Massage Therapy Relieves Upper Body Pain in the Scalene Muscles

Setting the Scalenes Straight

Often bypassed due to their anatomical surroundings, the scalene muscles may be the source of upper body pain and numbness. Learn about four scalene-specific techniques that, when applied carefully, can bring clients great relief from these common problems.

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:

Chest
Medial border of the scapula
Shoulder
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.

Scalene Release

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.

Recommended Study:

Advanced Anatomy for Professionals
Nerve Mobilization

References

Alexander, Doug, Nerve Mobilization Workbook, Natural Wellness, 2008.

http://en.wikipedia.org, Scalene Muscles, Wikimedia Foundation, Inc., 2008.

http://saveyourself.ca, Singing, Breath and Scalenes, Paul Ingraham, RMT, SaveYourself.ca, 2008.

Murphy, Donald R., DC, Scalene Trigger Points: The Great Imitators, Dynamic Chiropractic, November 1991.

www.realbodywork.com, Scalenes: Scalene Medius, Anterior and Posterior Muscles, Real Bodywork, 2008.

About the Author

Nicole Cutler, L.Ac., MTCM, Dipl. Ac. (NCCAOM)®

Nicole Cutler, L.Ac., MTCM is a long time advocate of integrating perspectives on health. With a Bachelor's degree in Neuroscience from the University of Rochester and a Master's degree in Traditional Chinese Medicine from Five Branches Institute, Nicole has been a licensed acupuncturist since 2000. She has gathered acupuncture licenses in the states of California and New York, is a certified specialist with the National Acupuncture Detoxification Association, has earned diplomat status with the National Commission of Chinese and Oriental Medicine in Acupuncture and Chinese Herbology and is a member of the Society for Integrative Oncology. In addition to her acupuncture practice that focuses on stress and pain relief, digestion, immunity and oncology, Nicole contributes to the integration of healthcare by writing articles for professional massage therapists and people living with liver disease.