What methods have you found to address stretching of the sternocleidomastoid muscle? Can you discuss the levator scapula involvement and what you do to address this muscleas well?
Answer
The levator scapula almost always gets involved. If the sternocleidomastoid is pulling the head into the laterally flexed position, then everything is going to get shorter, and you are not going to have a normal levator scapula. It is going to get shorter as the child grows. The football carry is a really good position to get a good passive stretch in the neck musculature. Stretching of the sternocleidomastoid is a challenge at times. I advise manually stretching it; take it into its full length as much as possible. That is very effective. I know a lot of therapists, including myself, who feel like some very gentle fascial type of stretching is important as well and possibly a gentle tissue massage. I like to do fascial stretches and tissue massage in the direction of the muscle. Some cross-fiber massage is good if the child can tolerate it. All of us who have experience treating children know that when they feel pain, they immediately contract that muscle and kick and scream and cry. I never want to do anything that is painful to a child, so I will usually stop.
We want to find the best method for stretching the SCM for each child. The passive positioning tends to work the best. I always instruct parents to try to do it if possible. If the infant is sleeping, we know it gets really hard after about 5 months when the child gets strong enough to pull away. That same sleeping position can be really good during feeding. If the child is still on the bottle, that can be a good time to do a passive stretch. It is easiest to stretch the muscle when it is relaxed. With levator scapula involvement, the stretching is about the same. You do nice lengthening type of positioning and you go along the length of the fibers to get the fascial stretching and then do some cross-fiber manual massage to relax the muscle.
Carolyn B. Armstrong, PT, DPT, PCS
Carolyn B. Armstrong, PT, DPT, PCS has practiced pediatric physical therapy in a variety of settings for over 35 years. She is the owner of Armstrong Physical Therapy, LLC in Colorado providing early intervention physical therapy services, and works in a public school setting providing school-based services to children ages 3-21. Dr. Armstrong specializes in clients with neurological impairment and has presented continuing education seminars on clinical management of this population.
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