Jul 2015 04

Tony's story - the scalene muscles

By: Dave Wheeler

Most people can tilt their head sideways - putting their ear towards their shoulder in a movement known as lateral neck flexion.

The "normal" range of motion that you expect people to be able to achieve is between 20 and 45 degrees when trying to flex their head sideways towards their shoulder.

Under certain situations though, the muscles that are responsible for lateral neck flexion can become shortened, or tight, and sideways head movement can become painful and difficult.


Muscle tightness - it's a lifestyle thing

Tony came to see me this week complaining that he was getting  soreness in certain parts of his neck when trying to do his job (he's a hospital surgeon).

Tony spends hours every day hunched over the operating table concentrating. He also cycles to work, so spends that time hunched over the handle bars of his bike. Oh, and his hobby is playing the piano in his spare time - guess what... hunched over the keyboard.

With years of keeping the same posture in his neck, the muscles had become "set". The position that they'd become used to, and rarely moved from, meant that Tony range of motion of lateral neck flexion was only about 15 degrees (instead of the normal 20-45 degrees) before he started experiencing pain.


The muscles of lateral neck flexion - the scalenes

A set of 3 muscles either side of the neck called the Scalenes are mainly responsible for the movement of lateral neck flexion (bending your head sideways, ear to the shoulder).



There are 3 scalenes:

  • Anterior scalenes towards the front of the side of the neck
  • Middle scalene, er in the middle of the side of the neck
  • Posterior scalene towards the rear of the side of the neck

All 3 of the scalenes are involved when you tilt your head to one side.

The sternocleidomastoid muscle also assists with lateral neck flexion - you can read about that muscle in a previous blog post.


Treating tight lateral neck flexors

Massage alone won't help greatly improve the range of motion of the scalenes (though it will, of course, help relax them a little). There are other more effective treatments that a soft tissue therapist can use to help.

  1. We started treatment with Tony laying face-down whilst I did some very precise friction along the muscles close to his cervical spine. This was to warm up and loosen up the tension that he was holding at the back of his neck, in preparation for tackling the scalenes at the side. Just a word of warning - you need to make sure that your therapist really knows what they're doing if they're working this close to the spine.
  2. Then, with Tony laying face-up, we continued with some muscle energy technique work both on the scalenes directly and on the trapezius muscle at the top of the shoulders / bottom of the neck. If the traps are tight, there's not much hope in loosing off the scalenes, so this preparatory work was important.
  3. We then did some soft tissue release with Tony seated, doing some really powerful deep tissue work on the scalenes themselves.
  4. Finally, we did work with Tony lying on his side: broad, fast massage strokes to "iron out" the scalene muscles along their whole length, followed  by some more assisted stretching using muscle energy technique.

By the time we'd finished, Tony's range of motion of lateral neck flexion had improved from 15 degrees to 30 degrees - well with the "normal" range. More importantly, his neck didn't hurt when he moved it.

If, like Tony, your neck hurts when you try to move it,  think about giving me a call.