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Atlas · Neck

Sternocleidomastoid

The sternocleidomastoid helps turn and support the head. It may feel sore with neck movement or after a change in activity, but dizziness, blurred vision, swallowing trouble and ear symptoms should not be assumed to come from this muscle. A useful plan checks those symptoms separately and builds comfortable head movement without deep neck pressure.

Sternocleidomastoid
Body region
Neck · Head
Trigger points
5
documented in this muscle
Common symptoms
4
patterns cataloged
Contributors
4
Factors to assess

Muscle overview

Symptoms and first steps

Practical first steps

  • Use supported, comfortable head positions and vary prolonged head-turning tasks.
  • Practise small, slow rotations without pulling the head backward or sideways.
  • Do not press deeply into the front or side of the neck, massage a pulse, or use tools over the SCM.

When to seek assessment

  • Sudden unusual neck/head pain with double vision, speech or swallowing difficulty, imbalance, facial or limb weakness needs emergency assessment.
  • New or recurrent vertigo, fainting, visual symptoms or hearing changes needs a medical/vestibular assessment; do not wait for massage to work.
  • A persistent neck lump, fever, unexplained weight loss or progressive swallowing difficulty needs clinical examination.

Resisted rotation away from the tested side recruits the SCM. A small supine nod instead examines cervical flexor coordination; superficial SCM activity is not automatically abnormal and neither maneuver diagnoses a trigger point.

Examination, palpation and treatment evidence

Illustrated overview

Sternocleidomastoid

Blue highlights the muscle. Crosses mark representative trigger-point sites; shaded areas show possible referred pain. These examples do not correspond one-to-one with the numbered points below. Patterns vary and cannot diagnose the cause of pain.

Illustrated overview

Sternocleidomastoid · Anatomy and referred pain 1

Representative source regions. The illustrated markers and pain pattern are not individual assignments to the numbered trigger points.

Open full-size image

Trigger points

1. TrP1

Location. Front of neck, from sternum to mastoid

Trigger point map
Sternocleidomastoid — Sternocleidomastoid · Trigger-point examples 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Referred pain map
Sternocleidomastoid — Sternocleidomastoid · Referred-pain pattern 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Pain referral. Side of neck, with possible accompanying head discomfort

Pain Pattern

  • Side of neck
  • Head or facial region — requires independent headache, dental or ENT assessment when indicated

What This Pain Feels Like

Soreness may follow the visible muscle from the mastoid toward the sternum or clavicle; a mass or swollen node requires separate examination. Turning to check traffic or hold a conversation can reproduce pain, but joints and other neck muscles participate.

What Patients Report

  • Side-of-neck ache
  • Discomfort turning the head
  • Headache accompanying neck discomfort

What Makes It Worse

  • Turning the head within an ordinary task
  • Sustained reading or screen use
  • Prolonged head support demands
Browse related exercises (15)

Symptoms patients report

Side-of-neck ache Soreness may follow the visible muscle from the mastoid toward the sternum or clavicle; a mass or swollen node requires separate examination.

Discomfort turning the head Turning to check traffic or hold a conversation can reproduce pain, but joints and other neck muscles participate.

Head-support fatigue Sustained reading or headgear use may become uncomfortable; assess actual task tolerance and sleep or workload changes.

Headache accompanying neck pain Record headache features and the response to movement; a tender SCM does not replace a headache diagnosis.

Contributors to assess

Sustained or unfamiliar head positions Prolonged looking to one side or a sudden workload increase may provoke symptoms; no single posture is inherently the cause.

Recent neck injury After trauma, assess the cervical region and neurological status before treating presumed muscle soreness.

Sleep and pain sensitivity Sleep disruption or stress may affect symptoms and tolerance without proving a particular muscle mechanism.

Increased respiratory effort The SCM can assist inspiration. New breathlessness or persistent coughing deserves respiratory evaluation, not a diagnosis of faulty breathing.

For clinicians and supervised training

Clinical reference

Use facial or head pain maps for orientation; dizziness, visual change and swallowing symptoms require their own assessment.

Anatomy and palpation

Anatomical relationships

The sternal and clavicular heads arise from the manubrium and medial clavicle and join toward the mastoid and lateral superior nuchal region. Unilateral action includes opposite-side rotation and same-side inclination; bilateral action depends on head and neck position. Motor supply is chiefly cranial nerve XI.[1][2][4]

  • Mastoid process behind the ear; follow the superficial belly downward.
  • Sternal head near the manubrium and broader clavicular head at the medial clavicle.
  • Posterior SCM border defines the front edge of the posterior neck triangle.

Nearby structures. The carotid sheath lies deep/medial, with major vessels and vagus nerve. Superficial cervical nerves, jugular veins and lymph nodes are nearby; the accessory nerve crosses toward trapezius. A pulsatile or nodular structure must not be treated as a muscle band.

Palpation

Patient position. Clinician examination only: supine with head supported in a comfortable slight flexion, or supported sitting. Examine one side at a time.

Find the landmarks

  • Locate mastoid, manubrium and medial clavicle visually and with light contact.
  • Brief gentle rotation away from the side being examined identifies the superficial belly; relax before testing tenderness.

Examination sequence

  1. With the muscle clearly identified, use light superficial contact; a trained examiner may gently lift the mobile superficial belly away from underlying tissues rather than pushing inward.
  2. Compare the accessible sternal and clavicular portions, avoiding attempts to dig beneath the clavicular head.
  3. Ask whether any evoked pain is familiar and record it alongside active movement. This is a cautious anatomy-guided examination, not a validated SCM trigger-point protocol.

Document the findings

  • A reproducible tender site can be documented; it does not establish the cause of headache or dizziness.
  • Asymmetry, wasting, a persistent mass or involuntary head position should change the assessment pathway.

Limits and precautions

  • No deep anterior-neck pressure, bilateral compression, pressure over a pulse, instrument-assisted digging or unsupervised pinching.
  • Stop immediately for light-headedness, visual change, nausea, electric sensations or swallowing discomfort.
  • If the belly cannot be confidently separated from adjacent structures, omit palpation.
[1][2][4]

Examination and tests

3

Active cervical motion and symptom response[3][4]

Establish a repeatable regional movement baseline and look for symptoms requiring a different pathway.

Position
Seated with trunk supported and eyes level; the examiner observes from the front and side.
Technique
Ask for slow active rotation each way, side-bending, flexion and extension within tolerance. Measure with the same inclinometer or goniometer at follow-up; record where familiar pain starts and whether symptoms remain local or travel into the arm. No end-range overpressure.
Positive finding
A repeatable restriction, familiar neck pain or a new distal symptom is an examination finding; there is no positive trigger-point cutoff.
Interpretation
A local, movement-dependent response helps select a tolerable starting movement. Arm pain, sensory change or weakness prompts a neurological examination.
Limitations
Several muscles, joints and nerves move together. Restricted motion cannot identify a single painful muscle. Stop for dizziness, visual symptoms, unusual severe headache or neurological change; a comfortable test does not exclude vascular disease.

Resisted head rotation and accessory-nerve motor examination[2][1]

Compare SCM recruitment and screen a possible motor deficit without inferring a trigger point.

Position
Seated upright, shoulders supported, head near neutral.
Technique
To assess the right SCM ask the patient to turn left gently against the examiner's hand on the cheek/jaw; repeat on the other side. Observe the superficial muscle and compare effort, pain and strength. Include shoulder shrug when cranial nerve XI injury is suspected.
Positive finding
Reproducible familiar neck pain with loading or clear weakness/atrophy compared with the other side.
Interpretation
Pain may guide a lower starting load. Disproportionate weakness or atrophy, particularly after surgery, requires neurological evaluation.
Limitations
Other rotators contribute and pain inhibits effort. This is not a selective sternal-versus-clavicular trigger-point test; avoid strong resistance after acute injury.

Craniocervical flexion test / low-load nod control[5][3]

Assess cervical flexor coordination and whether a low-load exercise is tolerable.

Position
Supine with knees bent, head supported neutrally; for the formal CCFT use a pressure-feedback cuff under the neck.
Technique
Ask for a small, slow nod without lifting or sliding the head. Observe superficial SCM recruitment and breath-holding. A trained clinician follows the published graded pressure-feedback protocol for a formal CCFT; otherwise document a qualitative nod-control observation, not a formal score.
Positive finding
Inability to maintain the target movement, prominent substitution, breath-holding or familiar pain is recorded with the task level.
Interpretation
Can identify a modifiable coordination/endurance task for training; reduced performance does not prove the SCM is the pain generator.
Limitations
This examines a muscle system, not one muscle. A cuff-free nod is not equivalent to the validated graded test; performance depends on instruction, effort and pain.

Distinguishing other causes

Vestibular or other causes of dizziness[6]

Findings that matter. Spinning with position changes, spontaneous attacks, hearing symptoms, presyncope or migraine features need their own history.

Next step. Use medical/vestibular assessment. Neck tenderness and improvement after touch do not establish cervical dizziness.

Vascular or central neurological disorder[4]

Findings that matter. Unusual sudden neck/head pain with double vision, ataxia, speech/swallowing change or focal neurological symptoms.

Next step. Emergency evaluation for acute focal signs; do not use neck extension/rotation as a vascular clearance test.

Cervical radiculopathy[3][7]

Findings that matter. Arm pain with neurological loss or symptoms affected by cervical motion can coexist with superficial tenderness.

Next step. Check strength, reflexes, sensation and appropriate regional tests rather than treating the SCM alone.

Dental/TMD or primary headache disorder[8][6]

Findings that matter. Pain linked to jaw use, tooth-specific symptoms, or a recurrent migraine-like pattern does not become SCM pain because palpation is tender.

Next step. Arrange dental/TMD or headache evaluation according to the dominant history and findings.

Treatment selection and progression

Exercise and rehabilitation

Graded neck movement[3][4]

Consider when. Assessed mechanical neck pain with a tolerable movement direction and no progressive neurological or vascular features.

Support the trunk and move the head slowly through a small comfortable rotation arc, return to center, and repeat on the other side. Add side-bending only if comfortable. Keep breathing and avoid pulling with the hand.

Dose and review
Pragmatic starting example, extrapolated from regional rehabilitation: 3–5 repetitions each way once or twice daily; start smaller for an irritable presentation.
Progression
Increase the comfortable arc before repetition count, then practise the actual task such as looking to the side while walking. Reduce the next session if symptoms remain above baseline.
Stop or reassess
Stop for arm tingling, weakness, dizziness, visual change or an unusual headache. Sharp pain or a lasting flare calls for dose reduction and reassessment.
Evidence and limits
Neck guidelines support active movement within a broader rehabilitation program. The suggested repetitions are a starting option, adjusted to symptoms and task tolerance.

Exercise and rehabilitation

Low-load nod coordination[5][3]

Consider when. Assessed mechanical neck pain with difficulty controlling a small nod and no concerning neurological/vascular symptoms.

Lie with head supported. Nod slightly as if saying yes, keeping the back of the head down and jaw relaxed. Reduce the movement if the head lifts, the throat strains or breathing stops.

Dose and review
Pragmatic example: 5 gentle repetitions held briefly, once daily. This is not a formal CCFT score or a validated isolated-SCM treatment dose.
Progression
Improve control first; then extend comfortable holds and practise comfortable head support during sitting tasks with clinician guidance.
Stop or reassess
Stop for headache escalation, dizziness, visual change or throat symptoms; reduce the task for pain or prominent substitution.
Evidence and limits
A regional motor-control option based on cervical flexor assessment and neck guidelines. It does not switch off the SCM or establish that it is overactive.

Self-care and activity

Restore comfortable head-turning tasks[3][4]

Consider when. Symptoms associated with sustained head turning, reading or work equipment after appropriate assessment.

Move screens or reading material to reduce prolonged end-range turning when helpful. Alternate task positions, support the head at rest and return gradually to the activity that matters.

Dose and review
Pragmatic example: start with a comfortably tolerated task bout and a movement break before symptoms build. Duration is set from the individual baseline.
Progression
Lengthen the task or add headgear/load one variable at a time; do not chase perfect alignment.
Stop or reassess
Do not continue a task that provokes dizziness, visual disturbance, weakness or swallowing difficulty; obtain assessment.
Evidence and limits
An individualized application of regional education and graded activity, not a trial-specific SCM protocol.

Reassessment and follow-up

  • Measure comfortable rotation and repeat a real task such as looking toward a second screen or checking to the side.
  • Track reading or headgear tolerance and whether symptoms settle after activity.
  • Repeat the same nod-control task or formal CCFT method, documenting substitution and tolerance.
  • Track headache burden separately; persistent dizziness, visual or swallowing symptoms require their own assessment rather than a palpation outcome.

Evidence and sources

  1. Anatomy, Head and Neck: Sternocleidomastoid Muscle

    2026 · Anatomical reference

    Used for attachments, actions and anatomical relationships only; broader causal claims in this chapter are not adopted.

  2. Walker. Cranial Nerve XI: The Spinal Accessory Nerve

    1990 · Clinical examination reference

    Resisted head rotation and shoulder shrug assess accessory-nerve motor function, not trigger-point validity.

  3. Blanpied et al. Neck Pain: Revision 2017

    2017 · Clinical practice guideline

    Regional neck assessment and multimodal rehabilitation; does not validate individual trigger points or prescribe the example doses below.

  4. Rushton et al. International IFOMPT Cervical Framework

    2023 · International clinical framework

    History-led evaluation of possible vascular disease before neck intervention; no positional maneuver reliably clears vascular risk.

  5. Jull et al. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test

    2008 · Clinical assessment paper

    Examines cervical flexor coordination and endurance, including superficial substitution; not a test for SCM trigger points.

  6. Seemungal et al. The Bárány Society position on Cervical Dizziness

    2022 · Society position statement

    Evidence for a mechanistic link between neck pathology and vertigo is lacking; clinical diagnostic criteria were not proposed.

  7. Wainner et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy

    2003 · Prospective diagnostic study

    82 selected patients; combined findings are more informative than isolated provocation and estimates had wide confidence intervals.

  8. Schiffman et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)

    2014 · Validated diagnostic criteria

    Familiar pain and jaw-related history support pain-related TMD diagnoses; does not prove a palpable nodule is the cause.

Associated Trigger Points