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Described as ringing sounds that come from inside rather than external noises, tinnitus is a common condition that affects between 15-20% of people.
Tinnitus can be present at all times or come and go, the sound heard can vary in intensity and be slightly different in tone for different people. For some people it doesn’t cause a great deal of discomfort whilst for others it can disrupt their daily lives, affect concentration, increase anxiety and stress.
Although tinnitus can be caused by underlying condition, age-related hearing loss, ear injury, vascular or neurological the most common cause for ear ringing that we come across in clinic is musculoskeletal, Myofascial Trigger Points (MTPs). This is a treatable cause that is often not considered and therefore not addressed.
People experiencing this condition usually lack guidance on what treatment options are available to them which usually results in them putting up with the condition and the repercussions that it might be causing in their lives.
How is Ear ringing or Tinnitus caused by the musculoskeletal system?
As we mentioned above tinnitus or ear ringing is caused in a great number of cases by Myofascial Trigger Points (MTPs). MTPs are hyper irritable spots in a taut band of skeletal muscle (you can read more about the way we treat them here).
These Trigger Points can cause pain and other symptoms locally as well as referred into other areas of the body, like in the case of tinnitus (read more about it here).
Once Trigger points area released the symptoms associated with them also dissolve.
Especial mention here to Dr. Janet Travell and her work on trigger point therapy. She realised that the referred pain pattern of each muscle was the same or very similar in everyone she treated, which means that she could identify the origin cause of the pain by tracking it down using the pain pattern described by her patients.
She illustrated the referred pain patterns of pretty much every muscle in the body giving us therapists access to these maps of knowledge.
These maps are now used by therapists all over the wold as an essential tool in identifying the root cause of conditions like tinnitus and in developing effective treatment plans.
What muscles cause ear ringing?
One of the odd symptoms that can be caused by TPs is ear ringing, usually caused by TPs in the Sternocleidomastoid muscle (SCM). This same muscle is responsible for not only Tinnitus but also other TMJD (Temporomandibular Joint Disorder) symptoms like jaw pain, face pain, anxiety or ear pain between others.
The SCM muscle is a ropy muscle located at the front of the neck, connecting the clavicle/sternum with the suboccipital bone/mastoid process at the base of the scalp and really close to the ear.
Below is a picture of the SCM Trigger Point referred pain pattern. Marked in red is the area where this muscle refers pain to.
The SCM is not the only muscle that causes ear ringing or tinnitus.
The Suboccipital muscles can also be the origin for this presentation. Located right at the base of the scalp and connecting it to the two first vertebrae Atlas (C1) and Axis (C2). These muscles are deep and very strong which means that Trigger Points here can cause a lot of trouble.
As we mentioned above once Trigger Points are released the symptoms associated with them also dissolve.
What is the best treatment approach to treating ear ringing caused by the Musculoskeletal system?
As mentioned above ear ringing can be caused by TPs in the SCM and Suboccipital muscles. These muscles should therefore be assessed when this condition presents itself.
Firstly an initial assessment is carried out of the neck tissue through both range of motion and palpation.
At this stage and considering that the body behaves as an interconnected system we have to also assess the bigger picture and look at the body as a whole. In order to do that we carry out a postural assessment.
This will help throw light into some of the reasons why these neck muscles are developing Trigger Points. An anteriorly shifted hip or a kyphotic back are some examples of where postural patterns can contribute to the loading of these neck muscles and the development of Trigger Points that will ultimately trigger ear ringing.
Once this initial assessment is done and a treatment plan is in place it’s time for the actual treatment.
Here we have different treatment tools available. At the clinic we find a combined approach mixing different treatment techniques to produce the most effective results. We mainly use Myofascial release techniques (focused on the fascia) and Trigger Point work, combined with sports massage and others.
Read more about our treatment method here
The importance of mindfulness on you and your therapist
We know that the central nervous system plays a major role in pain level perception as well as in the quality of the soft tissue.
A hypersensitized nervous system will trigger higher levels of pain and will decrease the quality and performance of the soft tissue, increasing the risk of injury and soft tissue related symptoms, like in this case, ear ringing.
A “relaxed” nervous system will allow for the the whole body to perform at its best and heal itself, including the musculoskeletal system.
Part of the treatment is therefore getting the central nervous system to switch from hyperactive sympathetic mode (characteristic of our fast paced lifestyle and high levels of stress) to parasympathetic mode (restoration mode and immune system mode).
A mindful and present therapist and a treatment environment that invites to relax is key to achieving this and are key elements of a good and complete treatment.
The importance of breathing
In every condition but in particular dealing with ear ringing or any other neck related presentation we put emphasis in the breathing pattern, which is usually shallow and short.
Learning to breathe correctly can cause a big impact not only in pain levels but also in our posture/presence and our overall feeling of wellbeing!
We talked about how Tinnitus can be caused by Myofascial Trigger Points (MTPs) or “knots” in the muscle. We covered the two most common muscles that cause ear ringing, the Sternocleidomastoid muscle (SCM) and the Suboccipitals. We’ve explained that once Trigger Points are released, the symptoms associated with them also dissolve.
We finished by pointing out that a combined approach of different treatment techniques produces the most effective results in the treatment of Tinnitus and by highlighting the importance of mindfulness and breathing, from both the therapist and the client, as key elements of a good and complete treatment.
About the author
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.