Scalenes - Common Trigger Point Sites

Treating Scalenes trigger points can bring fast relief for some common painful disorders

Treating Scalenes Trigger Points - Dr. Jonathan Kuttner

The scalenes are a complex group of muscles with varying muscle fiber lengths, and therefore demonstrate the potential for many trigger points

Trigger points in the scalenes are associated with a number of upper body complaints and can also refer pain along the whole length of the arm down to the thumb and index fingers.

Some therapists are slightly afraid to work on trigger points in the scalenes as they sit close to several nerve trunks and blood vessels in the neck.

Excellent palpatory skills (and a lot of study and practice) may be required to successfully locate and treat these trigger points.

Scalenes - Trigger Points can be treated safely and effectively

Treating Scalenes Trigger Points

Stretching and Muscle Energy Techniques can be very useful

SCALENUS ANTERIOR, MEDIUS, POSTERIOR

Greek skalenos, uneven; Latin anterior, before; medius, middle; posterior, behind

Origin

Transverse processes of cervical vertebrae.

Insertion

Anterior and medius: 1st rib. Posterior: 2nd rib.

Action

Acting together: flex neck. Raise 1st rib during a strong inhalation. Individually: laterally flex and rotate neck.

Nerve

Ventral rami of cervical nerves, C3–C8.

Referred Pain Patterns

Anterior: persistent aching, pectoralis region to the nipple. Posterior: upper medial border of scapula.

Lateral: front and back of the arm to the thumb and index finger.

Indications

Back/shoulder/arm pain, thoracic outlet syndrome, scalene syndrome, edema in the hand, phantom limb pain, asthma, chronic lung disease, whiplash, “restless neck,” irritability, hyperventilation syndrome, panic attacks.

Common Causes

Posture (head forward or upper crossover patterns), anxiety, stress, pillow height, chronic lung problems, heavy lifting/bracing, allergies, playing musical (wind) instruments.

Differential Diagnosis

Brachial plexus. Subclavian vessels. Cervical discs (C5–C6). Thoracic outlet syndrome. Angina. Carpal tunnel syndrome. Upper trapezius. SCM. Splenius capitis.

Scalenes Trigger Points

Self help compression techniques can help bring relief, but proceed with caution and seek professional advice before you start!

General Advice to Clients

Lifestyle - Use of pillows, avoid heavy backpacks, consider breast reduction in some cases, warm scarves in winter, avoid pulling and lifting.

Posture - head forward or upper crossover patterns can be treated with a combination of manual therapy and prescribed exercises.

Breathing - Hyperventilation syndrome is strongly associated with scalene syndrome. Breathing techniques from yoga and Butyeko method are worth exploring.

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.