were one piece. We moved an inch or so at a time and soon, my arm was lying above me on the bed, and I had experienced no pain.  In fact, for the first little bit, it felt good because my arm was getting a change of position. I couldn't believe that it worked!

I thought about it, and if I had not worked my pecs and my shoulder and upper back muscles, it might not have gone so smoothly. I probably would have succeeded in getting my arm in position for the CT scan, but I suspect it would have been somewhat painful, judging by how much those areas needed to be worked.

Fast forward.

They gave me my diagnosis, informed me that I would have to have surgery, and sent me home with some meds and an estimated surgery date. While I waited, I tried to keep myself relatively pain free.

One night, I was trying to get to sleep, and suddenly my left thumb started to hurt.  It was throbbing.  I was exhausted and not thinking very clearly, but my first thought was that the brachialis (p. 113) refers to the thumb.  I reached over and started to work the brachialis trigger points, which are located in the lower part of the front upper arm (by the biceps). They were sore. Within a few seconds, the pain was subsiding in my thumb, but I continued to work the brachialis until it was substantially softer. The next day, when I went to look things up in my trigger point manual, I saw that brachialis was the most likely muscle to cause pain in the thumb  It made sense. The brachialis had been held in the same position for several days. It was stressed because the bent elbow limited its movement in either direction.

On the first day of the correctly prescribed meds, I felt so much better, but then I got a weak, but very unpleasant headache. I thought, "Oh no!  I'm already taking all of this pain medication.  If that isn't taking care of it, I don't know what I'm going to do!" Then my inner trigger point detective kicked in.

My neck had been through quite a bit lately. Where do most headaches come from? The neck. I had been wearing a sling, and my neck was bearing the weight that my shoulder and arm usually bore. Not only that, it was dead weight, and it had been necessary for me to assume awkward positions to keep from bumping and hurting my arm.

Also, because it hurt my arm so much to sleep lying down, I had been sleeping sitting up in an arm chair with my feet up on a footstool. My neck had been in all kinds of positions. I was often sleeping in a "C" position, with my neck tucked into my chest. This made it harder to breathe, too. The muscles in the back of my neck were being held in an extended position too long, and the muscles in the front of my neck were being held in a shortened position too long. Both conditions create trigger points.

First, I worked my sternocleidomastoids (SCMs) since several of my symptoms appeared to be caused by the SCMs. Then I worked my scalenes and any of the muscles in the back of the neck that I could reach. I was not using very good ergonomics because I was limited to one hand. I tried to make up for this a little bit by taking frequent breaks. I focused on relaxing my working arm and hand each time I took a break. I also worked my right arm's flexor and extensor muscles after each session of neck massage. The headache pretty much disappeared halfway through massaging the SCMs, but I continued until I had got every trigger point that I could reach.

Later, I ended up with a similar headache and I was able to get it under control very quickly, but I realized that I need to do more in the way of prevention. I located a few pillows, including a neck pillow to help support my neck. I arranged things so that I was not sitting with my head thrust forward, or some other awkward angle. This helped a lot.

My sling was causing its own set of problems because of the extra strain it put on my neck. Also, the way that the sling fit my arm actually caused me pain. The straps of the sling attached at the elbow and wrist and I could feel a significant pull in both areas. Ordinarily, that might not be a problem, but my elbow was injured and the extra pull on my elbow made it hurt worse.  I decided to make my own sling and design it with these issues in mind.

I sewed up a 4-5 inch wide, padded strap, with one end folded back on itself about 11 inches and sewn to form a loose loop. I placed the loop over my splint and found that somewhere near the middle was the ideal place for the sling to pull up. I pulled the strap straight up and over my left shoulder, pulled it around my right waist to the front of my body. I was trying to decide what kind of fastener to use, when I noticed that the weight of my injured arm would hold the end of the sling in place, so I left it at that (I probably really shouldn't have been making a sling in my condition, anyway...). Sometimes, I use my arm as the weight and sometimes I tie the end of the sling to the loop part, depending on what I am going to do. The point is that I got a sling that was not hurting my neck or elbow. I was trying to prevent more problems than I already had.

The new sling is much more comfortable and my neck is not being pulled forward.  

The sling goes straight up to my neck, around my back, and to the front.
(Note:  For some unknown reason, my camera takes pictures in mirror mode, so even though it looks like the right arm is in a splint, it is actually my left arm.)

What I've been doing - Part I

Note:  Refer to the "What Happened..." post for background information.  

One of the first things that I did once we got my arm stabilized in a sling and once we had given me some ibuprofen, was to work any trigger points that I thought would have been affected by my fall.

I visualized what might have happened in the fall. I pictured my elbow hitting the ground. I could imagine that muscles and bones in my upper arms and my forearms would be jarred quite hard. I could see that all of my shoulder muscles were probably affected. They would have to work hard to keep my shoulder in place.

I steered clear of working trigger points in my arm in the beginning because I did not want to inadvertently put pressure on the broken bone, wherever it might be.

I started out working my infraspinatus, supraspinatus, and my pecs.

The infraspinatus and supraspinatus are the muscles that lie on top of the shoulder blade, or scapula. There is a raised part of the shoulder blade that goes across the upper half of the shoulder blade. It is sometimes referred to as the scapular spine. The infraspinatus is the muscle that lies below the scapular spine. (Infraspinatus means "below or under the spine.") The supraspinatus is a muscle that lies above the scapular spine.

I worked the infra- and supra- spinatus with a lacrosse ball against the wall. I was very careful to keep my injured arm from moving.  It felt good, not only because it felt good to work the trigger points, which did need work, but also because working the trigger points released endorphins; my pain was partially relieved.

Since I was already up, I decide to work my gluts, lower back, and quads, too. A fall like I had probably involved most of my body, now that I thought about it.

I also worked my pecs. I could feel that they were very tight.

During our first visit to the doctor, the practitioner suggested that I unwrap my arm from time-to-time and work on trying to extend my range of motion.  Later, when I was getting zero pain relief from the meds, I wondered if I had a pinched nerve somewhere.  It felt very much like pinched nerves I've had in the past.  I knew that working my trigger points would help to release something if it were pinched, so I began to work on the upper arm and lower arm muscles.  I had also been working on my scalenes and sternocleidomastoids.

The only measurable pain relief that I got during this time period (between the first doctor's visit and the ER visit), was when I worked my trigger points in my arms.  I worked from the top of the upper arm down toward my elbow, and from the wrist area up toward the elbow.  I used supported thumb or supported fingers, and sometimes used a pinching technique, which I know is not very ergonomic, but I was trying to be careful to avoid the bones as much as possible.  I could feel each muscle relax and the pain subside as I released its trigger points.  It became more difficult, however, as I got closer to the elbow. I was so exhausted but so happy that my pain had subsided enough for me to get to sleep. I would get to sleep, but I'd wake up an hour or two later with screaming pain again. The muscles that had just been loose and relaxed were now tight as a spring.

I knew there must be something else going on. At this point, I wondered if anyone would be able to help me with my pain at all. Here I was taking Lortab (I did not realize that I had been prescribed a half dose), and it was not helping at all. The only thing that had helped me up to that point was trigger point therapy, and that was only temporary. Plus, I was exhausted from no sleep, and from tensing up against the pain. I could feel the tightness going further up my arm, into my shoulder and neck muscles. I could also feel that my abdomen was as hard as a rock, and my hips and upper legs were tensing up, too. I felt like a giant corkscrew.

In the middle of the night on Wednesday/Thursday, my husband and I decided to try the ER. I really didn't know if they would be able to help. I anticipated them trying to take an x-ray of my elbow again. I hadn't been able to extend my elbow enough at the on-call doctor and the technician there was not very sympathetic. She said, "I warned you that it would not be fun."

Before we left for the ER, I worked my upper arm, shoulder, and pec muscles. I wanted to have as much flexibility coming into that experience as possible.

(To be continued...)

Working Your Pecs

I got up early this morning and I was stiff, but I was so tired still and didn't really want to get up and work trigger points. I decided to work my chest muscles. I could work them without too much effort, without getting out of bed, and I was pleasantly surprised at how much it helped to release the tension in other muscles as well.  

Your "pecs," or pectoralis major are your large chest muscles. They are three large bands of muscles that fan from each side just below your shoulder to the middle of your chest (p. 136, if you have the Trigger Point Therapy Workbook).  Among other things, your pectorals work with your upper back muscles to keep your posture upright. If your pecs are tight, they are putting constant pressure on those upper back muscles. They tend to pull your shoulder toward the front.  

There is a domino effect to this, which can end up sending trigger points to the sternocleidomastoids and the scalenes, muscles in your neck which can be responsible for pain and stiffness in a lot of areas. There are other chest muscles as well, and it is not necessary to differentiate them at this point. Working any of them will do some good.  

The chest muscles are more tender than the back muscles (in my experience, anyway) and it does not take much to work them. Remember that you want to "hurt good." Don't try to rub them out; you will make things worse. Just work them. You can come back every couple of hours or so if you want to.  

I use one hand with four fingers held together as the precision tool, and place my other hand on the back of the "precision tool" and push. 

Place opposite hand on back of "precision tool." 

Lying in bed is actually a great place to work these because I can place the elbow of my working hand (the hand that is pushing) on the bed, so it takes very little effort to work these.  

Top hand is the "power."  Bottom hand is the "tool."

To be more specific, lying on my right side, I use my right arm (which I am lying on), bent at the elbow, to support my left arm, which is also bent at the elbow.  The left hand has fingers held together.  Using my right hand, I press the left finger tips into the trigger points.
Sw

itch sides to use the other hand.  

Search all around your chest area.  For women, you are searching in the muscles, so you are working around and under the breast.  (The breast itself is not muscle.)  

Working the pecs and other chest muscles.

If you have never done this before, you may be shocked, alarmed, or even frightened at how many places hurt.  These are trigger points.  They hurt a lot, but working them a little bit does a lot of good.  

If you are already up and about, another way to work at least some of your chest muscles is with a lacrosse ball against a wall that is close to a corner, so that you can lean in further without being blocked by the wall. 

This was written October 1, 2011.  Extra information added October 22, 2011.

Note:  Please be patient with me as I learn how to use these publishing tools.  I have tried several times, for example, to fix the word "switch" above, but it keeps publishing the split word.  Eventually, I will figure out why it is happening and come back and fix it.