In my experience as a physical therapist (PT), I have found treatment of the scalenes to change my practice. I find that when I address the scalene muscle tightness properly in treatment, my patients feel better sooner! Many health care professionals acknowledge the scalenes as a possible factor into pain or tightness, but do not necessarily treat these muscle structures. it is important to understand how the scalenes can be contributing to your pain. They are found to cause neck pain, that nasty ache in your biceps, pain in your upper back, pain in your hand and forearm, and even numbness or tingling in your arm
So what exactly are the the scalenes? The scalenes are a muscle group made up of three parts- the anterior, the middle, and the posterior. (scalenes Pictures <http://www.amtamassage.org/uploads/cms/images/scalenes_fig5-59.jpg>). The anterior scalene starts in the neck and attaches at the first rib – in the front of your body – just under the collar bone. The middle scalene attaches from the sides of the cervical vertebrae again to the first rib. We usually group the anterior and middle scalenes together as they are so close in their attachments. The posterior scalene attaches from cervical vertebrae C5-7 and attaches to the second rib.
The three scalenes together form what is known as the scalene triangle. This is where impingement, or pinching, can occur on structures such as arteries, nerves and veins passing through the triangle. If the scalenes become tight, often due to poor head and upper body posture, they can easily compress any or all of these structures and lead to significant symptoms (burning, aching, tingling, etc) in your arm or neck. (Referral Pattern of scalenes- <http://www.triggerpoints.net/triggerpoints/scalene.jpg). You will see in this picture that the tightness in the scalenes can actually lead to pain in other areas of your body.
Here is an example of a case in which the scalenes are playing a role with pain. A patient comes to PT with shoulder pain that travels into the biceps region. The pain is worse at night and the ache in the arm is like a deep seated tooth ache. Many movements with their arm hurt and sometimes they cannot lift their arm at all. Some movements with their neck also cause increased pain, but they consider the pain to be “not too bad”. This person had been previously diagnosed with a rotator cuff strain or tear. Through our extensive evaluation, we find that the scalenes are like ropes – holding on very tightly – and most likely putting pressure on the nerve and artery passing through the scalene triangle and causing pain throughout the arm. Moving forward, we treat the scalenes with manual stretching techniques and reassess range of motion and pain. Many times the symptoms significantly decrease after this minor stretch.
During our evaluation, we are also looking for reasons why the scalenes became so tight in the first place. As previously mentioned, posturing – for example, while working your head leans forward to look at your computer screen rather than staying completely atop your neck and aligned with your shoulders and back – puts these muscles in a shortened position. We also look at the joints and muscles in the middle of your back. Our attempt is to see if we can help restore the body’s normal posture and reduce the strain in this area. The above is one example of how positioning can cause muscle imbalances leading to pain, symptoms, and difficulty performing daily activities. It is important to understand that each person is different and the reason for certain muscles and joints getting out of balance is individualistic. Just remember, the scalenes are often forgotten and if addressed initially, you may find them to be a large contributing factor to neck and arm pain.
If you are concerned your scalenes may be playing a role with the pain you are experiencing, or if you have had shoulder or arm pain that cannot be diagnosed, consider a trip to Sports PT for a detailed evaluation!!
*Editors Note: The proper grammatical form for the identification of this muscle group is scalenus (singular) or scaleni (plural). For ease of understanding, this blog was intentionally written utilizing the terms frequently used in the physical therapy setting, scalene (singular) and scalenes (plural).
Created by:
Alison Synakowski, PT, DPT, OCS, ATC, CSCS
Facility Manager
Certified Sportsmetrics Instructor
Sports Physical Therapy of NY, PC
1 West Ave, Suite 150
Saratoga Springs, NY 12866
(518)-583-7537 x2805
(518)-583-7606 (fax)
www.sptny.com
I recently injured my arm and shoulder when I was walking a large dog at night. He saw a kitty in a yard and began to buck and rare I couldnt see it and lost control of the situation. He dragged me down on my stomach and then over a log onto my back with my right arm over my head. Needless to say, I dont walk him any more and my arm and shoulder have been absolutely killing me. I talked to my Dr about it and he said to stretch it out by swinging it around and to alternate heat and cold. Well, it hasnt worked. It has been 6 weeks and it still really hurts. I have taken some massage classes but nothing deep enough to cover the scalenes much. I was probing around on my arm and shoulder and couldnt hit anything that helped. Then I thought about my neck and found these extremely sore little muscles. Did more research on them to try to help myself. OUCH!! I had my neck fused in 1999 so stretching is pretty much out of the question, so working out trigger point with massage is about my only hope. If you have any advice or suggestions, I would love to hear from you. I am a retired medical technologist and have an understanding of medical things. I look forward to hearing from you.