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.