Scalene Muscles: Heal your Scalene Muscles and 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.
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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: 1 day ago

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 scalene muscles is vital to understanding your neck and jaw pain. Awareness of your scalene muscles is vital in understanding your upper thoracic spine pain, rib pain, and shoulder pain.


The shape of your cervical spine is greatly influenced by the scalene muscles. The scalene muscles have attachments to the neck and to the upper ribs, and so their pull influences the shape of your rib cage, your pelvis, and everything on down.


Studies show that the way the teeth touch will influence body mechanics lower down the chain—all the way to the feet! I am a big believer in receiving direct manual therapy to the jaw, even when it’s “just the neck” that hurts. Restoring the jaw and shape of the cervical spine will help correct your posture and pain signals throughout your mind-body. And of course, some dysfunction begins in the feet, the lower legs, the femurs, and the hips. You will want to notice your relationship with each part of yourself: your feet, your hips, and your rib cage, and bring healing and muscle balance directly to those structures.


The scalene muscles flex the neck, which means they draw the chin towards the chest. And the scalene muscles are neck stabilizers. When they are chronically tight, they chronically draw the neck forward, and they cannot stabilize and protect the neck, head, and jaw the way they are designed to do. Hypertonic muscles exhibit excessive chronic tension, and when that happens to the scalene muscles, they become hard and compress nervous and vascular tissue.


The sternocleidomastoid muscle, a superficial muscle located in front of the scalenes, experiences stress from the same types of input—forward head posture, hinging at the neck and jetting the chin forward, straining the neck during fitness, and thoracic kyphosis.


In my opinion, the scalene's "lock down" and create a tough environment for the sternocleidomastoid. Healing the sternocleidomastoid—and all of this muscles crazy symptoms—will not be possible if the scalene muscles are not healing.


Side note: the sternocleidomastoid is an extremely important and fascinating muscle.

Learn important details and the symptoms of sternocleidomastoid dysfunction HERE and check out the sternocleidomastoid trigger points post HERE


When the neck moves forward, the shoulders round inward, affecting the ribcage and spine. Conversely, if you develop a pattern of drawing the clavicles in—something that often has a heart-protective and emotional component—your neck has no choice but to lean forward. Healing your neck means working with your rib cage, your clavicles, and your diaphragm.


More on breathing and the scalanes muscles later!



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. The scalanes muscles are 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 or tight and tense, neck muscles: anterior scalene, middle scalene, and posterior scalene. Your scalene muscles are dorsal (behind) the sternocleidomastoid muscle (SCM for short).



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 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!!!


  • A diaphragm that is not descending with each breath


  • 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 dysfunction


  • Pelvic floor dysfunction


  • Compensation from a disrupted structure below. The feet affect the knee, which affect the hip, and eveything on up. Check out my post on overpronation HERE (COMING SOON) and dorsiflexion HERE (COMING SOON).



Even if you have known foot or hip problems, the neck will still experience its own dysfunction. Yes, the feet can be the start of a chain reaction, but you are more likely to feel knee pain from a disrupted foot rather than neck pain. The neck needs thought of as part of your entire structure, and we must realize that the neck has developed its own patterns from computers and other types of input. If you have neck pain, or a cervical spine that has lost its shape, you must therapeutically work directly with the neck. 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 and trigger points are heightened areas of electrical activity. These points can hurt locally, right where they are located, but they often refer pain to other parts of the body. Based on the variance within 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 manual massage therapy session, but has not yet felt the referral pain—or at least it hasn’t significantly bothered them—during their day-to-day life. Trigger points can develop, and you may not feel them at first or when not being touched.


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 constantly after such an event. A load-bearing activity could mean carrying a child or looking down while chopping sweet potatoes.


It is common to worry about pain in the hand or shoulder, but have the root of the pain be coming from the neck. This can be because of nerve compression, but it is often because of referral pain from trigger points. Pain signals change based on activity and the length of the dysfunction.


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


Imaging techniques do not detect soft tissue dysfunction, like trigger points. But qualified soft tissue providers, such as manual massage therapist feel them and aid your mind-body in healing them.

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 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 or Surronding 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 upper trapezius muscles when these muscles are causing pain because they are overworked. They 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. Forcing the upper trapezius muscles into a sudden state of relaxation will leave the tight scalene muscles unchecked. The upper trapezius muscles need relief through holistic input: you work on the anterior neck muscles, you stop the chronic pull forward that the trapezius muscles are fighting against. You strengthen the lower trapezius muscle and provide the input needed to change the anterior neck muscles, your ribcage, your diaphragm, and your overall posture. 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 are 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 and as a learned daily behavior —heals the scalene muscles. As you move from one activity to the next, you must notice how you are breathing. During the day you 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 they are tight and being overworked.


Long-term health and healing requires the help of direct physical touch manual therapy and your own healing movements, breathing, and fitness routines.



Consider the following when seeking healing to the scalenes muscles:


  • Gently and consistently explore scalene muscle stretches. Access a post about stretching the scalene muscles HERE






  • Passive Reclined Bound Angle Pose is a restorative yoga pose using a bolster. A chest and clavicle opener. The head is supported but slightly extended off of the bolster. Usually this is shown online with a straight neck but I suggest keeping the neck supported but allowing the neck to take on a slight cervical curve shape.


When I was young, I used active yoga Fish Pose to heal my neck. This pose is great at strengthening the deep anterior neck flexors! Access a post about yoga for anterior neck health HERE






  • Important: strengthen your deep anterior flexor muscles. Strengthening these muscles can be 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. What I tell women in my practice is that these muscles will also strengthen themselves as function and organic, safe movement is restored to the neck. This happens by working on the other muscles and fascia within the cervical sleeve.


Chin tucks, the most common exercise given in PT offices for neck pain, often make women feel worse. This is especially true if you have dysfunction in the first two vertebrae.



  • 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!






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




  • Have your hips checked and rib cage checked for proper function and alignment




  • Replace your current pillow. No specific advice here but people often think that their pillow is not hurting them...until they change their pillow.




  • Develop a better relationship with breathing! To get a full breath in, 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 quickly, 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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