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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Patricia Cornelius

Wow, the self massage for the neck video was wonderful. I appreciate the info about the scalenes very much.

Shelley Vakil

Looking for scalene stretches

Annie

great information about wath scalenes do. Thanks for this article.

Resi

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.

Amanda Stoker

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!

Saori

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.

Sun Kim

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!

Tanja

Wonderful summary of anatomy and symptom-complex related to the scalene muscles! Thank you so much!

Mira

Great description of all that the scalene do, and the wide variety of symptoms that the scales may play a role in causing. .

Becky

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.

Katelynn Corman

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.

Nina

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.

Valérie Lavigne

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!

Alicia Lowe-Downes

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.

Alicia Lowe-Downes

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.!

Sonia

Wow, I didn’t realize all the areas could be affected by trigger points and tension in the scalenes. Thanks Christina!

Michelle W

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!

Ella

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.

Tessa Watson

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

Kelly

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!