clavicle
Chapter 4—Head, Face, and Neck Pain 63
suggested neck muscles as the source of many mysterious symptoms, she began feeling her neck muscles with her hand. She was startled to find a big knot in the left side of her neck that she hadn’t realized was there. While she was massaging the muscle, she experienced a release in her left jaw that was so sudden and intense that it fright- ened her. The side of her neck felt like it was expanding like a balloon. She ran to look at it in the bathroom mirror but could see no swelling or anything else wrong. Then she noticed the pain in her ear and jaws was gone and her bite felt different. Her jaw felt like it had shifted position. Her dentist, after inspecting the change, told Kate that her TMJ dysfunction had somehow resolved itself and she now had a proper bite.
From a myofascial viewpoint, massive chronic trigger points in Kate’s sternocleidomastoids were directly to blame for her headaches and ear pain. They had also maintained secondary trigger points in the jaw muscles that were the cause of her jaw pain and the misalignment of her temporomandibular joints. She has learned that a few minutes of massage to her sternocleidomastoid muscles gets rid of her
symptoms when she feels them coming back.
Symptoms
People are rarely aware of sternocleidomastoid trigger points, though their effects can be amazingly widespread. The trigger points can be so tender to pressure that they can be mistaken for swollen and sensitive lymph nodes. Swollen lymph nodes, however, feel like small unshelled peanuts floating just under the skin; they are so slippery that you won’t be able to pinch them with two fingers. Symptoms created by sternocleidomastoid trigger points fall into six groups: referred pain– sternal branch, referred pain– clavicular branch, balance problems, auditory disturbances, visual disturbances, and systemic symptoms. There are important differences in the referred pain patterns for the two branches of the sternocleidomastoid muscle, although both gener- ally send their symptoms upward to the cranium, face, and jaws (figures 4.2 and 4.3)
Referred pain– sternal branch (figure 4.2). Trigger points in the sternal branch can cause deep eye pain, tongue pain when swallowing, and headaches over the eye, behind the ear, and in the top of the head. They can contribute to temporomandibular joint pain and the cre- ation of satellite trigger points in the jaw muscles. Pain is also some- times sent to the back of the neck and to the top of the breastbone. Not shown in figure 4.2 is an occasional spillover of pain in the side of the face, which mimics trigeminal neuralgia, a disorder characterized by brief attacks of pain caused by irritation of the trigeminal nerve. This pain in the cheek can also be mistaken for sinusitis.
Referred pain– clavicular branch (figure 4.3). Pain from the deeper clavicular branch can make a frontal headache to the opposite side of the forehead, a deep earache, and a toothache in the back molars. A painless stiff neck that keeps your head tilted to one side is also possi- ble (Simons, Travell, and Simons 1999).
Balance problems– clavicular branch (figure 4.3). Another unusual trait of trigger points in the clavicular branch is that they are apt to make you dizzy, nauseated, and prone to lurching or falling. Fainting
Figure 4.2 Sternocleidomastoid, sternal branch: trigger points and referred pain pattern
Figure 4.3 Sternocleidomastoid, clavicular branch: trigger points and referred pain pattern
may occur unexpectedly. This dizziness can occur suddenly or last for minutes, hours, or days. Often given a diag- nosis of vertigo, or Ménière’s disease, it can become a lifelong recurrent condition, defying all treatments and medical explanations.
The myofascial explanation is that differences in tension in the clavicular branch of the sternocleidomastoid muscles help with your spatial orientation, keeping track of the position of your head. When aberrant tensions in the muscles are caused by trigger points, confusing signals are sent to the brain. Dr. Travell believed that the dis- torted perception caused by sternocleidomastoid trigger points were a hidden cause of falls and motor vehicle accidents.
Auditory disturbances– clavicular branch (figure 4.3). Clavicular trigger points can be a cause of unilateral deaf- ness or hearing loss on the side where these trigger points exist. This is thought to be due to referred tension in the tiny stapedius and tensor tympani muscles that attach to the equally tiny bones of the middle ear. Tension in these little muscles could inhibit vibration in the inner ear. Massage of the jaw muscles and the sternocleidomastoids has been known to bring back normal hearing when trigger points were to blame for the problem (Simons, Travell, and Simons 1999). Tinnitus, or ringing in the ears, can also be caused by trigger points in the SCM, lateral pterygoid, or masseter muscle of the jaw.
Visual disturbances– sternal branch (figure 4.2). Sternal branch trigger points can cause dimmed, blurred, or double vision. You may have reddening and excessive tearing of your eyes, along with a runny nose. These trigger points can cause a drooping eyelid from a referred spasm in the orbicularis oculi muscle that surrounds the eye. Referred effects on the orbicularis muscle can also cause twitching of the eye or eyelid. The print on the page may seem to be jumping around when you read.
Systemic symptoms– both branches (figures 4.2 and 4.3). A sixth group of symptoms from sternocleidomastoid trigger points can include disturbed perception of the amount of weight carried in the hands, cold sweat on the forehead, and the generation of excess mucus in the sinuses, nasal cavities, and throat. They can be the simple explanation for your sinus congestion, sinus drainage, phlegm in the throat, chronic cough, and continual hay fever or cold symptoms. A persistent dry cough can often be stopped with massage to the sternal branch near its attach- ment to the breastbone (Simons, Travell, and Simons 1999).
Causes
The primary functions of the sternocleidomastoids are to turn the head side to side and flex the neck down- ward toward the chest. The left SCM turns the head to the right by bringing its attachment on the leftside of the skull around to the front. The sternocleidomastoids also help maintain a stable position of the head during movements of the body. Trigger points can therefore be created by postures that keep the sternocleidomastoids contracted to hold the head in position— for example, looking at a computer screen or driving. Holding your head back to work overhead is particularly bad. Keeping your head turned to one side for any reason is sure to cause trouble. Trigger points in the lower half of the body, muscle imbalances, and postural dysfunction often distort posture to such an extent that the neck muscles must exhaust themselves in a constant attempt to compen- sate (Simons, Travell, and Simons 1999). Sometimes the lower body needs to be addressed before the muscles of the neck and upper back will