Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology.
The scalene muscles are a muscle group in your neck. You have more than 100 muscles in your neck, head, and face area. The scalenes are made up of three pairs of muscles, with one set located on either side of your body.
Sometimes the scalenes can give you problems because they’re prone to a lot of tension.
When the scalenes are healthy and working in a balanced way, they help support the upright posture of your cervical spine, which is the upper part of your spine.
The 3 Scalene Muscles
Before we dive into these conditions and what you can do to loosen your scalenes, let’s take a closer look at the three muscle groups that make up your scalenes. To imagine what they look like, you might think of the tangled rigging of a ship’s mast; the scalenes resemble and are positioned on the neck and collarbone similarly.
Of the three muscles that make up the scalenes, the anterior is located closest to the front. Like all scalene muscles, it is considered a side neck muscle. So what does the anterior scalene muscle actually do for you? A number of things, but first, it’s helpful to remember that you have these muscles on both sides of your neck. The anterior scalene, when acting only on one side of your neck, can bend and rotate your neck. It also lifts the first rib, but that’s a pretty subtle action that you might not be aware of while it’s happening. The anterior scalene muscle is considered an accessory breathing muscle because it lifts the first rib during an inhale. When both of your anterior scalenes work together, they flex (bend) your neck.
As the name suggests, the medial scalene (scalenus medius) resides between the anterior and posterior branches of the scalene muscle. As with the other muscle branches of this group, your left or right medial scalene can contract (move) alone, or your medial scalenes can contract together. When only one side contracts, it elevates (lifts) the first rib to flex and laterally bend (move to the side) the neck. Like the anterior scalene, the medial scalene muscle is considered an accessory breathing muscle because it lifts the first rib during inhalation. When both medial scalenes contract, they flex the neck. These actions are similar to those of the anterior scalene because the attachment sites (origins and insertions) are located near one another.
The posterior (back) scalene occupies the furthest back position of all the scalene muscle branches. It does not contribute to the scalene triangle; only the anterior and medial branches do that. When only one posterior scalene is contracting, it flexes and rotates the neck joints. When both posterior scalenes contract, they cause the neck to flex and raise the second rib, an action that may be difficult to detect when it’s happening. The posterior scalene muscle is considered an accessory breathing muscle because it lifts the second rib during inhalation.
Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain
One of the more enigmatic muscle groups in the human body, contracted scalenes are commonly found to be at the root of several pathologies. Due to their slightly hidden, highly innervated and vascularized locations, performing bodywork on these muscles requires extra care. Upon identifying contracted scalenes as problematic, carefully and thoroughly performing a sequence of massage techniques on these muscles can bring your client significant and seemingly miraculous relief.
Scalene Function and Dysfunction
Consisting of the scalenes anterior, scalenes medius, and scalenes posterior, the scalene muscles originate from the transverse processes of cervical vertebrae two to seven and insert into the first and second ribs. Located on the lateral side of the neck, the scalenes serve two primary functions:
- Neck movement by laterally flexing the head. In addition, the scalenes assist in rotating the head to the opposite side and flexing the cervical spine on the thoracic spine in an oblique direction.
- Assist in respiration by raising the ribs. The scalenes are considered to be auxiliary respiratory muscles, becoming activated when more thoracic cavity space is required – usually occurring during exercise when a greater volume of air is needed to meet increased demands for oxygen.
Those who recruit neck muscles for everyday breathing are likely to develop trigger points in the scalenes. To learn more about the problems associated with apical breathing and how to correct it, read the article Diaphragm Strengthening for Neck and Shoulder Pain.
The scalenes are notorious for generating pain, both locally and distally. In addition to causing widespread pain in the neck, scalene trigger points can cause pain to refer to the:
- Medial border of the scapula
- Posterior and lateral sides of the arm to the thumb and index finger
The brachial plexus and the subclavian artery pass between the anterior and medial scalenes and the subclavian vein passes anterior to the anterior scalene. Thus, a shortening of these muscles from trigger point development can compress or irritate these nearby blood vessels. Therefore, it is not uncommon for clients with tight scalenes to complain of paresthesia, anesthesia, coldness, claudication, and lymphedema in the involved extremity.
In general, a tight scalene group will pull the head to the same side. This can be tested by laterally flexing the neck and noticing where the motion is restricted. If flexion is restricted to the right, the scalenes on the left are tight. When working on the scalenes, massage therapists must be aware of the sensitive nerves and arteries nearby. The scalenes can impinge on the brachial plexus, causing nerve pain or numbness down the arm, otherwise known as thoracic outlet syndrome.
When it comes to the increasingly common diagnosis of thoracic outlet syndrome, massage therapists are equipped to provide one of the most effective treatments.
According to Doug Alexander, instructor of Natural Wellness’ home study continuing education course Nerve Mobilization, “When the scalenes are released the first rib can be shifted downwards and the clavicle mobilized to create more space and ease for the plexus (brachial) to pass between these bones.” In this course, Alexander teaches an effective sequence for releasing the scalenes, including the following techniques:
- Scalene length assessment and stretch
- Bowing the scalenes
- Scalene post-isometric relaxation
- Stripping of the scalenes
Due to the neighboring anatomical structures, Alexander consistently advises therapists to be careful of causing clients discomfort – and suggests ways of adjusting their technique if this occurs.
Since scalene constriction can cause pain in so many areas of the upper body, a comprehensive understanding of the neck musculature and underlying structures is essential for massage therapists. This anatomical familiarity will help therapists with accurate client assessment and safe, therapeutic applications to release the scalene muscles. With subsequently relaxed scalene muscles, clients are often amazed at the dramatic pain relief they experience.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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