Orthopedic Exam / Special Tests for Physical Therapy: HEAD & NECK
Special Test: Swallowing Test: (Procedure Below)
A trigger point or a muscle knot as it is often termed is an area of contraction within a muscle. This can be likened to a small patch of spasm in a muscle and is different from the entire muscle being tight. Because of the local contraction the blood flow to the immediate area stops resulting in a restriction of the blood supply (ischemia). This leads to accumulation of metabolic waste products and toxins which sensitize the trigger point causing it to send out pain signals and further increase contraction. Thus the local physiology of a trigger point involves a vicious cycle of a metabolic crisis.
Trigger points often cause pain far away from the actual site where they exist, i.e. referred pain. Referred pain caused by trigger points does not fit into the more familiar dermatomal or myotomal patterns as seen in radiculopathy. The referral patterns have been studied and well documented for over hundreds of years and are available as detailed trigger point charts. Each trigger point has a predictable referral pattern with only slight variation. Some of the other intriguing symptoms caused by trigger points are numbness or hypersensitivity. Autonomic symptoms such as increased perspiration or nasal secretions, hyperemia, nausea and dizziness are also associated with trigger points.
Clinically trigger points can be identified by examining signs, symptoms and by manual palpation. Usually there is a taut band in the affected muscle, and along this band a hard nodule which is the trigger point can be felt. A twitch response is often elicited when pressure is applied followed by a spread of the referred pain. For objective validity of trigger points research has used various tools – MRE, EMG, HiRes imaging ultrasound, algometry, tissue biopsy, and recovering small molecules in vivo from tissues has provided groundbreaking evidence in the existence, detection and the chemical nature of myofascial trigger points.
Sternocleidomastoid (SCM) Trigger Points:
The SCM muscle group can contain a whopping seven trigger points, making it’s trigger point density one of the highest in the body. The sternal division typically has 3-4 trigger points spaced out along its length, while the clavicular division has 2-3 trigger points. Trigger points typically develop in one SCM muscle group first, but quickly spread to the SCM on the opposite side of the neck.
The SCM’s sternal division’s referred pain is felt deep in the eye socket (behind the eye), above the eye, in the cheek region, around the temporomandibular joint (TMJ), in the upper chest, in the back of the head, and on the top of the head.
The SCM’s clavicular division’s referred pain is felt in the forehead, deep in the ear, behind the ear, and in the molar teeth on the same side. The really strange thing about this pain presentation is that the forehead pain may extend across the midline of the forehead to the other side.
Special Test: Swallow Test
- To test if SCM trigger points are the cause of the pain when swallowing.
Video Demo Instructions, Procedure, Positive Test:
Special Test: Swallow Test: Video Demo:
Special Test: Swallow Test: PROCEDURE:
• Patient is seated
• Palpate and pincer grasp patient’s SCM.
• Locate the most tender point, then
• Place a firm pressure on the most tender point (muscle belly) and have the patient swallow.
Special Test: Swallow Test: POSITIVE SIGN:
- Pain diminishes when the client swallows as you pincer grasp the most tender point. Otherwise: Pain may be caused by throat infection, hematoma, bony protruberance of the cervical spine or tumor so patient should be advised to see a medical doctor.