SCM Length Test/Stretch

SCM Length Test/Stretch Purpose of Skill: To assess/increase muscle length of the sternocleidomastoid. Origin: Medial clavicle and manubrium. Insertion: Mastoid process of the temporal bone. Action: Bilateral contraction—upper cervical extension and lower cervical flexion. Unilateral contraction—upper cervical contralateral rotation and ipsilateral side bend. Setup: Patient will lie supine with therapist standing at the head of the treatment table. Typically, the table will be fully raised for proper therapist mechanics. Taller therapists may need to sit on a stool. Step 1: 1:07 With patient supine, support their head and have them slide towards you until their head and neck are clear of the table. Step 2: 1:18 Cradle the patient’s head in a “football grip” supporting their head on your upper arm and controlling their head position with your middle two fingers on their chin. Use the arm on the same side as the SCM you are stretching. IE. When stretching the patient’s right SCM, support their head using your right arm. Step 3: 1:39 Tilt the patient’s head forward into a chin nod to produce upper cervical flexion. IMPORTANT: Assess cranial nerves and symptoms of cervical arterial dysfunction (CAD) with incremental challenge after each change in cervical position to assess cranial nerve function. Step 4: 2:02 Retract the head and neck towards the floor while maintaining the chin nod to produce lower cervical extension. Step 5: 2:14 Sidebend the patient’s head AWAY from the SCM that you are stretching only going through partial ROM. IE. When stretching the right SCM, create lateral flexion to the left. Step 6: 2:30 Maintain contralateral sidebend and rotate the patient’s head TOWARDS the SCM that you are stretching, again only through partial ROM. NOTE: This stretch will not require excessive lateral flexion or rotation if you maintain proper cervical retraction. Step 7: 2:50 Using the ulnar border of your opposite hand, create a stretch at the origin of the muscle by pushing against the sternum in the line of pull of the SCM. Ask your patient to identify the location and intensity of the stretch to ensure that your technique is effective. When assessing muscle length, compare to the opposite side by noting differences in the fully lengthened position. When stretching the SCM to increase muscle length, hold the stretch for a cumulative 90-150 seconds. Evidence: Leal & Dennison, 2011. ISC 21.1.3 pp.19