Hi all..I hope this will help some of you. I started going to a chiropractor last week whom I was referred to by my dentist as understanding the upper neck region, TMJ and muscles. He has been nothing short of a miracle for me. I have had little pain, but have been suffering from severe muscle spasms in my face, neck, shoulders, forehead and scalp along with Tinnitus, dizziness, brain fog and confusion for almost 2 1/2 years. Without going into too much detail, he spent over an hour with me and definately said I had muscle problems, but with most TMJ patients, the SCM muscle was a mess. 3 Adjustments later and I am telling you I feel like a new person. My brain fog is almost gone, my vision has improved (dealing with nystagmus for two years), I can think clearer, no pain, the tinnitus is still there but slowly dissappearing..I cannot tell you how thankful I am to my dentist for all his help and recommendations. I continue to wear my splint now and hope the recovery will continue this quickly. One thing I noticed, as soon as I started feeling better, my mood improved, my anxiety all but dissappeared. I noticed I was breathing cleaner, better breaths I guess..It has all helped me relax and therefore my muscles are relaxing. For me, it seems it is all muscle related. I added this article for my diagnosis, maybe some of you can relate.
The sternocleidomastoid (SCM) muscle is one of the most complex in the body. It functions as both a short range (clavicular head) and long range (sternal head) rotator, an upper cervical extensor, a flexor of the cervical spine on the thoracic spine, a lateral flexor, as well as a very important source of equilibrium sense.1,2,3 Likewise, when it becomes dysfunctional as a result of containing myofascial trigger points (TPs), it can present a complex clinical picture.
The pain referral pattern of the SCM includes pain over the cheekbone, in the forehead, on top of the head, in and behind the ear, over the chin, over the SC joint, over the forehead, and deep in the throat.3 The throat referral is a commonly overlooked cause of sore throat, often mistaken for pharyngitis. The patient will often feel a fullness in the throat, especially upon swallowing, which feels like a partial obstruction. The forehead referral pattern is one of the very few instances, if not the only instance, where referred pain can cross the midline, as the pain is frequently felt in the contralateral forehead area in a patient suffering from a TP in the clavicular division of the SCM.
In addition to pain, TPs in the SCM can cause autonomic and dysequilibrial symptoms. In the sternal division these relate to the ipsilateral nose and eye, and include lacrimation, conjunctivitis, pseudoptosis, blurred vision, coryza, and maxillary sinus congestion. The pseudoptosis is caused by spasm of the orbicularis oculi muscle, which lies within the pain reference zone of this section of the muscle.3,4 The clavicular division is the part of the muscle that can produce dysequilibrial symptoms. As stated earlier, this is a short range cervical rotator, and as with other short range cervical rotators, such as the splenius capitis and obliquus capitis inferior, is extremely important to our sense of equilibrium.4,5 Symptoms from TPs in the clavicular division include postural dysequilibrium, vertigo syncope (when severe), nausea, ataxia, and dysmetria, as well as localized sweating and blanching due to vasoconstriction to the frontal area of referred pain.3,6 These symptoms will usually be brought on by sudden turning of the head which will stimulate the trigger points, and can be reproduced by pincer palpation of the muscle. Of course, the dysequilibrial symptoms must be differentially diagnosed from labyrinthine disease, cerebelar disease, posterior column disease, vertebrobasilar arterial insufficiency, cervicogenic dysequilibrium from upper cervical joint dysfunction, and lumbogenic dysequilibrium from lumbar joint and/or muscular dysfunction (rare).
Treatment of the SCM TP can also be a complex matter, as underlying factors can be involved. Ischemic compression, spray and stretch, and/or postisometric relaxation are quite effective, but these must be done with the patient supine in order to ensure that the muscle will be completely relaxed. It is important to look at the upper cervical spine for joint dysfunction, as well as the sternoclavicular joint and the temporomandibular joint (TMJ). Of course, motion palpation procedures should be applied to the entire spine in order to detect joint dysfuction at lower levels as well. The patient's static posture and movement patterns, especially cervical flexion, sit-to-stand, and swallowing, should also be looked at.
Effective treatment of the sternocleidomastoid syndrome can be very rewarding to both doctor and patient, as when it is severe, it can be very distressing. Knowing how to diagnose and treat myofascial pain and dysfunction syndromes is essential in successfully managing these cases.
I am so happy that you have received help. I too have trigger points in the SCM. However, I haven't been fortunate enough to find someone to deactivate the trigger points long-term. A chiropractor adjusted my spine, but that didn't work. I am assuming that your chiropractor worked on your muscles. Any explanation of what he did in his treatment would be appreciated. I need all the information I can get to help me find help for SCM trigger points. Thanks.
I have some many of your symptoms. It si very dificult to find a specialist that si able to treat such a thing. Every time I call the chiropractor or massage theropist or whatever, they always tell me that they are capable of treating such a disorder. I have to find a referal in my area thyat can help me. I am also convinced that my wisdom teeth are the cause. The SCM muscle or my wisdom teeth are surely whats causing my pain. I juist have to have them both treated and hope that one works out for me. Thx for your post.
oh yeah sI was also wondering how the movements worked that the chiro did for you? In witch directions did he manipulate your neck/back. I just want to know so when I try to find a chiro that knows plenty about this muscle he doesnt try and scam me by doing just a typical movement to lossen up my neck. Also were your symptoms of headache and fogginess constant or did they come in spells? How long were you suffering with your headaches and other symptoms? Thx
Wow its unreal I just read this. In August my massage therapist learned myofacial and trigger point therapy. At the time my biggest complaint and disabling part of TMJ was ear and dizziness. I was miserable. I still have about 2 days a week from it, but its unreal, she started working on my SCM on both sides of my neck in certain trigger points and this slight grab and release motion. After 4 treatments my ear started to pop like it was releasing the fluid, like a normal persons ear would do. I feel so much better on some days and I don't want to rip my ear off.
The Following User Says Thank You to mdla For This Useful Post:
This is very informative and important information. I have had SCM problems for many years and have been diagnosed with Fibro many times by different Doctors because of it.
Just in the last few years in seeing a Massage Therapist who understands these muscles and the problems they cause, have I been helped with this. (I don't have Fibro)
My therapist has worked on the throat (as mdla describes) the collar bone area and chest or sternum area. She has been able to relieve throat tightness in one visit several times. I'm seeing her tomorrow. I'll ask about the trigger points.
Thanks so much for your response. I too was diagnosed with fibro several years ago, but I don't have it. I have believed for some time that my problem is trigger points--in the SCM muscle and spreading to other muscles in the kinetic chain. For me, it is on the left side predominantly. It is the left jaw joint that clicks and slightly grinds when the muscles are tight. I have seen at least six physical therapists and asked them to work on the SCM trigger points. Most of their treatment is done by assistants who put on heat, ultra sound, electrical stim--then the therapist spends about five minutes with the muscles. It doesn't work. I have seen three massage therapists, but they are mostly trained in "feel good" general massage therapy rather than therapeutic massage. It feels good for a couple of hours, then the tightness and pain returns. I am now seeing a physical therapist who does all the work himself. He spends the entire hour working on my muscles. He seems to know more about treating the whole syndrome than anyone else I have visited. He had my TMJ dentist make another splint for me to decompress the joint. This is short term to help the joint heal. Then I will go back to the permanent splint. The progress is slow, but I hope this time I will get help with the SCM trigger points which I believe have been the major source of my problems. It boggles my mind that it is so difficult to find someone who understands the problem and can fix it. The physical therapist I see does not take insurance. It is costing plenty, so I hope it works. It gives me hope to hear that you have been helped with physical therapy and a splint.
It sounds like you might have found the right person this time. The therapist that I've been seeing for the last 4 years totally does muscle work. One hour of strenuous work. She is trained in several types of massage therapy, works with sports injuries and took extra training for treating TMJD patients. Her practice is basically theraputic massage.
I had seen many others prior to her and didn't have much luck with muscle improvement, either. I did see a physical therapist for several years on & off who did muscle work and he helped me tremendously.
I also have to pay because insurance does not cover this, but it's been worth it.
My left side has always been the problem area, too. The left joint and condyle were damaged the worst with my first surgery. It took several visits to notice a lot of improvement, but I began to feel better after the first few . I had knots in the muscles down the left side of my back. They had been there for a very long time and it took a while for the muscles to "learn" not to go back to the knotted up condition. She also did intra-oral and improved my opening a few mm's. I was not in a splint during this time, so all of the improvements I realized were strictly due to her efforts.
I think I went to her regularly for about a year and all of my muscle problems from the face down were gone. I continued to see her on an as needed basis when I felt my face tightening due to stress or whatever. I would also see her if I felt any twinges of the muscle pain, usually due to over working or over stressing muscles. The original muscle problems have never come back.
After I got my splint last Dec. and had such wonderful results with it, I have only seen her occasionally. I think that's one reason the splint worked so well, all of the muscles, except facial, had been completely calmed down.
I'm seeing her weekly again now, because I strained my arm and the rotator cuff is swollen. I did have to have a steroid injection into the muscle, but the arm injury is referring pain across my upper back and neck and she is working on that for me. I hurt it a couple of months ago and let it go until I couldn't move my arm without pain. Now I have some overworked muscles compensatiing for the injured arm.
I told her about the SCM syndrome post and ask about therapists or other providers unable to find the trigger points. She showed me the charts and how the pain is referred. She said sometimes therapists are not trained to watch or ask for very subtle sensations when they find the trigger points. She said sometimes when they touch or hit the point, the patient feels pain. Other times it will refer the pain back to the injured area that is responsible, but it may be very subtle such as a tingling and the patient doesn't realize that the trigger point has been found. She asks her patients to tell her everything they feel, regardless of how insignificant it may seem. She has hit points in my neck, collar bone and sternum that shot a lightening bolt down my arm and up my face.She has also hit points that caused my finger tips to tingle or behind my ear to have a very slight sensation. She says knowing where the trigger point causes any type of sensation, helps her to know what's going on.
She does say that with TMJD and SCM problems, the results can vary and hitting the trigger points sometimes does not do exactly what they have been taught. She does understand the mess we get into with these problems.
I hope this makes some sense to you. I know you've done tons of research. As I was standing there watching her point out the trigger points on the chart and explaining these concepts, it did make perfect sense. I think without the visual aids, it may not be as obvious.
I do hope the new therapist you've found will be the one to help you. It sounds like he knows what he is doing.
After my TMJ doctor discovered that I had muscle issues and did the trigger point injections ....I went to the PT and told her about it. She didn't work on my muscles like the doc thought she should. Instead I got the ultrasound, tens, and a little muscle work...but, nothing compared to what you described. I've been going to PT because my insurance pays a portion of it. However, there is a massage therapist that treats tmj and is supposed to be very good. I'm going to check to see if he does the treatment you all described. I'll have to pay out of pocket, but, if that's what it takes, I'll do it. Fro some reason the ultrasound has been resulting in flare-ups and pain for me. My friend, who was a massage therapist said that it can actually dry out the joint area. So, if someone is already flared up and has dry, hurting muscles, this can aggravate it. My doctor still swears by this particular PT for help with the splint therapy and recapturing the disc...I'll just have to tell them no ultrasound or stem. Maybe they'll spend more time on the muscles then. It's amazing that all the other people I saw were focusing on the displaced disc when I've had underlying muscle problems probably the whole time. This is probably one of the reasons why I was in pain when they pulled me forward in a splint, the muscles were going into rebellion. Anyway, I thank all of you for this vital information.
I have been suffering from SCM syndrome for years. If you are searching for a chiropractor, look for one that is certified in applied kinesiology - a muscle testing treatment which then directs the chiropractor in which adjustments are needed. I am undergoing treatment now and, after 5 years of symptoms, hoping for results.
This post started in 2003, and I am wondering if marcessna who started the post can tell me the name of the chiropractor that brought him such relief. I am struggling with same issues and have tried lots of therapies and would love to contact this chiropractor.
You are so lucky to have had the help you needed. I too have had problems for almost 3 years now. All vertigo like symptoms every day. After some research I began to realize it was the scm muscle. I have seen over 20 doctors over the years and no one can seem to help me. They all do different work on me but nothing is long term. I wish I had my life back.
my pain doc injects anti-inflammatory medication directly into the muscle. it is also massaged as well. the pterygoid medialus is also a muscle that can lead to the 'brain fog' feeling which is the most difficult thing for people to understand. it's like you aren't even there, like a dream...
the p.m. muscle works with mastication and also controlling the inner ear which is what leads to vertigo and making things all foggy. you can only reach that muscle through the inside of the mouth which stinks but with a GOOD specialist their plans usually work to make that muscle not spasm, i am definitely feeling relief from it.