ScalenesThe 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!

Enjoyed this article? Read Try This YTU Therapy Ball Technique for Neck Pain Relief

Christina Summerville

Christina has been a physical therapist for over 20 years. She is a second degree black belt in Tae Kwon Do and is also a certified MELT Method® Instructor. Christina's passion is to inspire and empower her clients to rid themselves of pain and injury so they can perform at their BEST and live life to the FULLEST. She started her own small fitness and wellness business, Summerville Fitness, to help merge the worlds of healthcare and fitness, making instruction in quality movement accessible in a private wellness sessions or group classes. She loves teaching her students more about their bodies and how to help them improve posture and bring more balance to their frame. Yoga Tune Up® is her most recent certification and she is really enjoying practicing YTU and sharing it with others! Christina also incorporates Yoga Tune Up® in physical therapy sessions she provides at her PT office at Universal Chiropractic in West Seneca. She teaches at various locations in Western New York Including Universal Chiropractic in West Seneca and Live Fit in Lancaster. She is also happy to schedule customized private or group classes at your location or hers!

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Stéphanie Marchand

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!!

Tatjana Brandl

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

Janie

… you might just have answered to problems i have been having in a long time!! Ill definatly try to treat and tlc my scalenes!!!!

Elise

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… Read more »

Kendra

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?!

Alexandra

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!

margaret schwarz

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.

Vernatha Montoute

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.

sabrina

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!

Sophie Desmarais

Very fascinated by the effects of trigger points. Will definitely incorporate rolling the scalenes into my shoulder rolling routine. Everything is connected!

Ella

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.

Laurel Crane

Fascinating. I have a client who suffers from shoulder pain and numbness in her hand/fingers after a fall. I sent her this article.

Joy

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.

Stephanie

Wow, what a fascinating article! Thanks so much for the information. I had no idea what a tremendous impact these muscles could have.

Erika Belanger

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!

Janine Watson

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.

Ayn

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!

Heidi Schaul-Yoder

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!

Alison Miller

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!

Eva Jedlovsky

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.

Jen Montes

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!

Juliana Attilio

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!

Willow

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!

Rachel T.

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!

Jessica Haims

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!

Audrey Ventura

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.

Kate Colette

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!

Katy Loomis

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!

Wendy Rancourt

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!

Adriana Robertson

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!

Christine Phillips

great info! now how do we treat…?!?

Amy Moore

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.

Laura Davies

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.

Brittany L

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.

Christina Summerville

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… Read more »

Eva Hamilton

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.

Ed

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.

Trisha

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

Lisa Pitel-Killah

What a great article, the insight you have shown really brings to light how truly everything is intertwined with us.

Vivian Goldfield

Would you say that stretching and/or manually manipulating our scalenes before exercising would help us breathe during our workout?

Christina Broome

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.

Lisa

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.

Alison Ahmoye Buchanan

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.

Keiko Johnson

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!

Kimmi Ott

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!!

Karen

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.

Susan J

Absolutely spot on description of the source of my arm, shoulder and scapula pain! Now I understand! Thank you.

Lisa Salvucci

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.

Maureen

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.

Sharon

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!