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.


16 Responses

  1. michael

    very educative please discuss the Quadratus lumborum and back pain

  2. Racheal

    This is wonderful thank you for sharing
    I love the idea of utilising the ribs to free scalenes can’t wait to explore what happens

  3. Brie

    Can you elaborate on the correlation between Scalenes and extensor halliscus longus? Is this base on an observation you’ve made in your own practice, or is there supporting research? Thank you kindly for your thoughts.

    • neurokinetictherapy

      Anatomy Trains front line

      • Brie

        Haha, too obvious. Thank you.

  4. Excellent explanation and very helpful blog post.

  5. Laurie

    I’ve been working with a client that developed that exact problem between the cervical, scalenes, obliques and QL after carrying twins 25 years ago (one 7 lbs the other 8 lbs). Fascinating. Thank you.

  6. Lipi shah

    Knowledge is power and this is powerful indeed. Thank you for sharing such a great help ful post

  7. Drashti

    Thanks for the great blog .. plz let us know how neurokinetics help here.

    • neurokinetictherapy

      NKT helps by identifying the dysfunction and then reprogramming the motor control center to restore functional movement.

  8. Hey, thanks for the blog article.Really looking forward to read more. Much obliged. akbfdadbdbcfeddc

  9. Laura Gee

    Thank you so much for sharing your knowledge with us all!

    In massage therapy school we were taught that the scalenes rotate the head contralaterally but here you say ipsilaterally. Is this a common disagreement in the field? Our Trailguide books say opposite side too, yet my physical tharpist would often do scalene work where I felt the stretch ipsilaterally.

    • neurokinetictherapy

      Yes there is controversy. Trust what you feel.

  10. Anjali Shetty

    thankyou for this blog..scalene a muscle least studied but so useful.. m a physiotherapist i would like to learn more about the inhibition and facilitation i m little unclear in the above blog as to how it is facilitated/inhibited if you help me with that i would be thankful.

    • neurokinetictherapy

      you’ll need to take a seminar

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