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Trigger Point Therapy - Treating the Scalenes

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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.



Find a Trigger Point Professional in your area

NAT 5 Step Shoulder Technique

Dry Needling for Trigger Points

NAT Professional Courses

Certify as a Trigger Point Therapist

Trigger Point Workbooks 


About NAT Courses:

As a manual therapist or exercise professional, there is only one way to expand your business - education!

Learning more skills increases the services that you offer and provides more opportunity for specialization.

Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.

Best of all, we're always here to offer help and support.


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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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