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!