Those naughty Scalenes

If there is one muscle group that must be evaluated in every case of hand and arm pain, it is the group of three neck muscles called the Scalenes.  Taking a look at the areas of referred pain (shaded in red below) from trigger points in this muscle group, we see that the entire length of the arm from the shoulder down into the fingers can be affected.  Also, notice the extremely common area of pain that brings many patients into the office – right between the shoulder blade and the spine!

Even more significant, the major nerves and arteries that run down your arm pass through a small opening between the Scalenes.  When the Scalenes are tight and shortened, there is a risk of compressing those nerves and impairing blood flow to your arm and hand.  Conditions such as Thoracic Outlet Syndrome and Carpal Tunnel Syndrome can be directly caused or contributed to by this Scalene compression.  The ability of the Scalenes to trap and compress nerves and blood vessels led Dr. Janet Travell (physician to JFK) to give them the nickname, “The Entrappers.”
If you experience tightness or pain in any of the shaded referred pain areas, you have swelling in your hands, and/ or you experience any numbness or tingling in your hands and arms, please perform the following quick tests and self-care tips below to identify possible trigger points and myofascial dysfunction in your Scalenes.*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.

(3) Quick Self-Tests to Tell if You have Trigger Points in Your Scalenes:

Follow the instructions below to test whether myfoscial trigger points in your Scalenes might be causing your hand and arm symptoms.

TEST 1:  Scalene Finger Flexion 

While seated or standing, raise your arm to 90 degrees with your elbow also bent to 90 degrees (as shown).  Fold your fingers down so that the pads of your fingers touch your hand.  Make sure the wrist and fingers are straight. A Passing result is if all the fingers touch the hand.

A  Not Passing result is if one or more fingers cannot reach the hand (keeping wrist and fingers straight), indicating trigger points in the Scalenes.

TEST 2:  Lateral Flexion

 PASS                                      NOT PASSING

Standing or sitting upright, tilt your head to the side (lateral flexion) as far as you are able without straining or causing pain.  Do not elevate the shoulder while performing this test.  A Passing result is when the head tilts to the side without pain far enough so that the ear is almost touching the shoulder (over 45 degrees of lateral flexion, as shown).  A Not Passing result occurs when the head is unable to tilt at least 45 degrees or there is pain on lateral flexion.

TEST 3:  Scalene Palpation

As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points in your Scalene muscle group.

The Scalenes can be palpated on the sides of the neck, in the space just in front of the bony vertebra and just behind the thick SCM muscle. Press two fingers into this space and feel for tender points and taut bands of muscle tissue.  Press gently to tolerance.  Start at the base of the neck near your collar bone and proceed up to just below the ear, as indicated by the green line.

Simple Self-Care Remedies

Here are simple self-care tips for relieving myofascial pain and dysfunction in your Scalenes:

Step 1:  Warming Up with Moist Heat

To relax and warm up the fibers of the Scalenes, take a warm bath or place moist heat such as a Fomentek bag over the front and sides of your neck for 10-15 minutes.
Step 2:  Compression

Click here to view larger imagePositioning your chosen self-care tool as shown, cover the entire length of the Scalenes, looking for taut bands and tender spots.  When you find a tender spot, press into the muscle to pain tolerance (“good pain” – not pain that is sharp or makes you want to withdraw).  Hold for 10 seconds while completing at least two full breaths in and out.  Then continue searching for more tender spots until the entire Scalenes muscle group is covered.

Step 3:  Stretching the ScalenesThe best stretch for the Scalenes is similar to the Lateral Flexion test we just performed above, only with 2 added steps.

Using a stretching strap or jump rope, step on one section of the rope and hold the other end with your hand so that the rope is taut (as Shown).  You should feel a gentle pull on your shoulder down toward the floor.

Now, tilt your head toward the opposite shoulder, as you did in the Lateral Flexion test.  Gently rest your opposite hand on the top of your head and stretch gently down toward the shoulder a little further.  Hold this stretch for 20 seconds to tolerance.  Repeat 3 times and alternate to the other side.

Perpetuating Factors:  One of the major perpetuating factors that causes trigger points to return in the Scalenes is improper breathing, which we will be covering in upcoming issues.  So keep up your reading … and your self-care, of course!

Looking for another team member

Healing Hands would like to add another experienced therapeutic massage therapist to their team. The position would be that of a full time, independent contractor. Pay is commiserate with experience and repeat clientele. If you, or someone you know, are interested or are looking for a room to rent, please contact us. Energy workers need not apply.


We look forward to meeting you.

Introducing . . .

Natalie head shotNatalie Slaven!

We are so excited to welcome Natalie to the Healing Hands Therapeutic Massage team. Natalie is a highly qualified, talented massage therapist specializing in Neuromuscular Therapy (NMT).

Hi, I’m Natalie. I am a WI state licensed and nationally certified massage therapist in Cedarburg, WI. I graduated from Lakeside School of Massage Therapy in Milwaukee in 2006. Over the years I have come to believe in massaging with intent.  With intention and purpose I am able to connect on a physical, mental, and emotional level needed to achieve maximum benefits. Massage is a holistic therapy meant to minister to body, mind, and spirit.  It is very rewarding to see physical and mental transformations just by using a safe and effective touch!  Massage can decrease pain, tension and improve quality of life. Whether your goals are to help with stress, pain, or just to relax, I can help!


Click here to schedule an appointment with Natalie today.


Massage and Shoulder Dysfunction

The following is an excerpt taken from the November 2016 Massage Therapy Journal written by Christian Bond.


Whether you pull a muscle, have an overuse injury or strain, or are dealing with any number of issues, one thing typically remains true: You never really understand how much you use your shoulder, hip or knee until you’re dealing with chronic pain or injury.shoulder

Shoulder injuries and strains are common for many people, and according to George Russell, a massage therapist and chiropractor in New York City, massage therapy can be ideal for helping those who suffer from shoulder dysfunction.

Anatomy and Structure

The rotator cuff consists of four muscles— supraspinatus, infraspinatus, teres minor and subscapularis—whose fibers emerge directly from all over the shoulder blade and converge on the humeral head. These muscles are called a cuff because they attach like a cuff to the very outer top of the humerus. “Picture an epaulet on a military jacket,” Russell suggests. When contracted, these same muscles rotate the humerus, which is why the group of muscles is called the “rotator cuff.”

But that’s not all they do, and “rotator” may not even describe their primary function. “It’s true they move the humerus in various ways, especially rotation,” Russell says. “But kinesiology reveals the rotator cuff’s real function—to snug the humeral head into the middle of its shallow socket on the outside of the shoulder blade, no matter where the arm moves in space.”

Like a mortar and pestle, the shoulder joint (like any ball-and-socket joint) functions through roll and glide. When you lift your elbow over your head, the humeral head rolls up in the socket and would roll out and hit the acromion if there weren’t an equal and opposite glide down in the socket. The opposing glide is what keeps the joint from harm, and that glide is the job of the rotator cuff. “The rotator cuff muscles come off almost every surface of the scapula— front, back and top,” explains Russell. “That pattern of attachment suggests that the scapula is the stable end of the muscles and the ‘cuff’ all around the outer top of the humerus is what is moved—in whatever way glides the humeral head to the center of the glenoid fossa.” Think, for example, of a professional baseball player pitching a fastball: The rotator cuff is what keeps his arm from flying over home plate with the baseball. “When Masahiro Tanaka throws his fastball, the rotator cuff pulls the humeral head backward and toward his scapula, gliding the humeral head back into the center of the socket where it belongs,” Russell says.

Common Injuries

Instead of starting by releasing spasm and tightness in the rotator cuff, consider the shoulder joint itself as a whole. “In my opinion, all of the common injuries of the shoulder result from shoulder joint misalignment,” Russell says. “The rotator cuff becomes damaged when it tries its hardest—but fails—to glide the humeral head to the center of the socket.” Following are some of the most common shoulder injuries.

A SLAP tear (superior labral tear from anterior to posterior) is a tear of the superior labrum and, often, the long head of the biceps. The labrum is a ring of cartilage that deepens the socket for more controlled movement. In a SLAP tear, the bone rolls up to move the whole arm up in space, but for some reason, the rotator cuff fails to counter the force of that movement so there’s equal glide back into the socket. The labrum is the next line of defense, and it should act like a guardrail on a highway, bouncing the ball back into the socket. “But you can only drive so long against a guardrail before it gives,” Russell explains. Sooner or later, the humeral head will breach the labrum, and it almost always starts at the top and front of the joint, where the ligamentous and joint capsule protection is the least and where the human arm tends to go.

Acromial impingement, shoulder bursitis, and supraspinatus or other rotator cuff muscle tendonitis/tear.  All of these injuries have to do with the failure of downward/backward glide, which is also a failure of all the rotator cuff muscles. “Powered by the deltoid, the humerus rolls up to bring the arm overhead,” Russell explains. “If the rotator cuff cannot or does not glide the ball down into the glenoid fossa, the bone eventually hits the acromion, which sits above the humeral head like a carport above a car.” Damage to any structure from the humeral
head to the acromion can result. Eventually, one can expect arthritis as well, since a poorly seated joint doesn’t allow the cartilage surfaces to stay against one another and to be nourished by the joint fluid.

Who Gets Rotator Cuff Injuries

As might be expected, Russell explains, anyone whose work requires that they have their hands above their heads for long periods of time are prone to rotator cuff injuries. “The rotator cuff is ‘white meat’ muscle. It has no myoglobin, so it can’t burn glucose for energy. It’s like it’s on battery power (glycogen),” he says. “When the battery runs out, the liver needs a half hour to recharge the battery, so if you’re going past that deadline again and again, you’ll get overuse syndromes and fascial adhesions.”

Athletes who throw, too, are more likely to have rotator cuff problems because the rotator cuff is the structure that decelerates the arm once you’ve let go of what you’re throwing. “To throw with any power, you usually rotate your body,” Russell adds. “This means that the rotator cuff often has to work around a corner or at some odd angle because the shoulder blade is very protracted and the ribcage is rotated as well.”

Russell also notes that swimmers are at risk for shoulder problems because of the big range of motion they take their arms through against the resistance of the water, while also rotating their neck and ribcage. “It’s a complex task,” Russell says, “and can lead to rotator cuff strain, especially in the subscapularis, which stabilizes while it also assists internal rotation of the arm as you push the water back with the arm.”

Sciatic Pain? Maybe Not

The following is an article by Dr. Jordan Metzl  published November 5, 2015 on the Triathlete-Europe website. The article is targeting individuals who lead a very active, even aggressively athletic lifestyle. However, Piriformis Syndrome can affect anyone, at any time. I hope you find the information helpful. If, after reading this short article, you think you may be suffering from Piriformis Syndrome, it is important to know that massage therapy has proven highly effective as a form of treatment for this painful condition. Please click here for an appointment so we can begin a program to bring you relief today.


Piriformis Syndrome Treatment, Prevention

  • By Dr. Jordan Metzl
  • Published November 5, 2015

The Symptoms

Pain in the lower back and/or buttocks, sometimes feeling as if it’s deep inside the buttock muscles. It may be too painful to sit on the affected buttock. The pain and/or tingling can radiate down the backs of the legs as well.

What’s Going On In There?

The piriformis muscle runs behind the hip joint and aids in external hip rotation, or turning your leg outward. The catch here is that the piriformis crosses over the sciatic nerve. The piriformis muscle can become tight from, for example, too much sitting (a problem many working people can relate to). The muscle can also be strained by spasm or overuse. In piriformis syndrome, this tightness or spasm causes the muscle to compress and irritate the sciatic nerve. This brings on lower-back and buttock pain, sometimes severe. The diagnosis is tricky because piriformis syndrome can very easily be confused with sciatica.

The difference between these diagnoses is that traditional sciatica is generally caused by some spinal issue, like a compressed lumbar disc. Piriformis syndrome becomes the go-to diagnosis when sciatica is present with no discernible spinal cause.

Runners, cyclists and rowers are the athletes most at risk for piriformis syndrome. They engage in pure forward movement, which can weaken hip adductors and abductors, the muscles that allow us to open and close our legs. Throw in some weak glutes, and all those poorly conditioned muscles put extra strain on the piriformis. And you’ve got a painful problem.

Another risk for runners: Overpronating (when your foot turns inward) can cause the knee to rotate on impact. The piriformis fires to help prevent the knee from rotating too much, which can lead to overuse and tightening of the muscle.

Headaches and massage

Do you have frequent headaches? Think you’re stuck with them? Well, the  links below will take you to a number of Headachresources that indicate that massage therapy is very helpful in alleviating and even, possibly, preventing headaches.

If you experience constant headache pain or suffer from occasional tension headaches, I would encourage you to make an appointment by clicking here and I will do my best to bring you relief. But definitely check out the links below.

Types of headaches

Holding Headaches at Bay

Massage Can Be Effective for Tension Headaches

Massage Brings Relief  to People Suffering from Headaches