Got a pain in the neck? Yep that could be your scalene. Learn how to stretch & strengthen the scalene to relive tension and prevent further pain.

Working for long-hours, sleeping on stomach, carrying heavy backpacks or even excessive coughing can injure scalene (A group of three pairs of muscles in the lateral neck).

This can cause Myofascial Pain Syndrome which is very common. It is described as pain which originates over the neck area and radiates down to the arm causing deep, aching or burning pain.

However, if you’re suffering from any type of neck pain, this article will help you to have more clarity over your condition. We will dive deep into this subject, discovering the anatomy of neck, describing the structure of scalene muscles and how you can actually relief this pain through stretching and exercising.

Without any further ado, let’s get started.


Part of this group are: scalenus anterior, scalenus medius and scalenus posterior. Which simply means the front middle and back scalene muscles.

Sometimes a fourth muscle, the scalenus minimus is present behind the lower portion of the scalenus anterior.

The brachial plexus and subclavian artery pass between the anterior and middle scalenes, while the subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as the muscle crosses over the first rib.

Let’s see them in more details

Anterior scalene

The anterior scalene muscle, lies deeply at the side of the neck, behind the sternocleidomastoid muscle. It arises from the anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth cervical vertebrae, and descending, almost vertically, is inserted by a narrow, flat tendon into the scalene tubercle on the inner border of the first rib, and into the ridge on the upper surface of the second rib in front of the subclavian groove. It is supplied by the anterior ramus of cervical nerve 5 and 6.

Middle scalene

The middle scalene, is the largest and longest of the three scalene muscles. The middle scalene arises from the posterior tubercles of the transverse processes of the lower six cervical vertebrae. It descends along the side of the vertebral column to insert by a broad attachment into the upper surface of the first rib, posterior to the subclavian groove. The brachial plexus and the subclavian artery pass anterior to it. 

Posterior scalene

The posterior scalene, is the smallest and most deeply seated of the scalene muscles.

It arises, by two or three separate tendons, from the posterior tubercles of the transverse processes of the lower two or three cervical vertebrae, and is inserted by a thin tendon into the outer surface of the second rib, behind the attachment of the anterior scalene. It is supplied by cervical nerves C5, C6 and C7. It is occasionally blended with the middle scalene. 

Scalene minimus

A fourth muscle, the scalenus minimus (Sibson’s muscle), is sometimes present behind the lower portion of the anterior scalene.


The anterior and middle scalene muscles lifts the first rib and bends the neck to the same side as the acting muscle; the posterior scalene lifts the second rib and tilts the neck to the same side. 

Because they elevate the upper ribs they also act as accessory muscles of respiration, along with the sternocleidomastoids. 

Watch this video for better understanding:

Myofascial Pain & The SCALENE MUSCLES

It’ called MPS – Myofascial Pain Syndrome. This condition is often misdiagnosed with cervical disc herniation, cervical stenosis and thoracic outlet syndrome (TOS), as most of these conditions are associated with neck pain and pain radiation to the arm.

This painful syndrome causes the muscle to become weak and stiff, leading to reductions in range of movement. Thus, MPS has a significant impact on daily activity, function and quality of life.

The good news is that Myofascial pain is treatable. The bad news is that often, due to lack of awareness among clinicians this syndrome is not treated the right way. The most common feature of MPS, are trigger points.

Trigger Points & MPS

Trigger points, one of the main characteristics of MPS, are considered to be hyperirritable. These points are painful on compression and can produce referred pain, referred tenderness, and even autonomic phenomena.

Referred pain and tenderness occur when pain is referred to remote sites from compression of a myofascial trigger point. For example, pain from compression of trigger points in the scalene muscles of the neck may be felt in the hand.

Myofascial trigger points of different muscles are associated with their own characteristic pain pattern; thus, the unique distribution of pain can help the clinician to correctly determine which muscles are affected by MPS.

MPS trigger points can be classified as active or inactive. An active trigger point causes spontaneous pain and is associated with radiating pain. Inactive trigger points are tender but not spontaneously painful.

They usually are found in asymptomatic patients and can cause stiffness and limit range of motion.

A number of studies suggest that inactive trigger points can be commonly found in the shoulder-girdle muscles of 45% to 55% of asymptomatic young adults.

Inactive trigger points can be a result of active trigger points that have been suppressed with treatment. They also can develop into active trigger points as a result of psychological stress, muscle tension, and physical factors such as poor posture.


MPS has become a major cause of time lost from work, resulting in a loss of millions of dollars from the economy.


  • Unilateral neck and shoulder pain
  • Difficulty sleeping due to pain
  • A tender knot in a muscle
  • Pain that persists or worsens
  • Pain that persists or worsens
  • Trigger points that activate the pain
  • Headaches
  • Bad posture such as hunching, shoulder rounding, or forward head posture (not aligned with spine)

Treating MPS with scalene stretches.

Here’s how:

  1. Lower and anchor the shoulder of the side to be stretched by placing that side’s hand under your buttock
  2. Bring the opposite hand over your head so that your fingers make contact with the top of the ear.
  3. Gently pull the head and neck so that it tilts to the opposite side of the side you want to stretch, relaxing your neck muscles as you do so. Try to pull your ear down to your shoudler.

Now, you will rotate your head, and the degree of rotation will determine which scalene is targeted.

Posterior Scalene Stretch

To target the posterior scalene, turn your face toward the arm that is pulling

Anterior Scalene stretch

To target the anterior scalene, turn your face away from the pulling arm.

Medial scalene stretch

To target the middle scalene, look straight up at the ceiling, or just slightly toward the pulling arm.

Concentrate your efforts on the muscle that feels the tightest when you rotate your head to target that muscle.

Hold the stretch for around six to seven second.


Scalene PNF strengthening

To strength scalene sit in a comfortable chair.

  1. Place the palm of your right hand on the right side of your head. This hand acts as a stabilizer in the exercise.
  2. Begin to move your right ear toward your right shoulder while maintaining the resistance provided by your right hand.
  3. Repeat 8 to 12 times on each side.

By strengthening the scalene muscle you will increase your ability to stabilize your cervical spine, which reduces the risk of a future injury.

Strengthen the scalene exercise #2

  1. Sit or stand up straight with a resistance band looped around your head.
  2. Hold the ends of the band firmly to one side ensuring there is some tension in the band.
  3. Pull the band away from your head, resisting the movement by keeping your head in a neutral position.
  4. Hold this position, relax and repeat.

Self Massage For The Posterior Scalenes

Muscles in the front and side of the neck can get congested and cause tension into the shoulders, arm and chest. You can gently self-massage these muscles using a large soft spiky massage ball.

Lying on the floor and using a rolled up yoga mat to lift the ball off the ground and apply gentle force through the ball into the tissue. Taking the neck into flexion, extension and rotation gently apply pressure to release nerve fibres from sticky fascia and tight muscle tissue.

You can move the arm into different positions to help floss the fibres over the surface of the spiky massage ball. Go easy to start with and stop if you feel anything which is sharp or electric.

Massage Variation For Anterior Scalene

This self-massage for the scalene is another great way to relieve pain around the collarbone and deep inside the top of the shoulder.

If you get arm numbness while sleeping or while your arm is overhead, this is a way for you to reduce that tingling down the arm.

Massage this muscle for 30-90 seconds in various spots, starting by pressing down right behind the collarbone and working up the side of the neck.

Make sure to keep your posture upright, reaching the top of your head to the ceiling, and pulling both of your shoulders DOWN.

While pushing on the scalene with your fingers, take a deep breath, then side bend the head while exhaling.

You do not need to slide your fingers on your skin. If you do, use some lotion to allow the fingers to glide. You are welcome to use tools like the theracane, a lacrosse ball, a barbell, etc to get into the neck, but for a quick massage while you are on the go, just use your fingers!

Always consult your physician or doctor before trying any new type of stretching or exercises.

Let me know if these stretches and exercises helped you with your neck pain. If you need some motivation or personal feedback join me for a class.

In happiness and health,

Vanessa Barthelmes.

Check out my flexibility classes and online coaching.

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