The three scalene groups derive their name from the Greek word skalenos meaning “uneven.” Although anatomists depict the scalenes as individual muscles, most touch therapists are aware of how they work together as a functional unit during neck sidebending and rotation (Fig. 1). 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. This has led some researchers to drop the accessory label and regard them as primary muscles of inspiration.
Electricians, painters, dancers, and competitive athletes such as swimmers and pitchers may develop anterior scalene syndrome due to excessive frictioning of neurovascular structures. Cervical nerves and vessels often become trapped between fibrotic anterior and middle scalene tendons as they enter the thoracic inlet. Prolonged scalene spasm from injury, poor posture or overuse can also cause 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 titled ‘costoclavicular syndrome’ arises. This disorder is one of the leading causes of thoracic outlet syndrome (TOS).
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’. 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. These tests, accompanied by thorough history and posturofunctional evaluations, are extremely helpful for massage and functional movement therapists when it comes to treating entrapment sites that irritate the nerve bundle and bring sensation to the arm and hand.
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 (Fig. 2). In the following video, I demonstrate a very effective anterior scalene release. Those of you who have attended my workshops or have taken my Technique Tour home-study course have seen how this maneuver fits into an anterior neck routine that leads to improved posture and reduced TOS symptoms.
When learning anterior neck work, special caution must be taken to avoid placing finger pressure on all neurovascular structures. Therefore, I suggest you practice the following in a supervised setting.
Anterior Scalene Technique
GOAL: Release adhesions in anterior scalene muscles
ACTION: (Client left sidelying)
- Therapist helps client left rotate her head to expose clavicular (lateral) border of SCM
- Therapist’s left hand controls the client’s head and his right extended soft finger pads gently slide under SCM
- Therapist’s left hand slowly rotates client’s head and neck back to neutral and in to hyper-extension while fingers of right hand “scrubs” the anterior tubercles (transverse processes)
- Therapist repeats the entire maneuver as gently curled fingers inspect for scalene fibrosis along anterior tubercles (C2 to C6)
- If thickness or knots are palpated, client deeply inhales or tucks (and releases) chin as therapist holds sustained gentle pressure until GTO receptor release is felt
- Repeat 3 to 5 times and retest neck flexion firing order