What the neck!

The sternocleidomastoid (SCM) muscle, located in the cervical region, plays a crucial role in neck mobility and posture. Tightness in this muscle is a common issue among women in peri-menopause and menopause, primarily due to hormonal fluctuations and age-related stiffness. This can potentially impact the function of the nearby vagus nerve, which is integral to numerous bodily functions, including the regulation of gastrointestinal motility.

As the SCM muscle tightens, it can exert mechanical pressure on the vagus nerve, leading to potential neuro-inflammation, hyperalgesia, and consequent pain and burning sensations in the stomach. Furthermore, the vagus nerve's influence on stomach motility means that any dysfunction can disrupt the organ's normal functioning, exacerbating gastric symptoms.

Could there be a relationship between SCM, vagus nerve and digestive issues that are so common in peri-menopausal women?

I'm glad you asked! Pilates, renowned for its focus on muscle control, flexibility, and postural alignment, can be a potent tool for SCM release and vagal nerve function. Specific exercises aimed at stretching and releasing the SCM can relieve tightness, decompressing the vagus nerve and restoring its optimal function.

In one study, clinical observations support this approach. In patients who've experienced targeted relaxation of cervical soft tissues, including the SCM, gastric symptoms have significantly decreased. This suggests that addressing cervical tightness could indeed alleviate stomach problems linked with vagus nerve dysfunction.

Why does this matter and how might we apply this knowledge in the Pilates setting?

In women undergoing peri-menopause, it's common to observe an increase in gastric distress marked by symptoms like heightened food sensitivity, intolerance to alcohol, and bloating. Hormonal changes, particularly the rise in cortisol - the stress hormone, contribute significantly to this scenario. The body's physical response to stress is often held in the sternocleidomastoid (SCM) muscle. Consequently, tightness in the SCM can signal to the brain that the body is under stress. In response, the brain dispatches neurochemicals to induce the fight-or-flight response, escalating the body's overall stress level.

Simultaneously, the tight SCM muscle can impair the function of the vagus nerve, a crucial nerve that regulates inflammation in the body, including the organs such as the stomach. When the vagus nerve function is disrupted, it can potentially increase inflammation and exacerbate gastric distress. This link between hormonal changes, physical stress responses, and the vagus nerve underscores the complex interactions between our muscular system, nervous system, and hormonal balance. It exemplifies why addressing SCM muscle tightness, and thereby improving vagus nerve function, can be a critical strategy in managing gastric distress in peri-menopausal women.

The sternocleidomastoid (SCM) muscle is a vital part of our muscular system, primarily responsible for head and neck movements. Specifically, it facilitates neck rotation, assists in lateral neck flexion, and aids in the flexion of the neck at the cervical spine. Therefore, it's integral for activities that require head and neck mobility, such as looking over your shoulder or nodding.

As women age and enter the phase of menopause, hormonal changes, especially the decline in estrogen levels, can cause various physical alterations. Estrogen has a protective effect on muscles and ligaments, helping to maintain elasticity and strength. With its decrease, women over 40 may experience a loss of muscle tone and suppleness, leading to tightness in muscles like the SCM. Furthermore, elevated cortisol levels, often associated with the stress of physiological changes during menopause, can lead to additional muscle tension. This tightness not only reduces neck mobility but can also contribute to discomfort and potential complications like the impaired vagus nerve function we've discussed earlier.

Head and neck rotation is deeply rooted in our survival instincts

This action allows us to scan our environment for potential dangers and opportunities. As we rotate our head side to side, we are effectively gathering visual and auditory information and sending it to the brain for processing. This ability to perceive our surroundings and react accordingly is a critical aspect of our body's natural safety mechanism.

When we're unable to perform this essential action, such as in situations of neck stiffness or SCM muscle tightness, our brain may not receive this vital sensory information. This lack of environmental data can trigger a stress response as the brain interprets the absence of information as a potential threat. It signals our body to enter a heightened state of alertness, or the "fight or flight" mode, to prepare for unknown dangers.

Maintaining optimal neck mobility and SCM muscle health is crucial. Any impairment can disrupt this basic function, potentially leading to a chronic stress response which can have far-ranging implications for our physical and emotional health.

5 ways to decrease SCM tension and improve function

1. SCM release: One of the simplest ways to ease tension in the SCM is through release work. Sit or stand upright with your shoulders relaxed. Tilt your head to one side, bringing your ear toward your shoulder until you feel a gentle 'stretch'. For added feedback you can use the PTB on the trap table, in a side seated position and push the bar through while sitting tall on the sitz bones and tilting the head laterally away from the PTB. The spring load on the machine is a great way to give feedback, essentially eccentrically activating the muscles of the neck and shoulder complex. 
2. Self-Massage: Using your fingertips or massage ball placed on a yoga block (for better height and access to the SCM) apply gentle pressure along the length of your SCM, starting from just below your ear and moving down towards your collarbone. This can help ease tension in the muscle and promote relaxation and better blood flow, therefor oxygenating the muscle for improved function.
3. Neck Rotation Exercises: These exercises involve slow, deliberate movements to improve flexibility and reduce tension in the neck muscles, including the SCM. Begin by sitting upright and slowly turning your head to one side, aiming to bring your chin over your shoulder. Hold for a few seconds, then slowly rotate your head to the other side. Practice on the trapeze table with the push through bar, seated mermaid with head rotation and lay supine with a chi ball under the head for guided neck rotation movements.
4. Resistance Exercises: These exercises strengthen the SCM and promote flexibility. Place your hand on the side of your head and apply gentle pressure as you try to turn your head against the resistance. Hold for a few seconds, then relax. Repeat on the other side. 
5. Breathing Techniques: Deep, controlled nasal breathing exercises can help reduce overall body tension, including in the neck region and help regulate the vagus nerve. Inhale deeply, filling your lungs and belly completely, hold for a few seconds, and then exhale slowly through the nose. Performing this exercise regularly can help facilitate relaxation of the SCM and other neck muscles. It is important to note that nasal breathing has more of a calming affect than mouth breathing which is often taught in Pilates. It is common when teaching nasal breathing for your clients to yawn, sigh, laugh or cry. These are all positive indications of releasing stress from the body and should be encouraged.

These exercises can be integrated into a Pilates routine to target the SCM muscle, alleviate tension, and promote overall neck mobility and health.

The intricate relationship between SCM tightness, increased cortisol, decreased estrogen, and vagus nerve tone presents a complex challenge for women approaching menopause. The hormonal shifts, coupled with physiological stress responses, can cause disruptions in the muscular and nervous systems, leading to conditions like SCM muscle tension and impaired vagus nerve function. As Pilates teachers, it's crucial that we employ our observational skills in the studio to identify these changes in our clients and provide them with the necessary education and tools to manage these effects.

By understanding the potential physical alterations that menopause can bring, women can prepare their bodies and maintain their health through intentional movement and self-management strategies. The value of a proactive approach cannot be overstated. Educating women about these changes before they experience them fosters an environment of empowerment and self-awareness.

Pilates, at its core, is about empowering individuals to take control of their physical health. Through targeted exercises like SCM releases, neck rotations, and deep, controlled nasal breathing techniques, we can help our clients alleviate muscle tension, promote overall neck mobility, and improve vagus nerve function. In the broader scope, these exercises can contribute to managing the physiological changes of menopause, demonstrating the significant role that Pilates can play in women's health during this transitional phase of life.

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