Scalene Muscles Pain Pattern

The Scalene Muscles: Trigger Point Pain

The scalene muscles consist of 3 muscles, the anterior scalene, the middle scalene, and the posterior scalene.
Trigger points in the scalenes contribute to wide-ranging pain and symptoms in the shoulder, upper back, chest, arm, and hand. Numbness and tingling sensations are sometimes experienced in the affected areas. Swelling in the arm and hand are occasionally observed.
The muscles are involved in thoracic outlet syndrome (TOC). If you have been diagnosed with TOC you should check the muscles for trigger points.
Contents of Article


    Scalene Muscles

    Where are the scalene muscles?

    The Scalene muscles are a group of muscles consisting of the scalenus anterior, scalenus medius, scalenus posterior, and 30% of people have a fourth muscle, the scalene minimus. These muscles are located toward the side of the neck and attach the neck vertebrae to the 1st and 2nd ribs.

    What movements do the scalene muscles control?

    • Raises 1st and 2nd ribs during inhalation
    • Side bends the neck, ear to shoulder motion
    • Turns the head side to side

     For detailed anatomy information see:  Scalene Muscles Anatomy

    What pain and symptoms are associated with the scalene muscles?

    Though the muscles are located in the back of the neck, trigger points in the scalenes rarely cause pain in the neck. A classic symptom of trigger points in the muscles is a twitching, jerking, and restless feeling in the neck and shoulder. The sensations are compared to those of restless leg syndrome.
    Trigger points in the muscles can send pain into the shoulder and around the inside edge of the shoulder blade. The pain often travels down the arm into the pad area of the thumb spilling over into the index finger and sometimes the second finger. You may also experience tingling, numbness, and occasionally swelling in the arm and hand.
    You may also experience pain in the upper chest which may feel as if it is extending into the chest from the shoulder.
    The Scalene Minimus
    Approximately 30% of the population has a fourth scalene muscle called the scalenus minimus. The muscle is found between the scalene anterior and the middle scalene.  This rare and small muscle can cause and contribute to pain in the upper arm, forearm, all five fingers, and the thumb.
    The Scalene Muscles Are A Major Contributor To Thoracic Outlet Syndrome
    Thoracic Outlet Syndrome (TOS) happens when the nerves and/or blood vessels running from the neck down into the arm are compressed between the first rib and collarbone. The most notable symptoms of TOS are pain in the shoulder extending into the arm and down into the hand. Numbness, tingling and occasionally swelling in the affected arm and hand are common as well as a loss of strength and grip on the affected side.

    TWD Recommends

    Scalene muscle tightness and pain responds well to hot and cold treatments. The Huggaroo Neck Wrap treats the neck, top of the shoulder, and upper back. It can be chilled for injuries and muscle strains or warmed to ease stress and help muscles relax.

    What Causes Trigger Points In the Scalenes?

    Whiplash and Fall Injuries
    Whiplash injuries of the neck affect the scalene muscles and usually cause the development of trigger points in the muscles. If you have ever experienced a whiplash injury you should check all the scalene muscles for trigger points.
    Falls in which you land with your head and neck in a twisted position will cause trigger points. It may be days, weeks, or even months before the symptoms occur and you may not connect the pain to your fall. Again, check the scalenes and other neck muscles for trigger points after a fall.

    TWD Recommends

    The Craniocradle was developed to treat headaches and stiff necks. The cradle applies pressure to the muscles while providing gentle traction to the neck. Use for 5-10 minutes and feel a reduction in pain and stress. The cradle can also be used for treatment on other areas including the low back and hip area. Instructions are provided.

    Difficulty Breathing, Coughing, and Hyperventilation
    The scalene muscles pull the ribs up allowing the lungs to fill with air. If you suffer from asthma, emphysema, or allergies it is likely the muscles are stressed and have developed trigger points. Bouts with bronchitis and pneumonia that not only affect breathing but also cause bouts of coughing will cause trigger points. People who have hyperventilated will often experience symptoms of trigger points.
    Poor Head and Neck Posture
    Sleeping on your stomach, doing data entry with your head turned to the side while typing, or habitually holding your head tilted to the side puts incredible stress on the scalene muscles. The muscles on the side to which the head is turned become shortened while the muscles on the other side are overstretched which sets up a muscle imbalance which contributes to headaches, shoulder and arm pain, along with TrPs in the neck muscles including the scalenes.
    Forward Head Posture
    Forward head posture where the chin and head are carried out over the body affects all the muscles of the neck, shoulders, chest, and upper back. Forward head posture keeps the scalenes in a constantly stretched position which again will cause trigger points to develop.

    TWD Recommends
    If you have rounded shoulder, forward head posture, or have a habit of slouching, correcting your posture will reduce your muscle pain. The Truweo Posture Corrector is adjustable and comfortable. It gently pulls your shoulders back which helps retrain muscle memory to maintain proper posture. Many people notice an immediate reduction of pain and tension. Start slowly, wearing the brace for short periods throughout the day slowly increasing the time worn.

    Lifting and Carrying Heavy Objects
    If you lift or pull heavy items using your back, shoulder, and arm muscles the scalene muscles tighten and become strained. Be sure to use your leg muscles for strength and power when lifting, pulling, and carry heavy objects.
    Heavy Purses, Backpacks, and Briefcases
    When you carry a heavy purse, briefcase, or a backpack on one shoulder, it pulls the shoulder down which causes the muscles of the neck, shoulder, chest, and upper back to tighten trying to keep your shoulder in a neutral position. Over time these muscles become stressed causing muscle strains and trigger points.
    Neck Ties
    Tight neckties can restrict blood flow and put pressure on the nerves and muscles of the neck. If you wear a necktie often make sure it is not too tight and loosen it when you can.

    TWD Recommends

    Does your pillow support your head and neck?

    Sleeping without proper head and neck support will aggravate the scalene muscles as well as other neck and shoulder muscles. The Sweetnight Pillow has adjustable filling and is highly recommended for its neck support.

    Scalene Muscles Trigger Point Treatment

    If you are suffering from thoracic outlet syndrome, stinging burning pain and numbness down the arm, or any of the other symptoms of trigger points in the scalene muscles, consider Claire Davies The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. Mr. Davies explains the trigger point phenomenon and muscle pain in everyday language. But what makes this book worth its weight in gold are the individual muscle trigger point treatments that Davies has compiled. His diagrams and step by step instructions help you locate which muscles are contributing to your pain, how to find the trigger point and treat it. It takes time and practice to master finding trigger points, but once you learn you have a tool and method to help relieve muscle pain throughout the body. If you suffer from TOS and shoulder, arm, and hand pain I highly recommend this book. Relieving trigger points in the three scalene muscles have helped many people resolve TOS and their pain issues. This book is a must-have for anyone interested in finding the cause and treating muscle pain.

    Biofreeze Pain Relieving Gel is an excellent pain-relieving gel and I recommend it for those who have sudden onset muscle pain or recent injuries.  It is better than warm therapy gels and creams for recent injury muscle pain as it cools the area much like ice and does not promote swelling.   Biofreeze is recommended for those who have had a recent neck injury or sudden onset pain. Rub Biofreeze into the upper back and shoulders, into the front, side, and back of the neck going up to the base of the skull and over behind the ears.  Highly recommended for early treatment of whiplash.

    Sombra Warm Therapy Pain Relieving Gel is a pain-relieving gel that I use both personally and professionally in my massage therapy practice. Unlike other over the counter heating creams, it provides warmth without burning heat. It can help reduce tightness and pain in the back of the neck and the base of the skull often caused by the sternocleidomastoid muscles. Applying Sombra to the back and sides of the neck, up behind the ears and along the base of the skull will help headache and whiplash pain caused by the sternocleidomastoid muscles.

    How Long Before I Feel A Reduction In Pain?

    Trigger points in the SCM muscle can be stubborn and take several days of treatments before you notice a positive change. It is imparative that you stay with the treatment program to rid the muscle(s) of trigger points.  Consistent treatments several times a day for 1-2 minutes per treatment until the trigger point(s) can no longer be felt is necessary for successful treatment.

    Interesting Facts About The Scalene Muscles

    • In about 30% of the population, another scalene muscle, the scalenus minimus is found. The scalenus minimus is often only found on one side of those who have this ‘extra’ muscle.
    • The scalene muscles are seldom painful, yet refer pain throughout the chest, upper back, shoulders, arms and neck.
    • Symptoms caused by scalene muscle dysfunction is sometimes misdiagnosed as thoracic outlet syndrome or carpal tunnel syndrome.

    Scalene muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

    • Thoracic outlet syndrome
    • C4 C5 C6 C7 or C8 radiculopathy
    • Subacromial tendinitis
    • Bicipital tendinitis
    • Subacromial tendinitis
    • Lateral epicondylitis
    • Tennis Elbow
    • Spasmodic torticollis (Wryneck syndrome)
    • Carpal tunnel syndrome
    • Costoclavicular syndrome (Cervical rib syndrome)


    Other muscles that should be considered and examined in conjunction with the scalenes:

     Satellite trigger points associated with the scalene muscles:

    If you find trigger points in the scalene muscles you will want to check these muscles for additional trigger points.
    • Sternocleidomastoid
    • Pectoralis major
    • Pectoralis minor
    • Levator scapulae
    • Trapezius
    • Splenius capitis
    • Triceps Brachii

    TWD Recommends

    Doctors and physical therapists often recommend TENS to relax muscles and ease pain. The Belifu TENS Unit Muscle Stimulator is highly recommended and a great choice for treating neck, shoulder, and arm pain.