Massage & Bodywork

May/June 2012

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education PATHOLOGY PERSPECTIVES | BODY AWARENESS | FUNCTIONAL ANATOMY | SOMATIC RESEARCH Scalenes By Christy Cael The scalenes are located relatively deep in the lateral neck between the mastoid process and clavicle. A window to these muscles is found between the anterior edge of the upper trapezius and the posterior border of the sternocleidomastoid. This is the posterior triangle, a distinct area of caution in the anterior neck that contains the vertebral artery, jugular vein, brachial plexus, and a network of lymph nodes. The location can make the scalene muscles difficult to access and manually treat. The scalenes consist of three parts: anterior, middle, and posterior. Each portion has vertically oriented attachments on the cervical transverse processes, then spreads horizontally prior to inserting on the ribs. This dispersion of insertions resembles the sides of a tent and offers broad range of motion and strong lateral stabilization of the head and neck. The scalenes work with the upper trapezius, sternocleidomastoid, splenius capitis and cervicis, and levator scapulae to laterally flex, rotate, and stabilize the head and neck. Because the anterior scalenes wrap around the front of the neck, they are able to assist the sternocleidomastoid and deep anterior neck muscles with flexion. The scalenes also elevate the first and second rib during inhalation. This action increases space in the thoracic cavity, prompting greater inflow of air to the lungs. The diaphragm is responsible for normal, relaxed breathing, but other muscles like the scalenes, intercostals, pectoralis major and minor, serratus posterior, and quadratus lumborum assist to expand the rib cage when greater effort is required. This is common with heavy exercise, smoking, or respiratory pathology such as asthma or chronic obstructive pulmonary disease. Excessive tension in the scalenes can lead to limited cervical mobility, postural deviations, shallow or dysfunctional breathing, and compression of associated structures, such as the brachial plexus or subclavian artery. This compressive pathology is called thoracic outlet syndrome and can be experienced as pain, weakness, numbness, or a sensation of heaviness or fullness in the affected arm. Clients with these issues may benefit from lengthening and improved soft-tissue mobility in the scalenes. 1 2 3 4 5 6 7 scalene anterior middle posterior SCALENES Attachments • Origin: Transverse processes of C3–6 (anterior), C2–7 (middle), and C5–7 (posterior) • Insertion: Upper edge of first rib (anterior and middle) and lateral surface of second rib (posterior) Actions • Flexes the head and neck (bilateral action) • Laterally flexes the head and neck, and rotates to opposite side (unilateral action) • Elevates first and second rib during forced inhalation Innervation • Cervical spinal nerves C6–8 Celebrate ABMP's 25th anniversary and you may win a refund on your membership. 45

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