Fig 1. The Sternocleidomastoid Muscle | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 1 The Sternocleidomastoid muscle

The sternocleidomastoid muscle (Fig. 1) is frequently involved with a host of issues that bring patients into an acupuncture clinic. This muscle is a major contributor to muscle tension headaches, but also can contribute to positional vertigo, ear pain, facial pain, swallowing problems, and various eye problems. In addition to patient symptoms, this muscle is involved in a head forward position and cervical side bends, and contributes to an offset of the upper cervical spine, as unilateral contraction performs contralateral rotation while tilting the head upward.1 The sternocleidomastoid muscle is often injured in whiplash injuries, and in these cases it is essential to treat it for a successful rehabilitation.2

From a channel perspective, the sternocleidomastoid muscle has several relationships. First off, many important acupuncture points traverse this muscle and most acupuncturists are well aware of these. ST 9, LI 17 and 18, SI 16, and SJ 16 are frequently-used points which are located around the muscle. In terms of channel sinews (jingjin), this muscle is a convergence of three channels.

Fig 2. The Sternocleidomastoid Muscle & the Stomach Sinew Channel | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 2: Stomach Sinew Channel

The Stomach sinew channel (Fig. 2) is a continuous myofascial plane traversing the anterior portion of the body. In the chest, it includes the sternalis muscle and/or fascia (some individuals do not have this muscle, but the fascial compartment is still there) which then communicates with the sternal head of the sternocleidomastoid muscle.3 This sternal head is more easily needled through ST 9 (renying), though the practitioner does not needle perpendicular with the needle advancing between the thyroid cartilage and the carotid artery, as frequently described in acupuncture texts.4 This direction would approach the longus colli muscle and link this point with the yin qiao, an extraordinary vessel which travels through this point. To address the SCM, the practitioner would advance the needle lateral and through the sternocleidomastoid muscle. This is the muscle motor point, and really both heads can be influenced with this technique, but the sternal head is more readily available.5

The Sanjiao sinew channel (Fig. 3) traverses the arm and then travels through the upper trapezius fascial layer to connect with the sternocleidomastoid muscle; it has the greatest influence on the clavicular head. This muscle can be needled through SJ 16 (tianyou). Like ST 9, the needle direction is not perpendicular, but is directed through the sternocleidomastoid muscle, in this case in an anterior direction into the clavicular head of the muscle.

Fig 3. The Sternocleidomastoid Muscle & the Sinjao Sinew Channel | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 3: Sanjiao Sinew Channel

The Urinary Bladder sinew channel (Fig. 4) is the third sinew channel that includes the sternocleidomastoid muscle. Specifically, this includes the branch off the main channel which wraps around to the chest (pectoralis major) and then travels through the muscle. Either of the above needle techniques will influence the sternocleidomastoid muscle, and there is no adapted UB point to add to this discussion.

Fig 4. The Sternocleidomastoid Muscle & Urinary Bladder Sinew Channel | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 4: Urinary Bladder Sinew Channel

If you are incorporating the sternocleidomastoid muscle into a comprehensive treatment, how do you know if you are influencing one or another of these channels? Maybe, more important, how would you combine acupuncture to the sternocleidomastoid muscle with distal points? The two criteria I use are symptomology and postural assessment. If you review the trigger point (TrP) referral patterns of the sternocleidomastoid muscle, you will see that it refers pain to a number of regions.1

If a patient complains of frontal headaches and the referral has more of ayangming distribution, then I would likely consider yangming points and specifically ST 41 (jiexi) is indicated. If there are ear complaints (pain, ear stuffiness, positional dizziness), shaoyang distal points would be indicated and SJ 3 (zhongzhu) or SJ 5 (waiguan) are both good considerations. If the patient complains of pain referring to the occiput region, distal point could include taiyang points and UB 60 (kunlun) or UB 62 (shenmai) are both good considerations. In all of these examples, it is suggested to first palpate the sternocleidomastoid muscle and see if this recreates and contributes to the pain referral, as multiple other muscles might be the main pain generator and in that case another set of channel considerations would need investigation.

In addition to pain, it is worth looking to posture for hints on channel involvement. Generally, imbalances between the front and the back of the body (such as a forward head) would involve the relationship between the Urinary Bladder and the Stomach sinew channels. This would particularly be evident with upper cross syndrome (scapular protraction and a forward head position). In this case, the sternocleidomastoid muscle is bilaterally locked-short along with the pectoral muscles.

The sinews of the shaoyang channels traverse the lateral portion of the body and imbalances are frequently seen between the right and the left sides of the body, in this case manifesting with cervical lateral flexion, rotation, and a tilted head. These postural observations are not absolute, but they give important hints that can lead to further investigation.

There is a final thing to consider with the sternocleidomastoid muscle and channel relationships and that involves its jueyin relationship. Notice that a pain referral of the sternocleidomastoid muscle includes the vertex, a region associated with the jueyin. While neither the Liver nor Pericardium sinew channel includes this muscle, nor, arguably, do these primary channels travel directly through it, there is some important anatomy that links this muscle to the jueyin. First, the vagus nerve, one of the primary nerves of the parasympathetic division of the autonomic nervous system, shares some fibers with the accessory nerve (the nerve which innervates the sternocleidomastoid muscle).

Fig 5. The Sternocleidomastoid Muscle and the Pericardium Divergent Channel | SPORTSMEDICINEACUPUNCTURE.COM

Fig. 5: Pericardium Divergent Channel

I suspect this muscle is a link to the autonomic nervous system, and people who have parasympathetic deficiency (much of the modern world, unfortunately) will frequently have an irritated sternocleidomastoid muscle. TrP release to this muscle, especially on the right side, will frequently cause peristalsis, in my experience, especially for patients with digestive problems. P 6 (neiguan) is a useful point and will frequently reduce tension in the sternocleidomastoid muscle, specifically the clavicular head. While neither of the primary or sinew channel connects with this muscle, the Pericardium divergent channel (Fig. 5) might relate to this correspondence, and I suspect there is a relationship to the vagus nerve with this secondary channel.3

The sternocleidomastoid muscle is such an important muscle; the inclusion of direct needling of this muscle along with distal and adjacent needling will greatly enhance your results when working with the myriad of complaints associated with the muscle.

Below are instructions for needling the motor point starting at ST 9 and the common site of trigger point formation at SJ 16. Also, check out the video demonstration of these needle techniques.

Sternocleidomastoid Motor Point: Threading Needle Technique

  1. The practitioner locates ST 9 (renying) and SI 16 (tianchuang). Using the index finger and thumb, the practitioner lifts and squeezes the anterior and posterior borders of the SCM at ST 9 and SI 16. The practitioner’s intent is to squeeze the muscle belly at LI 18 (futu) or slightly above this point to find the place of maximum tenderness. Squeezing the muscle like this also helps the practitioner to gauge the thickness and circumference of the muscle (Fig. 6A). This is necessary to assess for the appropriate needle angle and depth. The practitioner releases the muscle before inserting the needle.
  2. Using the classical threading needle technique Tou Ci, the practitioner inserts a 1.5 inch/40 mm needle at ST 9 at a transverse-oblique angle toward SI 16. The needle angle and depth are based on the previous assessment of the size of the sternocleidomastoid muscle. The needle will cross-fiber the muscle and the qi sensation is usually felt in the LI 18 region or slightly above (Fig. 6B). Caution is advised: the needle should not be inserted perpendicularly because of the proximity of this motor point to the carotid artery.

Sternocleidomastoid Superior Clavicular Head Trigger Point: Threading Needle Technique

1. The practitioner locates SJ 16 (tianyou) located on the posterior border of the sternocleidomastoid muscle, 1 cun below GB 12 (wangu). Using the index finger and thumb, the practitioner lifts and squeezes the anterior and posterior borders of the SCM at SJ 16 and below SJ 17. The practitioner feels for the fibers of the clavicular head which lie deep to the sternal head at this region of the muscle. Squeezing the muscle like this also helps the practitioner to gauge the thickness and circumference of the muscle. This is necessary to assess for the appropriate needle angle and depth. The practitioner releases the muscle before inserting the needle.

Fig 6. Motor Point Needling of the Sternocleidomastoid Muscle | SPORTSMEDICINEACUPUNCTURE.COM

Callison, M. Sports Medicine Acupuncture, 2019
Fig. 6: Motor Point Needling of the SCM

2. Using the classical threading needle technique Tou Ci, the practitioner inserts a 1.5 inch/40 mm needle at SJ 16 and angles the needle anterior and into the clavicular head of the SCM. The needle angle and depth are based on the previous assessment of the size of the SCM. The needle will cross-fiber the clavicular head of the SCM muscle and the qi sensation is usually felt there and traveling to the ear. Caution is advised: While the needle will slide under the sternal head, the needle should not travel deep to the clavicular head because of the proximity of this region to the carotid artery.

REFERENCES:
  1. Travell, Janet G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams and Wilkins, 1999.
  2. Callison, M., Schreiber, A., 2019. Sports Medicine Acupuncture. San Diego, Calif: AcuSport Education.
  3. Myers, Thomas W., et al. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone/Elsevier, 2017.
  4. Deadman, Peter, et al. A Manual of Acupuncture. Journal of Chinese Medicine Publications, 2016.
  5. 

Callison, Matt. Motor Point Index: An Acupuncturist’s Guide to Needling Motor Points. AcuSport Education 2007.

About the author(s):

Brian Lau, AP, C.SMA is has been on the faculty of the Sports Medicine Acupuncture Certification since 2014, and also teaches foundation courses with AcuSport Education. Brian lives and practices in Tampa, FL where he owns and operates Ideal Balance: Center for Sports Medicine Acupuncture (www.ideal-balance.net). He blogs on anatomy and TCM at www.sinewchannels.com.