The scalenes are a complex and peculiar muscle group located in the anterior cervical spine. The scalenes often harbor trigger points with more diverse and peculiar symptoms than any other muscle tissue in the body. Pain in the scalenes is often felt just about anywhere but the scalenes themselves. Instead of your scalenes, your arm or chest might hurt.
Referred pain effects are par for the course with all muscle pain or any other internal pain, but the scalene muscles consistently produce unusually complex, variable, and extensive patterns of referred pain. The results can be a bit bizarre (mysterioso!), causing symptoms that most people never guess are coming from the scalenes — even doctors and therapists.
The scalenes muscle group consists of:
- Anterior scalene: cervical vertebrae 3-6 and inserts into first rib
- Middle scalene: cervical vertebrae 2-7, inserting into first rib
- Posterior scalene: cervical vertebrae 5-6, inserting into second rib
I will refer to the the scalenes as a group moving forward – just know that there are three muscles in each group and there are two groups of scalenes that are located on the anterior cervical spine.
The Primary Functions: Bilateral & Unilateral Engagement
- Bilateral engagement: Flexes the cervical spine onto itself and extends the cervical spine onto itself.
- Unilateral engagement: laterally flex the neck to the same side and rotate to the opposite side.
The Secondary Function: Auxiliary Respiratory Muscle
The scalenes act as an auxiliary respiratory muscle during exercise. During times of exertion, the thoracic cavity must expand to allow for a greater volume of air to be inhaled into the lungs. The scalene muscles elevate the rib cage; this action complements the sternocleidomastoid muscle in promoting lung expansion. If a person feels he is having difficulty getting enough oxygen, his body begins to clench these muscles every time he breathes in as an attempt to acquire more air, which can create dysfunction in this muscle group.
One of the coolest aspects of the scalenes – and a main reason the pain pattern can cause so much trouble – is its physical relationship to brachial plexus and the subclavian artery that both pass between the anterior and medial scalenes. When dysfunction is present in the scalenes, the muscle fiber shortens, which can result in entrapment to these structures and cause symptoms in the arms or chest, such as:
- Paresthesia (“pins and needles”)
- Anesthesia (insensitivity to pain)
- Claudication (cramping pain)
- Lymphedema (fluid retention and tissue swelling)
Treatment for Scalene Dysfunction
Effective treatments include:
- Targeted neuromuscular therapy
- Targeted and supervised stretching techniques
- Targeted foam roller exercises
Solving the Pain Riddle
As you now know, trigger points in the scalenes can cause an astonishing array of problems in the neck, head, chest, back, and arms. If scalene syndrome goes untreated or undiagnosed for a long period of time, it can result in significant dysfunction in the cervical spine, shoulder, and arm.
Are you experiencing a mysterious pain in the neck, head, chest, back, or arms? Give me a call today and we’ll get to the root of the problem! (404) 964-6754