March 1, 2020

Scalene Variation – Soft Tissue Release


You need short fingernails for this technique.

With your client’s head turned toward you, press your fingertips around the superior part of the clavicle near the sternoclavicular joint, pressing your fingertips in towards the first rib. Pull in an inferior direction and slide your fingers laterally toward the acromioclavicular joint while your client slowly turns their head away from you.

Use your other hand to traction your client’s arm in an inferior direction while doing this technique.

Then have your client inhale then turn their head toward you as they exhale. Repeat the action of hooking around their clavicle and sliding your fingers laterally as they turn.

Scalenus posterior will be stretched when your client turns their head away from you and scalenus anterior will be stretched when they turn their head towards you.

The technique is most effective when done slowly. It is also helpful to have the client inhale, then turn their head as they exhale completely. The scalene muscles raise the upper two ribs when you inhale, so they will be stretched more when you exhale.

This technique is effective, so you do not need to repeat it more than a few times.

Anatomy of the Scalenes

The word scalene comes from the Latin scalenus and means uneven, unequal, or having unequal sides. The three scalene muscles are of unequal lengths. In geometry, a scalene triangle is a triangle with unequal sides.

The scalene muscles are deep muscles in the neck connecting the transverse processes of the cervical vertebrae to the first and second rib. They help to raise the upper two ribs, helping with inspiration.

The brachial plexus (the nerve supply for the upper extremity) passes in between the scalenus anterior and scalenus medius. In some people, there is an anatomical variation in which parts of the brachial plexus may actually pass through scalenus anterior.

The scalene muscles are often strained in whiplash accidents. When the scalene muscles are tight they can put pressure on the nerves to the upper extremity causing Thoracic Outlet Syndrome.

Thoracic Outlet Syndrome

The thoracic outlet is the area in between the clavicle and the upper two ribs. All the nerves and blood vessels for the upper extremity pass through this narrow space. Thoracic outlet syndrome refers to the condition of nerves and blood vessels being impinged in the thoracic outlet area.

Impingement of the brachial plexus may be from tight scalenes, or it may be from pinching between the first rib and clavicle when the scalenes pull the first rib into the clavicle.

Common symptoms of Thoracic Outlet Syndrome (TOS) are:

  • Pain, tingling or numbness down the medial side of the arm going to the 4th & 5th fingers (C8 dermatome).
  • The arm goes to sleep at night or when held overhead.
  • The radial pulse diminishes when the arm is held overhead
Thoracic Outlet Syndrome is often confused with Carpal Tunnel Syndrome, and can cause carpal tunnel symptoms.

When working with nerve entrapment it is important to begin at the proximal ends of the nerves and release any restrictions before working with the more distal areas of entrapment. When there is pain, tingling or numbness into the arm the following areas may be sites of impingement and may be treated in the order shown.

Cervical nerve roots
First Rib
Pectoralis Minor
Bicipital Aponeurosis
Pronator Teres
Flexor Retinaculum

Related Techniques:

Thoracic Outlet Syndrome
Soft Tissue Release – Scalenes
Soft Tissue Release – Pectoralis Minor
Scalene Stretch
Scalenes – Anatomy
First Rib Release
Scalenes – Sidelying

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