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Trigger Point Therapy - Treating the Scalenes

Posted by Arnold Fomo on


Treating Scalenes Trigger Points - Dr. Jonathan Kuttner


Treating scalenes trigger points can bring fast relief for some painful disorders

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.

In reality, there are a number of safe ways to approach the treatment of these trigger points.


Scalenes - Common Trigger Point Sites




Scalenes - Trigger Points can be treated safely and effectively



Treating Scalenes Trigger Points


Stretching and Muscle Energy Techniques can be very useful



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


Transverse processes of cervical vertebrae.


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


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


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.


Scalenes Trigger Points



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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Treating Chronic Neck Pain - NAT Online Course

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About Niel Asher Education

Niel Asher Education is a leading provider of distance learning and continued education courses.

Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.

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We are honored to have received the "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.

Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.

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Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.

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Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.

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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. 




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