Sternocleidomastoid Muscle Contracture

Anatomy of the Sternocleidomastoid Muscle
Types of SCM Contracture
Causes of SCM Contracture
Symptoms of SCM Contracture
Diagnostic Tests for SCM Contracture
Non-Pharmacological Treatments
Drugs Commonly Used for SCM Contracture
Surgical Options for SCM Contracture
Prevention Strategies
When to See a Doctor
Frequently Asked Questions (FAQs)

Sternocleidomastoid (SCM) muscle contracture is a condition where the SCM muscle becomes abnormally tight or shortened. This can restrict neck movement, cause pain, and lead to an abnormal head posture. In some cases, especially in newborns, this appears as a visible tilt of the head (often called congenital muscular torticollis), whereas in adults it can occur after trauma, surgery, or due to chronic muscle overuse.

Anatomy of the Sternocleidomastoid Muscle

Understanding the anatomy of the SCM muscle is key to grasping how a contracture can affect your neck movement and posture.

Location and Structure

Location: The SCM is a long, paired muscle that runs on both sides of the neck.
Position: It is visible when you turn your head. One can see it as it extends from behind the ear down along the side of the neck.

Origin and Insertion

Origin: The SCM has two heads:
- The sternal head originates from the manubrium (upper part of the sternum).
- The clavicular head originates from the medial portion of the clavicle (collarbone).
Insertion: Both heads merge and attach to the mastoid process (a bony bump) behind the ear and to part of the superior nuchal line at the back of the skull.

Blood Supply

Arterial Supply: The muscle receives blood from branches of the:
- Occipital artery
- Superior thyroid artery
- In some cases, smaller branches from other nearby vessels also provide blood.

Nerve Supply

Nerve Supply: The SCM is mainly innervated by the accessory nerve (cranial nerve XI), with additional sensory input coming from cervical spinal nerves (from the cervical plexus).

Functions of the SCM Muscle

Head Rotation: Turning the head to the opposite side. For example, contracting the left SCM helps turn your head to the right.
Head Flexion: Bending the head forward.
Lateral Flexion: Tilting the head to the side.
Neck Extension Assistance: Helping in raising the head or extending the neck when needed.
Postural Support: Contributing to maintaining an upright head posture.
Assistive Role in Breathing: In certain cases, especially when the primary muscles of respiration are compromised, the SCM may help elevate the ribcage.

Types of SCM Contracture

SCM contractures can present in several forms depending on the underlying cause or timing. Although there is overlap, they are generally divided into:

Congenital Muscular Torticollis:
Present at birth, usually due to intrauterine malposition or birth trauma. It results in a shortened SCM muscle, causing a head tilt.
Acquired Contracture:
Develops later in life due to injury, overuse, or certain systemic conditions.
Spastic Contracture:
Typically occurs secondary to neurological injury (e.g., after a stroke or due to cerebral palsy), where increased muscle tone leads to prolonged contraction.
Post-Traumatic or Post-Surgical Contracture:
Can occur after neck trauma or as a complication following surgical procedures.
Idiopathic Contracture:
Occurs without any clear identifiable cause.

Causes of SCM Contracture

Understanding the potential causes can help in both prevention and treatment. Here are 20 possible causes:

Congenital malformation: Abnormal development of the muscle before birth.
Birth trauma: Injury during a difficult delivery may lead to muscle damage.
Intrauterine malposition: Abnormal positioning of the baby in the womb affecting muscle growth.
Muscle injury: Trauma from accidents (e.g., whiplash from car accidents).
Surgical complications: Neck surgery can sometimes result in scarring and contracture.
Radiation therapy: Head and neck radiation may damage muscle tissue.
Neurological injury: Conditions like stroke can cause abnormal muscle tone.
Inflammatory conditions: Inflammation can lead to fibrosis (scarring) in the muscle.
Infections: Certain infections can lead to muscle inflammation and subsequent contracture.
Repetitive strain: Chronic repetitive neck movements or overuse.
Poor posture: Prolonged poor posture can contribute to muscle shortening.
Cervical spondylosis: Degenerative changes in the neck that alter muscle function.
Myofascial pain syndrome: Trigger points and constant tension may lead to contracture.
Muscle ischemia: Reduced blood flow causing tissue damage.
Tumors: Rarely, benign or malignant masses may invade muscle tissue.
Autoimmune myositis: Inflammatory muscle diseases can cause scarring.
Degenerative muscle diseases: Conditions that weaken and damage muscles over time.
Iatrogenic causes: Incorrect injections or other treatments causing localized damage.
Fibrotic changes: Scar tissue formation after injury.
Posture-related developmental issues: Especially in infants with improper head control.

Symptoms of SCM Contracture

People with SCM contracture may notice one or several of the following symptoms:

Neck pain: Ranging from mild discomfort to severe pain.
Limited neck movement: Difficulty turning the head.
Head tilt: The head may lean to one side.
Stiffness: A feeling of tightness in the neck muscles.
Muscle tightness: Sensation of a knot or hard band along the muscle.
Visible bulging: The affected muscle may appear more prominent.
Headaches: Tension headaches can arise from muscle strain.
Difficulty bending the neck: Challenges in nodding or looking up/down.
Restricted range of motion: Reduced ability to perform normal neck movements.
Muscle spasms: Sudden, involuntary contractions.
Neck swelling: Slight swelling due to muscle inflammation.
Tenderness: The muscle may be sensitive or painful when touched.
Asymmetry: Uneven appearance of the neck or shoulders.
Dizziness: Altered balance from uneven muscle tension.
Balance issues: Changes in posture can affect overall balance.
Fatigue: Muscle overuse may lead to tiredness in the neck.
Shoulder pain: Pain radiating from the neck to the shoulder.
Difficulty sleeping: Discomfort may interfere with sleep.
Chronic tension: Ongoing tightness that affects daily activities.
Reduced quality of life: Impaired neck mobility can affect work and leisure.

Diagnostic Tests for SCM Contracture

Diagnosing SCM contracture may involve a range of tests, including:

Physical examination: Direct assessment of neck movement, muscle tone, and symmetry.
Detailed medical history: Discussion of symptoms and potential causes.
Ultrasound imaging: Visualizes muscle structure and detects fibrotic changes.
X-ray imaging: Helps rule out bone abnormalities in the neck.
MRI: Provides detailed images of soft tissues, including the SCM.
CT scan: Offers cross-sectional images of the neck to assess tissue damage.
Electromyography (EMG): Measures electrical activity in the muscle.
Nerve conduction study: Evaluates the function of nerves supplying the muscle.
Manual muscle testing: Assesses strength and range of motion.
Range-of-motion testing: Quantifies how far the neck can move.
Palpation exam: A hands-on approach to feeling for muscle tightness or knots.
Biopsy: In rare cases, a tissue sample might be taken for analysis.
Blood tests: Check for markers of inflammation or muscle damage.
Serum creatine kinase levels: High levels may indicate muscle injury.
Inflammatory marker tests: Such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Ultrasound elastography: Assesses the stiffness of the muscle.
Dynamic fluoroscopy: Real-time X-ray to observe neck movement.
Posture analysis: Observational tests to evaluate head and neck alignment.
Video motion analysis: Digital recording to assess movement patterns.
Functional assessment scales: Questionnaires and scoring systems to determine the impact on daily activities.

Non-Pharmacological Treatments

A variety of non-drug treatments can help manage SCM contracture. Here are 30 strategies:

Physical therapy: Tailored exercises to improve strength and flexibility.
Stretching exercises: Gentle stretches specifically for the neck.
Manual therapy: Hands-on techniques by a therapist to loosen tight tissues.
Massage therapy: Helps reduce muscle tension and improve blood flow.
Heat therapy: Using warm compresses to relax muscle stiffness.
Cold therapy: Applying ice packs to reduce inflammation in acute cases.
Ultrasound therapy: Promotes healing through sound wave energy.
Electrical stimulation: Using mild electrical currents to reduce pain.
Transcutaneous Electrical Nerve Stimulation (TENS): Alleviates pain through electrical impulses.
Posture training: Techniques and exercises to correct and maintain good posture.
Occupational therapy: Strategies for daily activities and ergonomic adjustments.
Neck traction: Gentle pulling techniques to improve range of motion.
Yoga: Specific poses to gently stretch and strengthen the neck.
Acupuncture: Fine needles inserted at specific points to relieve pain.
Dry needling: A therapy similar to acupuncture focused on myofascial trigger points.
Ergonomic adjustments: Modifying workspaces to reduce strain on the neck.
Pilates: Low-impact exercises that focus on core and neck strength.
Strengthening exercises: Targeted workouts to support the neck muscles.
Range-of-motion exercises: Repetitive movements to restore full motion.
Self-mobilization techniques: Simple movements to keep the neck flexible.
Mirror therapy: Visual feedback techniques that assist in movement correction.
Trigger point therapy: Techniques to relax specific tight spots in the muscle.
Biofeedback: Learning to control muscle tension using electronic monitoring.
Myofascial release: A manual technique to relieve muscle tightness.
Cognitive Behavioral Therapy (CBT): Helps manage chronic pain and stress.
Breathing exercises: Methods to reduce tension and promote relaxation.
Relaxation techniques: Practices like meditation to ease overall stress.
Activity modification: Changing daily habits to avoid overstraining the neck.
Soft tissue mobilization: Hands-on techniques to loosen adhesions in the muscle.
Supportive devices: Using collars or soft neck braces (under professional guidance) to alleviate stress.

Drugs Commonly Used for SCM Contracture

Medications can help reduce pain and relax the muscle. Here are 20 drugs that might be used as part of a treatment plan:

Ibuprofen: A non-steroidal anti-inflammatory drug (NSAID) to reduce pain and swelling.
Naproxen: Another NSAID for pain relief.
Aspirin: Often used for mild pain and anti-inflammatory effects.
Diclofenac: An NSAID that may be prescribed for severe inflammation.
Acetaminophen (Tylenol): Helps relieve pain though it does not reduce inflammation.
Celecoxib: A COX-2 inhibitor that targets inflammation with fewer gastrointestinal side effects.
Indomethacin: An NSAID known for strong anti-inflammatory properties.
Corticosteroids (e.g., Prednisone): Can reduce severe inflammation when used short-term.
Cyclobenzaprine: A muscle relaxant that reduces muscle spasms.
Baclofen: Helps alleviate muscle tightness by acting on the central nervous system.
Tizanidine: A short-acting muscle relaxant useful for controlling spasms.
Diazepam: Provides muscle relaxation as well as an anxiolytic effect.
Methocarbamol: Another muscle relaxant that helps reduce muscle spasms.
Carisoprodol: Can be used for short-term relief of muscle pain and tension.
Gabapentin: Sometimes used off-label for neuropathic pain associated with muscle issues.
Pregabalin: Similar to gabapentin, it may help control nerve-related pain.
Topical Lidocaine: Applied directly to the area to numb pain.
Capsaicin Cream: A topical agent that can reduce pain through desensitization.
Botox Injections (OnabotulinumtoxinA): Temporarily relax the muscle by blocking nerve signals.
Anti-inflammatory topical gels: Such as diclofenac gel for localized application.

Surgical Options for SCM Contracture

Surgery is generally reserved for severe cases that do not respond to conservative treatment. Options include:

Sternocleidomastoid Release Surgery: A procedure to lengthen or release the contracted muscle.
Myotomy: Surgical cutting of part of the muscle to reduce tension.
Tenotomy: Cutting of a tendon portion when scarring is the primary issue.
Fibrotomy: Removing fibrotic tissue within the muscle.
Scar Revision Surgery: Correcting scars that may contribute to contracture.
Soft Tissue Release: General procedure to free tight or adherent tissues.
Muscle Lengthening Surgery: Specifically aimed at increasing the length of the contracted muscle.
Endoscopic Release: A minimally invasive method to release tight bands.
Open Neck Release: A traditional approach providing full access to the affected tissue.
Corrective Cervical Surgery: Sometimes combined with other procedures to realign the neck.

Prevention Strategies

Prevention focuses on reducing risk factors and early intervention to avoid the development or worsening of SCM contracture:

Early Physical Therapy: Initiating therapy early, especially in infants, when a head tilt is first noticed.
Proper Posture Training: Learning and maintaining good posture during daily activities.
Regular Neck Stretching: Incorporating neck stretches into your routine to maintain flexibility.
Avoiding Repetitive Strain: Taking frequent breaks and changing positions to avoid overuse.
Ergonomic Workplace Setup: Adjust your desk, chair, and computer to support healthy neck alignment.
Avoid Prolonged Immobility: Regular movement can prevent stiffness.
Timely Treatment of Injuries: Seek help for neck injuries to avoid long-term complications.
Neonatal Screening: Early examination of newborns to identify any congenital issues.
Proper Sleeping Posture: Use supportive pillows to maintain alignment during sleep.
Regular Exercise: Engage in activities that promote general muscle flexibility and strength.

When to See a Doctor

You should consider consulting a healthcare provider if you experience any of the following:

Persistent neck pain that does not improve with home care.
Noticeable head tilt or an abnormal neck posture.
Restricted range of motion in the neck.
Frequent or severe muscle spasms.
Headaches or shoulder pain accompanied by neck stiffness.
Difficulty performing daily activities or reduced quality of life.

Early diagnosis and treatment can help prevent complications and improve outcomes.

Frequently Asked Questions (FAQs)

Below are 15 FAQs about sternocleidomastoid muscle contracture answered in simple language:

What is a sternocleidomastoid muscle contracture?
It is a condition where the SCM muscle becomes tight or shortened, leading to neck pain, restricted movement, and sometimes a noticeable head tilt.
Is congenital muscular torticollis the same as an SCM contracture?
Yes. In newborns, congenital muscular torticollis usually results from a contracture of the SCM muscle.
What causes SCM contracture in adults?
Causes can include trauma, poor posture, repetitive strain, surgical complications, and neurological conditions.
How do I know if I have an SCM contracture?
Signs include neck pain, stiffness, limited head movement, and sometimes a visible bulge in the neck. A doctor will assess these with a physical exam and imaging tests.
What non-drug treatments work best?
Physical therapy with stretching, massage, heat therapy, and posture correction are commonly recommended.
Can SCM contracture go away without surgery?
Yes. Many cases respond well to conservative treatments such as physical therapy and lifestyle changes.
What medications are typically used?
Over-the-counter NSAIDs like ibuprofen, muscle relaxants such as cyclobenzaprine, and in some cases topical treatments and even botox injections may be used.
When is surgery recommended?
Surgery is considered for severe cases that do not improve with conservative care, especially when there is significant functional limitation.
Are there risks with surgical treatment?
Like all surgeries, risks exist (infection, nerve damage, scarring) but they are minimized when performed by experienced surgeons.
How long is recovery after treatment?
Recovery depends on the treatment type—from a few weeks for physical therapy improvements to several months after surgery.
What daily practices can prevent recurrence?
Maintaining good posture, regular stretching, and correcting ergonomic issues can help prevent recurrence.
Is SCM contracture painful?
It can be uncomfortable to very painful, depending on severity and associated muscle spasms.
Can infants with SCM contracture catch up with normal development?
With early intervention and physical therapy, most infants improve and develop normally.
Are there any exercises I can do at home?
Yes, gentle neck stretches and range-of-motion exercises prescribed by a physical therapist can be very helpful.
How often should I do these exercises or stretches?
Your therapist may recommend daily exercises—generally, a few times a day—to maintain flexibility and muscle balance.

Conclusion

Sternocleidomastoid muscle contracture is a complex condition that can affect anyone—from infants with congenital muscular torticollis to adults suffering from trauma or chronic poor posture. By understanding the anatomy and functions of the SCM muscle, being aware of its many causes and symptoms, and knowing your treatment options—from non-pharmacological therapies to medications and even surgery—patients and caregivers can better manage the condition.

Early recognition is essential. If you or your child shows signs such as neck pain, restricted movement, or an abnormal head tilt, consult a healthcare provider. With proper treatment and lifestyle modifications, many individuals experience significant improvements and a return to normal function.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Update: April 14, 2025.

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