The scalenes are a group of 3 muscles (anterior, middle and posterior scalene) that originate from the transverse processes of the cervical spine and insert onto the first and second ribs. Their name comes from the Greek word meaning “uneven” and the 3 muscles are of different lengths, representing the sides of a scalene triangle.
Scalene muscles work bilaterally to help to stabilize and flex the neck. Unilaterally they laterally flex the head and neck to the same side, and rotatate the head and neck to the opposite side. But their main job is to elevate the upper 2 ribs upon inhale.
The scalene muscles fascinate me because of the wide array of symptoms they can cause when they are dysfunctional. Trigger points in the scalene muscles can refer pain and/or numbness to the shoulder, down the arm to the thumb and index finger, to the chest and also to the upper back between the shoulder blades. This is a huge distribution of pain and numbness that can be coming from 3 small muscles in the neck! Symptoms caused by trigger points in these muscles are misdiagnosed very easily. Scalene trigger points can mimic carpal tunnel syndrome or degeneration and compression in the cervical spine. They may also cause people to drop objects easily or experience restlessness in their neck.
Thoracic outlet syndrome can be caused by scalenes that are shortened and pulling the first rib up against the clavicle, which squeezes blood vessels and nerves that pass through this area (specifically the subclavian artery and vein, and nerves of the brachial plexus). Scalene trigger points can even cause unexplained “phantom pain” in an amputated arm or hand. You can see how misdiagnoses can be very prevalent when trigger points in the scalenes are involved. It is possible that many unnecessary procedures are performed when trigger points in the soft tissues of the neck are actually the culprit.
What causes trigger points and tension in the scalenes? If the neck is chronically flexed with a forward head posture, they can become tight and restricted along with the sternocleidomastoid (another strappy neck muscle). Chest breathing severely taxes these muscles as well as emotional tension, nervous hyperventilation, excessive coughing, asthma and emphysema. So, if you have a desk job, sit with forward head posture, are “stressed out” and have a cough…this could be a recipe for disaster in the scalenes! And you probably won’t suspect that your symptoms are coming from your anterior neck because it may not even hurt there! Other sources of scalene strain and spasm can be whiplash, carrying a heavy backpack, falling, strenuous lifting or sports activities.
If you are experiencing pain in the shoulder, arm, hand, upper back or chest that is not completely relieved by massage and corrective exercise for these areas, treating the scalenes is worth a try, since they can be an unexpected cause of symptoms in these parts of the body. I almost always assess the scalenes of my physical therapy patients who have pain in the above areas, and I find repeatedly that they are a contributor to their symptoms. Often when I massage a scalene trigger point, the patient feels pain in the area it is referring to as opposed to wear my hands are applying pressure. Massage, stretching and resting your scalene muscles, along with postural education, can help relieve trigger points and tension.
Tune in later this week when I will share techniques to help provide relief to the various symptoms that the scalene muscles can cause!
Wow, the self massage for the neck video was wonderful. I appreciate the info about the scalenes very much.
Looking for scalene stretches
great information about wath scalenes do. Thanks for this article.
What a clear article about the scalenes. I did not realise how many different problems can be pointed at these muscles, because of this article I have a better understanding. I will read your article of the therapy ball session for neck pain, and do it also! I have a shoulderproblem on the right side and hope this will attribute to a little relief. Thank you for this compact information.
I recently had a tumbling accident where my head went into forced lateral flexion. I started to feel radiating sensations around my shoulder blade and down my arm. Reading your blog and all of the issues tight scalenes can cause, I will be working my YTU balls around my 3 scalenes to releive tension and heal my body. Thank you!
Thank you SO much Christina for this post! Everything you mentioned – excessive coughing, asthma, nervous hyperventilation, emotional stress & tension in general in that area – I experience often! Can’t belibe such small muscles can cause so much pain.
I have scalene tension & all of the symptoms above!! Excess use of smartphone can also cause tight scalene because we tend to use only our thumb & index finger while we scroll & type!
Wonderful summary of anatomy and symptom-complex related to the scalene muscles! Thank you so much!
Great description of all that the scalene do, and the wide variety of symptoms that the scales may play a role in causing. .
Thank you for sharing such a clear and detail explanation of the scaliness and the related problems and symptoms to be aware of! I definitely haven’t given them as much attention as I have the sternocleidomastoid, but will be exploring them since reading this.
I’m always so interested in this area, as most of the clients I see are having neck, shoulder, and/or some sort of arm pain. I will absolutely be reading your next post (to see how to use the YTU balls to get to this problem area) as well as get back to my anatomy books to really see where these little muscles are hiding ;). Thanks for this informative article.
Love it! Thanks Christina, I will actually have to start treating my scalenes myself, this might be a huge problem solver for both myself, and am sure useful information that will help others in the future.
Love it!
SCM are very popular to causing neck pain… But scalenes are often overlook!
The questions is, how to massage thoses muscles with yoga tune up without compressing blood vessels and nerves in this sensitive area?
I am going to read your next blog post with enthousiasm! Thank you!
This article describes my issue to a T! I was diagnosed with TOS about 4 years ago and I used to complain all the time about not being able to tell if my head was in a neutral position. My therapist told me no it wasn’t it was always slightly tilted upwards and I always had referral pain down into my shoulder and fingers.
This article hit my issue right on the head. I was diagnosis with TOS about 4 years ago..and I would always complain to my therapist that I could never tell if my head was actually in a neutral position. I was told it wasn’t always slightly tilted upwards. This explains it.!
Wow, I didn’t realize all the areas could be affected by trigger points and tension in the scalenes. Thanks Christina!
So interesting! So many people carry so much tension in their necks. I wonder how many people were misdiagnosed and unnecessarily treated, when the solution was already available within the tissues and muscles of the body. So interesting!
Wow! I have pain in all those areas on my right side and can feel with my fingers how fibrous my neck is there.
I will check out the next post for some exercises to see if tight scalenes are the culprit.
I am so glad to read this. I can share it with my brother who has had chronic shoulder problems resulting in surgeries that didn’t always correct the pain. Namaste
Wow – this post blew me away. My chiro noticed my scalene muscles and commented on how tense they were. Once I read all of the areas they could cause referral pain all I could think of was ‘that’s me’. Looking forward to the next post!
I hate being on my computer typing this comment; I’m checking my posture and I’m like OUTCH! Today, we learned the importance of the diapraghm and how every other important muscles are connected with. And when we breathe… we never use 100% of its capacity. Every movement are happening in the shoulders; imagine how our neck is stiff?! and it’s just breathing… OMG, I’m rolling my scalene right now!!
Dear Christina,
thank you for opening my eyes again, how amazing our body is. Just one little muscle that affectes so much. I am surprised, that a triggerpoint in your neck can mimic carpal tunnel syndrome. Tatjana
… you might just have answered to problems i have been having in a long time!! Ill definatly try to treat and tlc my scalenes!!!!
I love when a word from my Montessori elementary schooling is reintroduced to me now in life: scalene, coming from the Greek word uneven. This post revealed to me just how much these three little neck muscles can affect. As I touch my scalenes now I can feel their tautness and I am curious to explore how their lack of suppleness is manifesting in my shoulders or the range of motion of my top two ribs when breathing. This is of particular interest to me because most of my aches and pains tend to show up in my upper body and sometimes I feel like I can’t quite track down their root. I’ll work a therapy ball into my shoulder sometimes and it just won’t give. Next time I will take an obtuse view to my acute pains and check in with my scalenes!
What a great outline of a small group of muscles that can cause a whole lot of grief! Not only was this is a great outline of the anatomy itself, but provided great insight into how many things can be affected by trigger points in the scalenes and how these trigger points can develop in day-to-day life with concrete examples. Once determining the cause of the symptom, it is so much easier to gain relief that why wouldn’t you try an out home release to find out if they are the culprit?!
I found this article to be very interesting as I am constantly struggling with neck pain. It’s very informative and eye opening to know that a lot of the issues we have with out necks and neck pain aren’t necessarily coming from the neck. I will definitely keep trigger points in mind now!
The scalenes are sadly the last on the list to target when clients are diagnosed with Thoracic Outlet Syndrome. The neck is often overlooked as a piece of the puzzle in most if not all upper extremity compromised movement/discomfort/pain. Thanks for bringing their importance to light.
This is interesting to me because I noticed that after pulling a muscle in the back of my neck, over a period of time the pain moved to my shoulder and chest area. So to me this makes sense that pain in these areas can also attribute to the neck. Its’ good to know these connections to help resolve a lot of pain issues within our bodies.
As someone who has had tons of trauma through the face, neck & clavicle I always appreciate guidance & nuggets of wisdom that can potentially help ease the tension & pain I carry in my upper back. I must admit that the work I do with the tune up balls really helps tame the tension at least temporarily. Thanks for the insight!
Very fascinated by the effects of trigger points. Will definitely incorporate rolling the scalenes into my shoulder rolling routine. Everything is connected!
Very enlightening article! I didnt know much about the scalenes, but it seems they are worth knowing about. I always find it fascinating how pain in one area, can be caused by something going on in a completely different area. I have clients with upper back and shoulder issues, so will look into rolling this area out for them and see if it helps.
Fascinating. I have a client who suffers from shoulder pain and numbness in her hand/fingers after a fall. I sent her this article.
I often have scalene trigger points and when I get a massage I make sure they work them out. I also get relief by using the YTU balls to cross fiber the sternocleidomastoid mastoid , trapezius, and levator scapulae to relieve the trigger points there and ‘unglue’ them and allow more slide and glide with the scalene muscles.
Wow, what a fascinating article! Thanks so much for the information. I had no idea what a tremendous impact these muscles could have.
Great article! I didn’t know the intricacies of those little muscles. Good to know how they impact not only the neck but the shoulders and scapula!
Really good article. I had no idea how much impact these little muscles had. I’ll pay special attention to anyone who has these symptoms and suggest to roll gently out the area.
Doctors Janet Travell and David Simons, authors of Myofascial Pain and Dysfunction: The Trigger Point Manual have also attributed anterior neck trigger points, which include the scalenes, with dizziness. This dizziness is often misdiagnosed as vertigo.
Self-applied trigger point massage using YTU therapy balls can help relieve dizziness and vertigo. I can attest to this first hand, having helped a client by massaging the scalenes and SCM. Now with techniques using the YTU therapy balls, this client, who has been suffering from vertigo for over two decades, can apply self-care to relieve his own pain and dizziness!
So interesting how the neck can refer pain to so many other places! It’s so useful to have this understanding, so we can treat not only the initial site of discomfort. Thanks for this wonderful explanation!
What an excellent and thorough article. As a physiotherapist myself, I too often assess the scalenes for any upper body ailment and more often than not, they are contributing to my client’s pain. In our society that is such a forward flexed society now, I imagine that tight scalene are not going to go away any time soon. Thankfully, we can also empower our clients to massage out their scalenes as well using various Yoga Tune Up techniques too!
Very interesting and fascinating article. I recently became more aware of the neck muscle trigger points being the cause behind my pains that were nowhere near the actual muscles causing them. In one of the books I need for my training I discovered a whole section on trigger points with the illustrations of referral pains and it is my to go to place to look for cause of my pains.
Thank-you Christina for this post.
I do all of those things that contribute neck pain, chronically flexed with a forward head posture desk job. ALSO, I love sleeping on my tummy which means I normally have my head turned in one direction for a while and I think that this pose definitely contributes a large part of my “pain in the neck”. I am looking forward to reading your blog about techniques to help provide relief to the various symptoms that the scalene muscles can cause!
I have always been a fan of specific massage work on my Scalenes as I find most people are chronically tight and restricted here. However, I was not aware of all the symptoms that could arise as a result of the tension and trigger points. Decreasing major carpal tunnel surgeries and daily discomfort could be as simple as looking deeper into our neck at the Scalenes! I will make sure to keep this in mind as I work with my athletes!
I am definitely one of those people that has overactive scalenes. My arm pain was misdiagnosed many times before someone realized it was the neck. I agree that its impressive how many symptoms unhappy scalenes can cause. I have done a lot of neck retraining but am excited to see what else I can do on my own to ensure they get some relaxation and love. Looking forward to your next blog post!
I have personal experience with scalene trouble and have been interested in them and their issues since I learned that they often try to work for my much bigger and stronger rectus and Transverse abdominus. Massaging the front of my neck felt like I was choking myself at first but helped me become aware when the scalenes turned on before the rest of my core. Your article helped me understand these muscles, their structure, and their tendencies! Thanks!
This article was a great insight to how the position of our skull effect the muscles of the neck leading into a wide range of pain in the surrounding neck tissues. I wasn’t aware that the tightness from the neck could be causing issues down the arm, chest, or many other trigger points. Reading this will make me much more aware of my head position when I’m driving (I do A LOT of driving) and hopefully that will have an impact on the stiffness/pain in my neck!
I see this in clients a lot and I am looking forward to reading the next blog and get your tips for how to empower people to treat this for themselves.
Thank you for this post Christina – so many people have suffer with the symptoms you describe. I am looking forward to your next post to see what can be done to work with scalene dysfunction!
Thank you for this article! It was a great reminder about the scalenes. With so many forward head postures combined with chest breathing, the scalene muscles are the last ones I think to check in with. Will be making a change to that!
My scalenes recently went completely nuts following a serious multiple-muscle strain, incurred from lifting a very large and heavy object over my head. I suffered strain to the bicep and bicep tendon, as well as pectoralis minor and subscapularis. Trigger-point work from my neuromuscular therapist helped a lot, as did focused pin-and-spin work with the YTU ball. I also suffer from a spondylolysthesis at C3-C4, so I have to be very careful with my neck. The YTU balls have been my savior!
Thank you for sharing such useful and interesting information. I never realized that the scalene trigger points could be responsible for referring pain/ numbness to the shoulder, down the arm, and to the chest, as well as in between the shoulder blades. Nor did I realize that it could mimic carpel tunnel syndrome. I have struggled with pain in these areas for many years and am looking forward to trying some of the therapy ball techniques to support these muscles. Thanks again!
great info! now how do we treat…?!?
I have been dealing with shlukder pain and discomfort in my neck. I never considered that the scalenes might be part of the issue. Thank you for the info.
The neck holds the key to so many areas of the body, who would have thought! So cool to have more insight into this area and muscles.
Appreciate the breakdown of this muscle group. As a beginning practitioner I would mistake my neck pain after a few chaturangas as strain. If very well may have been but I now understand that flexion in the neck during up dog position was the likely culprite . Thank you.
Vivian I would say that yes, stretching and manipulating the scalenes, or any muscle that attaches into the ribs, before exercise can help you breathe better during your workout. Some ways to help are described in my second article, “Support for your Scalenes”.
Alison, if you want to help your yoga students to know if their scalenes are dysfunctional you can have them use a Yoga Tune Up® therapy ball to perform Supraclavicle Scrub-out found on page 329 in the Roll Model Book, or have them turn their head to one side, find the rope like sternocleidomastoid muscle, press fingers or ball into the area behind this muscle to find the scalenes (DO NOT massage anterior to the SCM were you find your carotid pulse!), and bring head back to neutral. While massaging this area, if it is tender there are likely trigger points harboring here. Hope this helps!
Thanks Christina! I have previously had an RMT tell me my scalenes were tight & affecting my breathing capacity, but i never made the connect of how they might be related to or agitated by my symptoms as an asthmatic. I will definitely be giving these muscles more attention in my practice.
The scalenes haven’t really been on my radar with respect to shoulder issues I’ve been working through – but now they are thank you very much. I’m a little stuck on the term “trigger point” as I don’t know what they are physiologically and figure I’ll have to investigate further.
Great detailed knowledge about the many issues in dealing with neck pain. I’ll be looking forward to your next post about exercise that can help relieve sore neck pain
What a great article, the insight you have shown really brings to light how truly everything is intertwined with us.
Would you say that stretching and/or manually manipulating our scalenes before exercising would help us breathe during our workout?
Wow, thank you Christina for the explanation and the possible symptoms that can occur from tight & restricted scalenes. It’s not my first thought to connect carpal tunnel like symptoms/hand/finger pain to neck misalignment. Very helpful.
Thanks for the overview. I’ve struggled with scalene and referral pain for a few years now. This is a good reminder to put some regular attention to this area.
This blog post is eye-opening! I had no idea that these seemingly small muscles in the neck can create such discomfort in the shoulders, upper back, chest (and even arms and hands). I’m fascinated by this. But I would never know how to assess this in my yoga students. Any advice on how to help others discover if their scalene muscles are dysfunctional, and therefore causing pain in other areas? I look forward to reading your next post on how to provide relief to those suffering pain due to these muscles.
Thank you for explaining a very complex set of muscles that always seemed mysterious to me. Your fascination with the myriad symptoms these muscles trigger is infectious!
Thanks Christina, I have had problems with this trio for years!! It helps when I get my YTU therapy balls in there and roll them out!!
Thank you for your concise explanation of the issues possibly caused by the scalenes. I have found this to be true on myself and many of my massage clients. I will be reading your blog on relief of these symptoms.
Absolutely spot on description of the source of my arm, shoulder and scapula pain! Now I understand! Thank you.
Great article Christina! As a result of scoliosis my C3 is laterally rotated which in turn creates major tension and sometimes pain primarily between my shoulder blades. With YTU I’ve learned how to roll out the tension and your blog has helped to clarify issues even more.
Thank you for such an amazing amount of information. You have redirected my way of thinking about the body and pain. I have always known that hip dysfunction could be the cause of back or shoulder pain. And I guess that I always assumed referent pain was usually from the bottom up. Now I know that it really could from anywhere. I have so much more to learn.
thank you! great insight to the many issues neck pain can point to that is not just a pain in the neck! looking forward to reading your next blog post!