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Scalene Muscles: Heal your Scalene Muscles, Heal your Life! Understand the Root of your Neck Pain, TMJ and Jaw Pain, Rib Pain, and Shoulder Pain. Scalene Trigger Points, Healing Tips, and More.

Updated: Aug 15

An anatomical drawing showing the three scalene muscles on each side of the neck. The scalene muscles attach to the cervical vertebrae and the first and second ribs. They elevate the ribs, compress the neck, and can create severe chronic pain.
Dysfunctional scalene muscles create wide spread symptoms that include: headaches, migraines, TMJ and jaw pain, rib pain, chest pain, neck pain, and even pain across the shoulder, down the arm and into the fingers.

Understanding the function of the scalene muscles is vital to understanding your neck and jaw pain. It can also be vital in understanding your upper thoracic spine pain, rib pain, and shoulder pain.


Your cervical spine’s shape, determined in-part by the anterior scalene muscles, influences the shape of your rib cage, pelvis, and the rest of your body.


Studies show that even the way the teeth touch will influence mechanics lower down the chain. And whereas influencing the jaw and cervical spine will help correct both posture and pain signals throughout the body, you will want to notice your feet, your hips, and your rib cage, and bring healing and muscle balance directly to those structures as well.


Below is a list of the muscles’ origins and insertion points, so you know exactly where they are located. You have three scalene muscles on each side of your neck. You have a unit of three muscles connected to your cervical spine and upper ribs, and this repeats bilaterally (on both sides of the neck). Two sets of three, six total, strong and stabilizing, tight and tense, neck muscles: anterior scalene, middle scalene, and posterior scalene.


Your scalene muscles are dorsal (behind) the SCM (sternocleidomastoid) muscle. The SCM is another important, strong, and—thanks to forward head posture—unbalanced hypertense muscle. Check out my article on the SCM HERE (coming soon!)


A drawing of one woman—shown three times—placing her hand in various places on her head, neck, and jaw, and shoulder. This woman likely suffers from chronic pain stemming from neck dysfunction and tight and tense scalene muscles.

Not only do tight scalene muscles cause acute pain, but over time they lead to degenerative changes in the spine.

What happens when the scalene muscles are tight and tense, or even hypertonic to the point of feeling hard and painful?


Indications of dysfunction in the scalene muscles range and include:


Headaches


Migraines


Limited range of motion of the cervical spine


Chronic neck pain


Rib pain and chest pain


TMJ and jaw pain


Positional asymmetry


Neurovascular compression


Coldness of the fingers


Pain and tingling down the fingers, especially in the pinky, ring, and partial middle finger. Nerve pain and tingling can vary based on individual anatomy.


Forward head posture


Rounded forward shoulders


The lower neck stuck in flexion, creating dysfunction in the upper cervical spine


Dowagers—kyphotic thoracic curvature


Shallow breathing because of ribcage stress


Whiplash events


Trigger point and referred pain


Pain by the shoulder blades, across the shoulder and down the arm


Issues surrounding balance and control because of forward head posture


Scapular upward rotation


Disc degeneration and bone spurs


Asthma and respiratory issues create hard and tight scalene muscles (See my Anatomy of a Cough post HERE)


Contributes to anterior neck and throat tension, ear pain and fullness, and more


The image shows a woman sleeping in an eye mask, lying on her back with her neck raised on a large pillow. The front of the neck and the scalene muscles are in a shortened, tight position. Sleeping on a large pillow hurts the neck and jaw and causes widespread chronic pain.
This image shows a woman sleeping in a way that is hurting her neck, TMJ, ribs, and shoulders. Scalene muscles should not be placed in a shorted position while sleeping.

What creates tight and tense scalene muscles?


Shallow breathing strains and overworks the scalene muscles!!! Notice all the exclamation points!!!


Emotions such as anxiety can cycle with strained scalene muscles


Heavy lifting with disrupted mechanics


Sleeping with the neck strained upward on a pillow that is too large. A flexed position while sleeping.


“Slouched” position while standing


Looking down at the phone, computer, keyboard, art, or other head-hanging activity


Looking and reaching forward (and down) with the chin, head, and neck when on the computer or connecting with others


A whiplash event


Respiratory illness


Panic attacks


Diaphragm and psoas Dysfucntion


Pelvic Floor Dysfunction


Compensation from a disrupted structure below. Even with foot or hip problems, the neck will still experience its own dysfunction (always treat the neck!).

The image is an abstract representation of a trigger point. It is a digital image of a circle in pink. Trigger points can feel round, or feel like small bundles. Trigger points cause local and referred pain.
Clinicians often describe trigger points as feeling like a circle or pea-sized bundle. Other times, the trigger point will be multiple painful spots all in the same area. When doing bodywork, I perceive trigger points as having edges that are connected together.

Trigger Points in the Scalene Muscles


Muscles have trigger points, heightened areas of electrical activity. These points can hurt locally, where they are, but they often refer pain to other parts of the body. Based on the variance within an individual’s soft tissue, these patterns are not always exact but they are mainly predictable and always recognizable.


There are four known trigger points on the scalene muscles. These points refer pain from the lower neck, across the shoulder and back of the shoulder, the rhomboids near the spine, into the chest, down the thumb side of the arm, into the thumb and pointer finger, and into the palm.


Sometimes, someone feels a trigger point when touched during a session, but has not yet felt the referral pain—or at least it hasn’t significantly bothered them—during thier day-to-day life. Pain signals change based on activity and the length of the dysfunction. Someone may have trigger point pain in the back of the shoulder between the spine and scapula, but after a load-bearing activity with the head looking down, they will have an increase in pain down the arm. They may feel the trigger points after such an event.


If you have concerns about a disrupted joint space causing arm pain, you should get it evaluated, and avoid unnecessary worry. But know that trigger points are powerful, and they are signals that your mind-body is asking for help through physical medicine, breathing, proper mechanics, and proper fitness.

The image is grey and white and shows syringes in a pattern. The syringe represents Botox. The generous distribution of Botox is inappropriate and does not heal.
Botox destabilizes. Manual therapists, chiropractors, and others do hands-on medicine. Hands-on medicine mixed with proper breathing, movement, and fitness actually creates balance and heals. When you truly reshape and heal one muscle, you reshape and heal another muscle. When you heal your nervous system by noticing your body’s pain signals and holistically responding, you heal not just one muscle but other muscles—all muscles. Holistic therapy that uses the intelligence of your own mind-body is what you need for long-term health and wellness.

Should I Botox these Muscles?


NO.


Botox does not create joint stability.


Injection culture has caused an untold amount of pain and confusion. Your body is compensating for something—and it is telling you that. When we inject muscles, we are not fixing the structure or the reason. Instead—often—we simply silence the messenger of pain and create an even worse problem/pattern.


If you are diagnosed with a myofascial pain syndrome, and experiencing a severe flare-up needing immediate help, address your immediate needs and then return to mindfulness and physical medicine. This blog post can not speak directly to your needs and there is no judgement.


But know this: it is because we have a medical culture that is not trained to deal with muscle pain, neuromuscular imbalances, and pain signals that women of a variety of medical backgrounds are at risk for heightened acute pain and chronic pain. Modern medicine is life-saving but has not been part of the physical medicine conversation. There is so much more than what we have been offered!


And please realize, and this is so important, doctors often inject painful trapezius muscles when those muscles are doing their best to protect you from your forward head posture. They do not need to be triggered to “loosen up,”through a Botox injection. They need relief through your providing the input that changes the front neck muscles. When you Botox your hurting trapezius muscle, further destabilization is imminent.


To heal your neck, TMJ, jaw, and shoulder pain, please seek individual advice from practitioners educated to help you use your own body to create healing, health, and wellness.

Anatomy of the Scalenes

Before we talk about how to assist your scalene muscles, let's clearly define where they are.


Listed is the muscles origin and insertion. The origin of a muscle remains fixed during the action/contraction of the muscle and is located closer to the midline—the center—of the body. The insertion of the muscle is a more distal point—away from the midline of the body—and is on the bone that moves under the action of the muscle.


Do not get overwhelmed by the technical description. Keep it simple and notice the parts highlighted in pink. Remember when looking at the function of the muscle, that you have one of these muscles on each side of the front of your neck.

Anterior Scalenes


Origin of Anterior Scalene

Anterior tubercles of the transverse processes of C3-C6


Insertion of Anterior Scalenes

Scalene tubercle of first rib, the superior border of the rib just above the subclavian groove.


Function of Anterior Scalene's muscle

When it bilaterally contracts (both muscles on both side of the neck contract) you produce neck flexion.


Intentional bilateral neck flexion pulls your chin down towards your chest.


When it contracts unilaterally (one side mainly contracts) there is lateral neck flexion (the neck bends to the same side. Think same ear to same shoulder of the side that the muscle contracts on). And there is contralateral rotation (the head rotates to the opposite side that is mainly controlling the contraction. Think the left muscle contracts and guides the head as it turns to the right. Your head rotates and your eyes look over your shoulder.)


Intentional unilateral contraction either assists in side bending or rotating the head.


When this muscle contracts it elevates the first rib.

Middle Scalene


Origin of Middle Scalenes

Posterior tubercles of the transverse processes of C3-C7.  It is located dorsal (behind) the anterior scalenes..


Insertion of Middle Scalenes

Superior border of the first rib, behind the groove for the subclavian.


Function of Middle Scalene Muscle


Assists in lateral neck flexion (lateral flexion assists in bending the ear towards the shoulder on the same side that is contracting).


When this muscle contracts it elevates the first rib.



Posterior Scalene


Origin of Posterior Scalene

Posterior tubercles of the transverse process of C4-C-7.


Insertion of Posterior Scalene

External surface of the second rib.


Function of Posterior Scalenes Muscle


Assists in lateral neck flexion (lateral flexion assists in bending the ear towards the shoulder on the same side that is contracting).


When this muscle contracts it elevates the second rib.

The image is a digital drawing of a woman sitting in a meditation pose. The image has a pink filter on it, and there are flowers rising above her. Mindful breathing heals the scalene muscles.
Mindful breathing as an intentional practice aids in healing scalene muscles. You must also notice how you are breathing during the day as you move from one activity to the next. Pause. Check in. Breathing slowly gives your scalene muscles a break!

Healing the Scalene Muscles


A short list of ways to heal:


Anything that aids your posture will aid your scalene muscles. When your head is hanging forward, some muscles become weak and others work overtime. Some muscles are both weak and tight and tense. Muscles will send pain signals when they are weak. Muscles will send pain signals when you are overworking them. Long-term health and healing requires the help of direct manual therapy and physical medicine and your own healing movements, breathing, and fitness routines.


1) Explore scalene and SCM stretches.


Access a post about stretching the scalene muscles HERE




2) Passive Reclined Bound Angle Pose. A restorative yoga pose using a bolster. A chest open. Head is supported but slightly extended/back off of the bolster. Usually this is shown online with a straight neck but I suggest supported and gently extended.


Active yoga Fish Pose. This pose is great at strengthening the deep anterior neck flexors! Access a post about yoga for anterior neck health HERE




3) Strengthen your deep anterior flexor muscles. Strengthening these is important, but what is overwhelming ignored is the fact that the deep anterior neck muscles can also be tight and tense and need manual release



4) Gentle tractioning of the cervical spine in extension (no harsh pull needed). Here is a link to the cheap device that women tend to like (when they use it!). Start gently and for short periods of time!




5) Manual therapy of the scalene muscles. While various techniques exist, direct therapy should be applied to the front muscles—deep and superficial muscles—of your neck. To heal your anterior neck muscles, including those that support the tongue (those are not mentioned in this post), you may need direct hands-on manual release. Just consider that as you seek healing


6) Have your hips checked and rib cage checked for proper function and alignment


7) Replace your current pillow


8) Develop a better relationship with breathing! The scalene muscles elevate the ribcage. Allow your neck muscles to rest by breathing deeply and slowly. Quick breaths require your scalene muscles to work, elevating the top ribs double time! Breathing post coming soon!


If you are having trouble breathing deep and slow into your low belly, side, ribs, low belly, and pelvic floor, notice where you have restrictions. Connecting to your pelvic floor will greatly improve your relationship with your neck



Heal your Scalenes Heal your Life?

Not only will healing your scalene muscles create long-term health in your neck and shoulders, but practicing breathing for scalene health will revolutionize your entire being!


Want to Know More?


I have more posts coming soon,. Stay tuned!


Check out my books on health and wellness!



This is the cover to The Elemental Woman book. A book on Ayurveda focused on women's health.

The Elemental Woman

A Conversation for the Modern Western Woman Inspired by the Healing Wisdom of the Ancient Eastern Sage


This shows the cover of Food & Mood Journal. A mindfulness journal for women's health to connect emotions and food.

Food & Mood Journal

 A tracking guide to connect the food you eat, the emotions you feel, and increase the feeling of deep self-love



This imagine show the cover of the Mindful Movement Journal. A mindfulness journal for women's health that connects emotions and movement and fitness.

Mindful Movement Journal

 A tracking guide to connect the motions you make, the emotions you feel, and increase the feeling of deep self-love



This image shows the cover of Basic Ayurveda. This is a hard cover women's health book that is a colorful refine guide to the main The Elemental Woman book. The Elemental Woman is a women's health book.

Basic Ayurveda 

The Elemental Woman Supplement Guide






About the author:

Since 2004, Tara Lee Clasen has been assisting women on their healing adventures. As a woman-focused physical medicine provider, also trained in Eastern medicine, she knows transformation is possible and knows that with reflection and self-love, your future is full of bright possibilities.


 
 
 

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