Massage & Bodywork

January/February 2011

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MYOFASCIAL TECHNIQUES (left): The nerves of the brachial plexus (yellow) pass between the anterior and medial scalenes. (middle): Neck rotation can "scissor" the brachial plexus and artery in the narrowing space between the scalenes. (above): Compression of the brachial plexus by the scalenes or other structures can result in tingling, numbness, or weakness in the ulnar nerve distribution area (yellow). Images 5 and 6 courtesy Advanced- Image 7 courtesy Primal Pictures. Used with permission. a result of both their upper and lower attachments now being posterior to the articulations they affect, making it impossible for the scalenes to counterbalance the lack of length in the posterior neck (Image 4). Shortness in the scalenes will thus perpetuate and reinforce the cervical lordosis. The scalenes are involved in other conditions as well: • Scalenes are often injured in whiplash injuries, especially when lateral forces are involved. (Although working the scalenes can dramatically aid recovery from whiplash, massage is most appropriate with "cold" whiplash— fixed, chronic, older injuries. Direct work on the scalenes can aggravate whiplash symptoms when applied too soon after an injury, too aggressively, or in the presence of "hot" whiplash signs (muscular spasm, autonomic activation, instability, or guarding).1 • Because the scalenes also aid in forced inspiration by lifting the first two ribs, they are often chronically shortened when there are respiratory issues, such as asthma. • The scalenes stabilize the base of the neck against the asymmetrical forces of being right- or left-handed. For this reason, people who habitually use their dominant hand to apply force (such as manual therapists), will have scalenes that are often significantly tighter on the side opposite the dominant hand. • The deep pleural ligaments (Image 5: transversopleural, vertebropleural, and not pictured, costopleural) are fibrous bands that anchor the endothoracic fascia around the lungs to C7, T1, and the first rib. Lying deep to the scalenes and roughly parallel to their oblique arrangement, the pleural ligaments can have effects similar to the scalenes on the alignment and mobility of the base of the neck. • Because the nerves of the brachial plexus pass between the anterior and the medial scalenes, crowding here can exacerbate symptoms of neurovascular compression (such as thoracic outlet syndrome). Working the scalenes is indicated when there is numbness or tingling in the ulnar nerve distribution area (the small and ring fingers and medial hand, Image 7), especially when symptoms worsen with forced inhalation (which engages the scalenes) or neck rotation (which scissors the brachial plexus between the anterior and medial scalenes, Image 6). ANTERIOR SCALENE TECHNIQUE These are all good reasons to include scalenes whenever you address the neck. However, working them directly 110 massage & bodywork january/february 2011 can be tricky. The scalenes are often more contracted and denser than the tissues around them. (Researcher V. Janda classifies the scalenes as "tonic" muscles, meaning that when stressed they are prone to tightness rather than weakness, which may explain why they're so often contracted.)2 The scalenes also lie close to the sensitive nerves of the brachial plexus (Image 5). This combination of hardness and proximity to nerves makes it difficult to use any degree of pressure or sliding without causing referred nerve pain. However, if we avoid sliding on them, and first slacken the scalenes by approximating their attachments, we can address them more comfortably and at much deeper levels. To accomplish this, begin by cradling your client's head in one hand (Image 8). With the other hand, use the broad touch of several finger pads together to feel for the hard, longitudinally angled bellies of the anterior and medial scalenes, just above the clavicle and deep to the sternocleidomastoid. The hardest structure you feel here that isn't bone is usually the anterior scalene. Now lift the head, gently flexing the neck around the static fulcrum of your other hand. You'll feel the

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