This is What You Need to Know About Your Powerful SCM Muscles: the Sternoclediomastoid and TMJ, Neck, and Face Pain, Ear and Throat Dysfunction, Breathing Difficulties, and More!
- Tara Lee Clasen
- 4 days ago
- 10 min read
If any muscle seems to hold mystical powers, it is the sternocleidomastoid. And that is because the sternocleidomastoid can be responsible for truly remarkable symptoms, and working with the sternocleidomastoid can affect the vagus nerve, conversely stimulating remarkable relaxation.
For short, the Sternocleidomastoid is called by its initials, SCM. Its sites of attachment create this muscle’s name: sternum, clavicle, and the mastoid process.
This blog details the many ways that the sternocleidomastoid affects the entire mind-body. The sternocleidomastoid interacts with the vagus nerve and affects TMJ, jaw, face, and neck, the hyoid bone and swallowing, ear symptoms, dizziness, headaches, migraines, the trigeminal nerve, and clavicle, ribcage and thoracic spine positioning. The positioning of the ribcage directly affects structures farther down the chain. In my practice, I see women with each of these complaints.
In another post HERE (COMIMG SOON) we will outline the anatomy of the sternocleidomastoid and trigger points.
The SCM is a paired muscle; you have one on each side of the neck. Other muscles, such as the scalenes, affect the SCM, and the SCM affects other muscles. When troubleshooting complex pain signals, and something such as ear and face pain, we are working with the SCM as part of the cervical sleeve. Both SCM muscles can be dysfunctional, often with one more so than the other.
Here is a quick list of symptoms related to the SCM. After this list, there will be a more in-depth look at these symptoms. Some of these symptoms will end up being featured in future blog posts.
A quick list of symptoms that the SCM contributes to (in varying degrees):
Vagus nerve dysfunction
Shortness of breath
Trigeminal nerve pain
Cervicogenic pain
Face Pain
Headaches
Migraines
Degenerative changes in the spine
Altered clavicle and scapular movement patterns
Rounding of the thoracic spine
Ear pain and dysfunction. Ear “fullness”
Swallowing and throat constriction
Swelling and issues with lymph drainage
Proprioceptive issues and healing after a brain injury
Lessening tension in the SCM improves the outcomes of your other bodywork sessions, such as chiropractic care.
Let's look at these symptoms with a little more detail:
The SCM and the Vagus Nerve
The SCM has a relationship to the vagus nerve. Vagus nerve dysregulation affects the SCM and, conversely, chronic tension in the SCM—caused by forward head posture and cervical curve issues—will place stress on the vagus nerve.
The vagus nerve regulates and connects many of the body's functions. As an example, the vagus nerve acts upon the inferior thyroid artery through the external laryngeal nerves. SCM stress plays a role in chronic neck tension that can lead to cervical instability, affecting and even shearing the fibers of the vagus nerve, therefore acting upon the entire mind-body system.
Find out more about the vagus nerve HERE (POST COMIMG SOON!)
Sternocleidomastoid and the Jaw
The SCM, which is innervated by the cervical complex, experiences a neural coupling with the trigeminal system, which innervates the jaw and ear muscles.
In anticipation of chewing, the SCM will increase its tone and stabilize the neck. Evidence suggests that during mastication, a trigeminal-cervical reflex stimulates electrical activity of the SCM. Healthy SCM innervation is fundamental to a healthy TMJ function, and TMJ function affects the SCM. The SCM also tracks whether you are chewing on one side or more evenly on both sides, shifting as you do.
If the SCM dysfunctions, the brain will feel unstable, and other muscles will compensate, which alters the jaw’s movement pattern. A tense SCM, its powerful pull, its effect on nerve complexes, and altered movement patterns can cause or worsen TMJ pain.
Sternocleidomastoid and Swallowing (hyoid bone)
Although not attached to the hyoid bone, the SCM is up against, and affects, the other anterior neck muscles that are attached to the hyoid bone. Tension in the anterior neck can elevate the hyoid bone and restrict hyoid bone mobility, making swallowing more difficult.
In treatment, we work on lowering the electrical activity of the SCM by stimulating a relaxation response.
SCM and Breathing
The SCM is an accessory breathing muscle. But whereas the scalene (also anterior neck muscles) muscles are active during regular moment-to-moment breathing, and when you sleep (more on the scalenes muscles HERE and HERE), the SCM only helps elevate the ribcage during forceful inhalation.
If you think of this neurologically, as we will in another section below, we can philosophize about how when tense SCM muscles are in a chronic state of lifting the clavicles—as they do during deep inspiration—the brain will have an altered perception of the mind-bodies current needs. A chronic state of lift—when normally it is only needed in times of great work—will create a chronic sense of sympathetic nervous system tension.
Also, once the SCM is “burnt out” from a chronic sense of trying to stabilize the head and/or lifting the ribcage up, it cannot perform its actions when you actually need it to. So if, for example, you jog down the street, the SCM will not be effective in helping your body get in that extra air needed.
SCM and your Clavicles and Ribcage
When your head is in a chronically flexed position, your clavicles will draw in. Your ribcage and thoracic spine shift. This affects your diaphragm and pelvic floor and further disrupts your breathing.
Important: Everything in your body is working with and around everything else. So if you ever had prolonged anxiety, or walked around sucking in your tummy, or had painful menstrual cycles—any condition that creates tension in the diaphragm and pelvic floor—your ribcage will become disrupted. If the ribcage and all the surrounding soft tissue are disrupted, the neck and jaw will also be disrupted.
In the office, I work in a couple of different ways. Some women really need the jaw and neck focused on quite a bit. They are having big symptoms, a lot of pain, and even when we know there is more to be addressed further down the chain, our focus is to reduce pain and clicking effectively. I also work with women who are only coming short term; they are looking to heal an ear symptom, and then return to their normal bodywork routine. There are also women who come in for a neck focus, and we are working on the psoas and diaphragm from the first session. And it is through this work that the jaw will have big shifts.
So yes, we could talk about many body patterns and how by working directly on them, you would aid the position of the neck and jaw. But with their direct connection, when thinking of the neck, you must consider the clavicles and upper ribcage.
Here is what happens to your upper body when tight SCM (and scalene) muscles draw your neck forward:
The clavicles retract. This means that the lateral edge of your clavicle (the edge close to your shoulder) draws forward, pressing towards the chest.
The muscles attached to the clavicle will become stressed.
The condition affects the shoulder blade, changing its movement patterns.
The thoracic spine will become rounded.
When you add this to other daily posture and lifestyle habits, patterns are created, and the neck moves forward even more.
SCM and Neck Pain
Please see the section below to understand the trigeminal-cervical complex and how the SCM creates pain in the upper head.
To understand neck pain, know that when the SCM is tense the entire neck will drawn into a flexed position. One side can be tighter than the other. Tightness in this muscle will cause trigger point pain, nerve pain, and compress the whole cervical spine. One side of the neck can compress more than the other. Compression leads to degenerative changes in the cervical spine, a permanent lessening of joint space, which will create more pain.
People who have more electrical activity present in the SCM are likely to experience chronic neck pain. SCM therapy increases the range of motion of the C-1 and C-2.
SCM, Nerve Pain, Face Pain, Headaches, and Migraines
To understand how the SCM affects face pain, headaches, and migraines, you must know that nerves talk to each other. The accessory nerve (CN XI) innervates the SCM, branches of the cervical plexus (C2-C3). The trigeminal nerve innervates the muscles of the face and ear.
The trigeminal-cervical reflex sends signals from the neck to the face and vice versa. Face pain can come from the cervical plexus through the trigeminal-cervical reflex — a neural pathway connecting the trigeminal nerve and cervical spinal cord. Stimuli create a reflexive response, and so a hypertonic, tight and tense SCM can be the reason for intense neck pain, ear pain, and face pain.
In my practice, I have seen this manifest in many ways. For instance, I saw a woman who was diagnosed with trigeminal neuralgia. She had intense face and ear pain (see ear below) and had been to the emergency room many times. She could not drive because of the medication. She was working with her naturopath, chiropractor, ENT, and others. She had taken rounds of antibiotics. What was missing was soft tissue manipulation of the neck muscles—so simple!
We worked on her jaw, which was helpful and shifted the pain a little. But it wasn’t until we really focused on the SCM that the pain totally shifted. Yes, she needs to work on other underlying factors, such as scalene tension, and undoubtedly the diaphragm, and pelvic floor. When someone is in that much pain, it isn’t that we need to just change the SCM; we need to investigate everything that leads to the conditions of that dysfunction and why the body is hospitality to feeling that much pain. But in that moment, working on the SCM took away her ear and face pain.
The SCM also has trigger points that refer up to the head and eye. Trigger points can vary in intensity. Please see the trigger point section later in this post.
The SCM and the EAR
The SCM affects the ear in several ways. As seen in the case study above, the SCM can be responsible for pain felt inside the ear. The skull behind the ear has the SCM attached to it. When the SCM is tight and tense, it is pulling on everything that houses the ear. This limits micro-motions of the skull and soft tissue and indirectly, affects inner ear pressure and middle ear balance. SCM relaxation indirectly affects the ear by reducing indirect compression on soft tissue vessels. Studies show that SCM mobilization reduces symptoms such as tinnitus.
SCM, the Lymphatic System, Cerebrospinal Fluid, and Neurological Balance
The SCM muscle’s proximity to the lymphatic chains creates a functional interplay. SCM tension can affect lymphatic flow. The SCM defines the boundaries for several crucial lymph node groups.
As part of the neck, the SCM tension might affect cerebrospinal fluid. All the activity in your brain requires fluid that drains waste out. When there is dysfunction and instability of the upper cervical vertebrae and surrounding soft tissue, there can be arterial blockage and a lack of drainage. A lack of drainage can affect the nerves. For example, fluid that is not draining can affect the nerves of the ear. Although not the primary structure considered, the SCM can lead to degenerative changes that create the fluid blockage.
For more on lymph drainage and the SCM head HERE (Coming Soon!) and for a post on ear symptoms, check HERE (COMING SOON!).
SCM, Other Neck Muscles, and Cervicogenic Dizziness
When the nerves to the ear are affected, balance issues can result. Not only can the SCM be part of the reason for the lack of drainage and the accumulation of fluid around ear nerves, but it can also be one of the major reasons for forward head posture. Chronic forward head posture will lower the gaze and cause the suboccipital muscles to strain themselves, trying to raise the gaze back up. Cervogenic dizziness is connected to suboccipital strain. If the SCM is not happy, the suboccipital will not be happy.
The SCM can create stress in the upper cervical vertebra which then affects the vertebral artery vessels.
To recap, the SCM can create dizziness by pulling on the skull behind the ear, by its mechanical and nervous system connections to the upper cervical vertebrae, impairing circulation, creating chronic forward head posture, and by negatively affecting other muscles that can also can you to become dizzy. A tight SCM impairs circulation.
SCM, How the Brain Controls the Body, and Brain Injury
A tight SCM, head looking down, increases proprioceptive noise in the vestibular system. In fact, that forward head posture will increase proprioceptive noise in every system in the body. Your nervous system has to work harder to figure out where you are in space and then works harder to compneate for head positioning.
The neural mechanisms underlying balance are disrupted by mechanical dysfunction. Forward head posture will exacerbate the head and neck pain of someone with a brain injury.
Not only does forward head posture make getting a head injury more possible, but at the moment in which you take an impact, your neck will be in an even more vulnerable position. And if your neck is tucked in flexion, healing from a head injury will be more difficult, overwhelming your entire system, and adding extra work stress to your brain.
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SCM and the Effectiveness of your Chiropractic Adjustment
Your chiro adjustments will be more successful, and you will hold the adjustments longer after by mobilizing—using soft tissue manual massage therapy to heal—the SCM. Smart manual therapy applied to this muscle, and other neck muscles, will also reduce resistance on the joint capsule during chiropractic manipulation.
So what Heals the SCM?
More on that in another post very soon!
Want to Know More?
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The Elemental Woman
A Conversation for the Modern Western Woman Inspired by the Healing Wisdom of the Ancient Eastern Sage
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Mindful Movement Journal
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About the author:
Since 2004, Tara Lee Clasen has been assisting women on their healing adventures. As a woman-focused physical medicine provider, also trained in Eastern medicine, she knows transformation is possible and knows that with reflection and self-love, your future is full of bright possibilities.
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References
Kohan EJ, Wirth GA. Anatomy of the neck. Clin Plast Surg. 2014 Jan;41(1):1-6. [PubMed][Reference list]
Anwar G, Moustafa IM, Khowailed I, et al. Comparison of corticomuscular coherence under different balance paradigms in individuals with and without forward head posture. Sci Rep. https://pubmed.ncbi.nlm.nih.gov/40594912/ G, Moustafa IM, Khowailed I, et al. Comparison of corticomuscular coherence under different balance paradigms in individuals with and without forward head posture. Sci Rep. https://pubmed.ncbi.nlm.nih.gov/40594912/
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