Neurokinetic Therapy® Blog

The Scalenes, the Dynamic Duo + 1

The Scalenes are an important neck muscle comprised of three parts, the anterior, the middle, and the posterior. The anterior and the middle will be the subject of this post because the posterior is mostly involved as a synergist for the upper trapezius. The brachial plexus passes through an opening between the anterior and middle scalenes, making it subject to dysfunction if the scalenes are hypertonic. The scalenes are also accessory muscles of respiration and can cause breathing imbalances if one is a chest breather. The scalenes are also involved in the kinetic chain of the arm as well as the front line and lateral line. We will examine all of these relationships to reveal just how dynamic these muscles truly are.

In cervical dysfunction the scalenes can be either facilitated or inhibited. If the sternocleidomastoid muscle is inhibited, the scalenes may compensate to stabilize neck flexion. In the case of whiplash, the scalenes may become inhibited by facilitated neck extensors. I find it very important to release the scalenes indirectly by stabilizing the first and second ribs while performing a myofascial stretch. I have found that working directly on the scalenes can cause them to rebound and tighten up even further. To strengthen the scalenes, resist at the forehead while nodding towards the ipsilateral shoulder. The scalenes also ipsilaterally flex the neck, and therefore can become inhibited by either the ipsilateral or contralateral upper trapezius. The scalenes produce ipsilateral rotation of the cervical spine, and can become facilitated by an inhibited contralateral sternocleidomastoid or an ipsilateral longus colli.

Because the brachial plexus passes through an opening between the anterior and middle scalenes, hypertonicity, whether caused by facilitation or inhibition, must be addressed. The extra pressure on the brachial plexus caused by hypertonic scalenes can result in Thoracic Outlet Syndrome. Symptoms include numbness and tingling in the arms and hands, as well as loss of strength in both the arms and hands. I have found the scalenes to be compensating for 13 different functions in the arm line with someone who had TOS. Reestablishing the proper relationship between the scalenes and these 13 different functions was crucial in the resolution of the TOS.

The scalenes are an important part of the front line kinetic chain. It is not unusual for the scalenes to be facilitated for an inhibited ipsilateral psoas and adductors. They may also be facilitated for an inhibited contralateral TFL and adductors. Even dysfunction of the extensor hallucis longus can be compensated for by the ipsilateral scalenes.In the lateral line, the scalenes oftentimes become facilitated in combination with the peroneals in cases of over pronation or ankle sprains. The most likely inhibited muscle in this scenario is the TFL. The scalenes can also be dynamically involved with the obliques and the quadratus lumborum.

The scalenes are also accessory muscles of respiration. They elevate the first and second ribs, and in chest breathers, they can become,along with the pectoralis minor, dominant muscles of respiration. In this situation they can become facilitated for inhibition of the muscles that depress the rib cage, such as the quadratus lumborum and the obliques. Resolution of these dynamic muscular relationships along with restoration of proper breathing patterns can go a long way to resolving this issue.

The scalenes are important to consider in cervical dysfunction, Thoracic Outlet Syndrome, problems with the arms and hands, dysfunction of the muscles of the front line, dysfunction of the muscles of the lateral line, and improper breathing patterns. Remember to treat these muscles with respect and they will reward you with outstanding therapeutic outcomes.

 

The Pectoralis Minor, King of Compensation

The pectoralis minor is a muscle that becomes easily shortened and tight due to many factors, including rounded shoulder posture, glenohumeral joint dysfunction,breathing dysfunction, and a variety of compensation patterns. It sits on top of the brachial plexus, and can therefore contribute to Thoracic Outlet Syndrome. The pectoralis minor is located in an area of the shoulder with many other muscles, including the pectoralis major, biceps, deltoids, coracobrachialis, subscapularis, serratus anterior, and the latissimus dorsi. I find that clusters of muscles like this often can become dysfunctional due to poor biomechanics. This can lead to adhesions, facilitation/inhibition, and synergistic dominance. The pectoralis minor is often the overactive muscle in these compensation patterns. Read More »

The Popliteus, the Tiny Muscle of Knee Pain

ANATOMY

The popliteus tendon originates on the lateral surface of the lateral femoral condyle (in front of and below the lateral collateral ligament origin) and also from the fibular head. It also has an origin stemming from the posterior horn of the lateral meniscus. The tendon then courses under the lateral collateral ligament, descends into the ‘popliteal hiatus’, and becomes extra-articular (outside the knee joint) before joining its muscle belly. It inserts into the tibia above the popliteal line. It is therefore a relatively horizontal muscle lying deep in the back part of the knee. Read More »

The Often Overlooked Tensor Fascia Lata

The Tensor Fascia Lata (TFL) is a muscle with many different functions. It is an abductor, and internal rotator of the hip, and a hip flexor. Having so many functions, the TFL can be involved in many dysfunctional movement patterns throughout the body. We will explore its role in each of the aforementioned functions, assessing the resultant dysfunctions based on whether it is facilitated or inhibited. The TFL is most commonly associated with the IlioTibial Band, which unfortunately has led to its being treated as one unit. The usual treatment for this unit is myofascial release or foam rolling without assessing whether or not it is facilitated or inhibited. This can lead to further biomechanical complications and unnecessary pain and discomfort. Read More »

The Piriformis is a Real Pain in the Ass

The piriformis muscle is the most superior of the deep external rotators of the hip. The sciatic nerve passes underneath it and sometimes through it. Hypertonicity of the piriformis can contribute to many kinds of Low Back Pain, also known as Piriformis Syndrome. We will examine the factors that make for a hypertonic piriformis muscle so that we can have an effective treatment strategy. The most common imbalance associated with this condition is a facilitated piriformis inhibiting the ipsilateral hip internal rotators. These muscles, such as the gluteus medius, gluteus minimus, and the tensor fascia lata are prone to inhibition. This balance can easily be ascertained through the manual muscle testing protocol employed by NeuroKinetic Therapy. Release of the piriformis muscle is immediately followed by activation of the internal rotators to reprogram the dysfunctional movement pattern that has been stored in the motor control center. This change is first stored in short-term memory, so it becomes imperative for the client to perform their homework twice a day in order to convert this new functional movement pattern into long-term memory. Read More »

Temporomandibular Joint Dysfunction

Temporomandibular Joint Dysfunction or TMJD is a common malady affecting millions throughout the world. According to statistics most sufferers are women. I believe the reason for this is, that in many cultures women are not allowed to express their anger, and as a consequence, it somatizes in the jaw. We do know that suppressed anger and stress contribute greatly to TMJD. Most jaw clenching occurs at night but can also happen on an unconscious level throughout the day. In my experience, treatments like EMDR, are very effective for the psychological aspects of  TMJD. The physical causes include malocclusion, improper orthodontia, cranial trauma at birth, whiplash, and of course any blows to the jaw. Standard treatments include night guards, oral appliances, adjusting tooth height, orthodontia, cranial osteopathy, physical therapy, and chiropractic. It is my contention and experience that these treatments would be more effective if they included a method to make  the jaw muscles less facilitated/reactive to other muscles and functions throughout the body. Read More »

Hip Joint Jam

Hip joint impingement or Femoroacetabular impingement is a common malady affecting millions of people. If left untreated, this condition will result in osteoarthritis, hip replacement, severe groin and buttock pain, and limited and painful range of motion. FAI can result from playing sports or sitting too much. A student of mine brought his client to me who was suffering for years from severe buttock pain. She had had several MRIs as the doctors suspected she had sciatica resulting from some impingement in her lower lumbar spine. The MRIs were of course negative. She also received anti-inflammatory injections in her lumbar spine which did nothing. After getting her history I put her through some range of motion testing which included her hip joint. I found her hip joint to be very jammed. After balancing the muscles around her hip joint, I applied light traction to her leg, and voila, there was an audible pop, and while weeping, she reported that her pain was completely gone. Read More »

The Diaphragm and its Global Relationships

The diaphragm, being a centrally located muscle, when it becomes facilitated, its effects can be felt throughout the entire body. There are many reasons why the diaphragm becomes facilitated. One of these is emotional stress which causes the diaphragm to contract. Another is poor breathing habits. This results in chest breathing with the scalenes,serratus posterior inferior, quadratus lumborum, and the intercostals becoming overburdened. Regardless of the cause, let’s examine the effects of a facilitated diaphragm. The diaphragm, along with the upper trapezius, neck extensors, pectoralis minor,iliacus, and the jaw muscles, has the potential to be one of the most facilitated muscles in the body. Read More »

The Pelvic Floor-Overactive or Underactive?

Weakness of the pelvic floor muscles is associated with lower back pain, incontinence, constipation, and sexual dysfunction. The use of Kegel exercises to correct this is commonplace and widely utilized by physical therapists and Pilates instructors. When employed correctly these exercises can strengthen the core, the lower back, and the pelvic organs. Problems occur when these muscles are overactive and are inhibiting associated core and lower back muscles. Asking overactive pelvic floor muscles to perform Kegel exercises can lead to pelvic floor pain and irritation of the pudendal nerve. The question is then how do we determine if the pelvic floor muscles are overactive or underactive? Read More »

The Importance of Functional Lats

There are very few muscles in the body whose functionality is as important as the lats. Because it connects the thoracolumbar fascia to the humerus, inhibition of the latissimus dorsi can cause compensations in the neck, shoulder, elbow, lower back, and gait. This article will detail these compensation patterns and how to resolve them. This information is important for all massage therapists, Pilates instructors, personal trainers, physical therapists, etc. because inhibition of a muscle that is centrally located causes global responses. Understanding how these patterns are formed and relate to each other  is essential in resolving long-standing and difficult presentations. Read More »