Unlock Instant Relief: Top Scalene Muscle Massage Techniques to Eliminate Upper Body Pain and Numbness Fast!

The scalene muscles, often overlooked due to their anatomical surroundings, can be a significant source of upper body pain and numbness. These enigmatic muscles are frequently found to be the root of various pathologies. However, performing bodywork on these muscles requires extra care due to their slightly hidden, highly innervated, and vascularized locations. This article explores massage techniques to help free the scalene muscles and relieve pain.

Understanding the Scalene Muscles

The scalene muscles consist of three groups: anterior, medius, and posterior. They originate from the transverse processes of cervical vertebrae two to seven and insert into the first and second ribs. The name "scalene" derives from the Greek word "skalenos," meaning "uneven." Although anatomists depict them as individual muscles, touch therapists know that they work together as a functional unit during neck sidebending and rotation.

Functions of the Scalene Muscles

The scalene muscles perform several essential functions:

Neck Movement: Laterally flexing the head.
Respiration: Assisting in respiration by raising the ribs.
Inhalation: Considered accessory muscles of inspiration, they can elevate the first and second ribs and aid in neck flexion. It was once believed the scalenes were only active during heavy or forced breathing, but improved electromyography shows the scalenes firing even when the intake of breath is quite small.
Neck Flexion: When both sides of these muscles contract, they flex the neck. Furthermore, they help to lift the ribcage and assist the diaphragm during inhalation.

Scalene Muscle Dysfunction and Pain

The scalenes are notorious for generating pain, both locally and distally. A shortening of these muscles from trigger point development can compress or irritate nearby blood vessels and nerves, leading to various symptoms.

Causes of Scalene Muscle Issues

Several factors can contribute to scalene muscle dysfunction:

Recruiting Neck Muscles for Breathing: Those who recruit neck muscles for everyday breathing are likely to develop trigger points in the scalenes.
Excessive Frictioning of Cervical Nerves: Electricians, painters, dancers, and competitive athletes such as swimmers and pitchers may develop anterior scalene syndrome due to excessive frictioning of cervical nerves as they traverse through fibrotic anterior and middle scalene tendons at the interscalene triangle.
Prolonged Spasm: Prolonged anterior and middle scalene spasm due to injury, poor posture, or overuse can also cause residual problems as they tug on the first rib pulling it up against a drooping clavicle.
Poor Posture: Poor body posture can lead to pain in various parts of the body, including the scalenes. People who sit in front of computers with their heads leaning forward for long hours often grapple with upper body pain complaints.
Respiratory Conditions: People with chronic respiratory conditions like asthma, pneumonia, and bronchitis often struggle with scalene issues.
Labored Breathing: Labored breathing is often a symptom of underlying conditions like anxiety, panic attacks, emotional tension, etc.
Coughing: Every time you cough, you engage your scalenes. Coughing incessantly for long periods can weaken your scalene, making it difficult for your lungs to expand and process fresh air.
Attachment Disorder: The Scalenes have an attachment disorder. For a group of muscles to be working so hard, understanding where they are, what they do, and the black hole they live in is key to our approach.

Symptoms of Scalene Muscle Issues

Scalene muscle dysfunction can manifest in various symptoms:

Pain: In general, a tight scalene group will pull the head to the same side. The scalenes are often involved in common neck pain and headaches, but that’s just the tip of the iceberg. Seriously, this is a weird area: the scalenes often harbour TrPs with more diverse and peculiar symptoms than any other muscle tissue in the body.
Restricted Neck Motion: This can be tested by laterally flexing the neck and noticing where the motion is restricted. If flexion is restricted to the right, the scalenes on the left are tight.
Anterior Scalene Syndrome: Symptoms may present in the anterior neck, chest wall, or down into the arms and hands sometimes making it difficult to hold onto objects or to reach overhead.
Costoclavicular Syndrome: When the brachial plexus gets squashed between the clavicle and rib, a condition termed ‘costoclavicular syndrome’ arises. This disorder is one of the leading contributors to thoracic outlet syndrome (TOS).
Referred Pain: Pain in the scalenes is often felt just about anywhere but the scalenes themselves. Spreading painJust like the pain of a heart attack spreads from the heart into the shoulder and arm, the pain of painful scalene muscles spreads throughout the chest, upper back, and chest, the arm and hand, and the side of the head.

The Brachial Plexus and Thoracic Outlet Syndrome

The brachial plexus and the subclavian artery pass between the anterior and medial scalenes, and the subclavian vein passes anterior to the anterior scalene. Thus, a shortening of these muscles from trigger point development can compress or irritate these nearby blood vessels. Prolonged anterior and middle scalene spasm due to injury, poor posture or overuse can also cause residual problems as they tug on the first rib pulling it up against a drooping clavicle. When the brachial plexus gets squashed between the clavicle and rib, a condition termed ‘costoclavicular syndrome’ arises. This disorder is one of the leading contributors to thoracic outlet syndrome (TOS).

Assessment Techniques

Before initiating any massage techniques, assessing postural strain patterns is crucial. A few commonly applied provocation tests for assessing TOS such as the Adson maneuver (scalenes), ‘Hands-up’ (pec minor), Allen (radial pulse) and the Elevation maneuver for costoclavicular canal impingement may be used. These tests may or may not momentarily reproduce symptoms, but are sometimes helpful in ruling out other causes which may produce similar symptoms. Due to the overlapping of symptoms, it’s often difficult to make a definitive assessment using provocation tests. Fortunately, advancements in nerve imagery using Magnetic Resonance Neurography are providing more accurate monitoring of exact sites of peripheral nerve damage. Therapeutic outcomes reap greater rewards when the nerves along the entire length of the arm are examined and treated beginning proximally from the cervicothoracic spine down through the wrist and hand.

Wartenberg’s Test (WT)

This test was proposed by Dr. P. Wartenberg in the 1930’s. The first part of the video shows the initial placement of the thumb for the execution of the test. Notice that the thumb must be placed flat just above the clavicle. The second part of the video shows the application of the pressure in the right spot. WTis considered positive if the patient feels acute pain while the practitioner applies even moderate pressure in this area or an already existing symptoms get worse, e;g.

Trigger Point Test (TPT)

Wartenberg’s Test is very accurate, but sometimes it does not give all of the information if tension is formed in the upper third of the scalene muscle. TPT is also easy to perform. The first part of the video shows the anatomical arrangement of the anterior neck when the patients’ head is turned to the opposite, unaffected side (left side in the video). The trigger point is located in the middle of the ASM, between the clavicle and mastoid process, underneath the posterior edge of the sternocleidomastoid muscle. The second part of the video shows the application of the TPT in the patient position on their back. In the video the index finger indicates the area of the trigger point, and the thumb shows the mobilization of the sternocleidomastoid muscle. After pushing the posterior edge of the sternocleidomastoid muscle medially, carefully re-direct pressure to the vertebral column. This area is sensitive in general, so use a moderate pressure.

Scalene Muscles Massage Techniques

When working on the scalenes, massage therapists must be aware of the sensitive nerves and arteries nearby. Since scalene constriction can cause pain in so many areas of the upper body, a comprehensive understanding of the neck musculature and underlying structures is essential for massage therapists. This anatomical familiarity will help therapists with accurate client assessment and safe, therapeutic applications to release the scalene muscles.

General Guidelines

Caution: When learning anterior neck work, special caution must be taken to avoid placing finger pressure on all neurovascular structures.
Awareness: When working on the scalenes, massage therapists must be aware of the sensitive nerves and arteries nearby. Since scalene constriction can cause pain in so many areas of the upper body, a comprehensive understanding of the neck musculature and underlying structures is essential for massage therapists. This anatomical familiarity will help therapists with accurate client assessment and safe, therapeutic applications to release the scalene muscles.
Intent: Because the shoulder and neck area consist of very complex body parts with muscles and connective tissues going in all possible directions, therapists must focus intent on correctly assessing postural strain patterns prior to ‘chasing the pain’.

MEDICAL MASSAGE PROTOCOL for Anterior Scalene Muscle Syndrome (ASMS)

If Wartenberg’s Test and/or Trigger Point Test are positive, the practitioner should always start the treatment of any abnormality of the upper extremity with the application of the MEDICAL MASSAGE PROTOCOL for the ASMS.

Step 1: Work on the Posterior Neck and Shoulders.

For the first 2 to 3 strokes use superficial effleurage, and later switch to deep effleurage maintaining a fold of skin in front of the fingertips during the stroke. Begin with longitudinal friction along the medial edge of the scapula, and later apply friction across the fibers at their insertion into the edge of the scapula. Be sure to apply friction strictly next to the bone, and do not slide the thumb over the skin. Concentrate along the insertion of the trapezius muscle into the spine of the scapula. Again, begin with friction along, and later across, the fibers at their insertion into the spine of the scapula. Begin with application of the technique on the unaffected side. Apply 2 to 3 repetitions. Work longer and slower on the affected side.

Step 2: Repetitive Friction

Apply repetitive friction on the lateral surfaces of the spinous processes of the C5, C6 and C7 cervical vertebrae. First, employ intense circular friction and moderate compression of tissue in the paravertebral area between the spinous processes of the C5 and C6 vertebrae. Move to the next segment between the C6 and C7 spinous processes to address the cutaneous branch of the C7 spinal nerve with the same combination of techniques. Before applying friction, be sure to stretch the skin over the area addressed here.

Step 3: Work on the Anterior Neck

The practitioner must be very careful on the anterior neck. An already inflamed brachial plexus finds itself just underneath the fingertips. Thus, any technique on the anterior neck must be applied within a short time frame and efficiently, so as to minimize potential irritation of the brachial plexus. Pay attention to the location of the trigger point in the anterior scalene muscle. This area is very important for upcoming steps. The trigger point is located in the middle of the anterior scalene muscle, between the clavicle and mastoid process, underneath the posterior edge of the sternocleidomastoid muscle. In the video, the index finger indicates the area of the trigger point and the thumb shows the mobilization of the sternocleidomastoid muscle. After turning the patient onto his or her back, and before addressing the anterior neck, work on the posterior neck and shoulders for one minute employing effleurage and moderate friction. Please notice the position of the right hand. Also, notice that the tip of the thumb ALWAYS stays behind the posterior edge of the sternocleidomastoid muscle. Very light pressure is applied only when the thumb moves down along the anterior scalene muscle. Therefore, pressure must be directed horizontally. Employ the same strokes observing the same principles of application, except that in this case the head is turned to the opposite side. This position renders accessible the anterior scalene muscle, however puts additional pressure on the brachial plexus. Switch to circular friction using the thumb, but keep it flat. The final part is the application of circular friction in the supraclavicular fossa just behind the clavicle. Begin with local stretching of the entire anterior scalene muscle during the patient’s prolonged exhalation. Apply the right thumb below the mastoid process and direct the pressure horizontally, carefully sliding the thumb along the anterior scalene muscle and getting the thumb ONTO the clavicle. Please pay attention to the movement of the wrist during the stroke; the efficacy of the stroke depends on this. Notice that the initial position of the palm is perpendicular to the axis of the spine. While the practitioner executes the stroke and moves the hand forward, the wrist comes to be extended in such a way that at the end of the stroke the palm is parallel to the axis of the spine. Only in this way will you be able to get the thumb easily on the clavicle. Now, apply local stretching of the lower half of the anterior scalene muscle. Place the 2nd to 5th fingers of the left hand (brought together) on the trigger point area in the anterior scalene muscle. The right thumb slides down from the level of the left fingertips; when it arrives onto the clavicle, the practitioner should gently pull both hands in opposite directions such as to stretch the lower half of the anterior scalene muscle. The pressure of both hands is directed horizontally. Place one hand under the patient’s occipital ridge and place the 4th and 5th fingers of the other hand (brought together) under the chin. Ask the patient to quickly inhale and exhale slowly through the mouth. Observe the patient’s facial expressions. He or she should inform you about any uncomfortable sensations during the stretch. Decrease the intensity of the pull if the patient is uncomfortable.

Read also: Sports Massage for Two

Additional Techniques

Superficial Friction and Skin Kneading: Turn the patient’s head to the opposite side (left side in the video). Place your left hand behind the right mastoid process and your right hand on the right shoulder with your thumb on the clavicle. Do not employ strong vertical pressure during friction and manual vibration. However, the pressure applied should be strong enough to hold the skin during the application of these techniques. Apply superficial friction and skin kneading in this area. Connective tissue zones may form on the posterior and anterior neck. Connective tissue massage is the best way to eliminate them. The connective tissue massage (CTM) protocol is shown in the video. CTM on the posterior neck should be added at the very end of Step 2 of the previously discussed protocol.
Trigger Point Release: There is thus a special approach to working in the trigger point area of the anterior scalene muscle. While turning the head, keep the third finger in the same spot to secure the location of the trigger point. Turn the patient’s head to the unaffected side within his or her comfort level. Ask the patient to effect two consecutive movements against your resistance: first, to slowly turn his or her head to the right; and then, without either of you releasing pressure, to bend the head forward. The next step is three passive stretches during the patient’s prolonged exhalation. Ask the patient to move up toward the head end of the table such that both of his or her shoulders are on the edge of the table. The practitioner must efficiently support the patient’s head so that the patient feels that his or her head and neck are secure. Turn the patient’s head to the left (for right-side pathology) while supporting the head with your right hand. Now, ask the patient to slowly turn the head to the right while you resist this movement using your thumb. Without either the patient or you releasing pressure, ask the patient to bend the head forward while you resist this movement with your index finger. After the resistance part, apply three passive stretches during the patient’s prolonged exhalation. Each stretch must be conducted within the patient’s comfort level. The practitioner must interrupt any additional pulling as soon as the patient manifests any signs of experiencing ANY uncomfortable sensations. For this reason the practitioner should determine the comfort level of passive stretching before the treatment. The end of the third passive stretch is the beginning of the second resistance-against-contraction movement. After 10 to 15 seconds, lift the patient’s head up to make him or her comfortable and again conduct three passive stretches.
Periostal Reflex Zones Treatment: Periostal reflex zones can be found on the anterior and posterior surface of the clavicle. Employ this treatment only if periostal reflex zones are detected.
Self-Trigger Point Therapy: Clip your nails to avoid hurting your neck.Use 1-2 fingers to make short, half-inch strokes; use a lacrosse ball or tennis ball to reach deeper spots.Perform multiple strokes on each point throughout each muscle, and 10-12 strokes on tender spots multiple times a day.When touched, trigger points shouldn’t be painful beyond 4 or 5 on a scale of 1-10.Don’t press down on a spot that has a pulse.Don’t stress about perfecting your move. Repeat Step 1 above, this time starting right underneath your ear and pressing against a ‘bony knob’ on the side of your neck.Breathe in a few times to see if a muscle twitches below your fingertips. Once you start feeling a pleasant sensation around your scalene muscles by using this self-trigger point therapy, you can continue for as long as you need.

Lifestyle Modifications and Prevention

Proper Diaphragmatic Breathing: On your own, you can practice proper diaphragmatic breathing to reduce pressure on your chest. It helps people distress when dealing with anxiety and crankiness.
Body Posture: Always stay conscious of your body posture, no matter what you do, especially if you do something for long hours. The best posture always has your head held up in an upright position along with your spine, whether you’re sitting, standing, or walking.
Avoid Smoking: Anything that makes breathing more difficult could easily provoke over-use of the scalenes. There are many possibilities, but probably the most common and preventable is smoking - which is also a risk-factor for chronic pain independently, so it’s a double whammy.

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