Well, we’re all familiar with having a pain and the neck – sometimes that’s actually what it is - rather than the kids, pets, work or life in general!
Did you know there are over 100 muscles in the neck, head and face? Is it any wonder that we get headaches and jaw tension when even a fraction of these go into sustained contraction?
Often this area of the body is glossed over by therapists and not really given the full attention it so desperately requires during treatment. Many are scared of working on the neck in case of causing injury – after all, there are a several “no-go” zones where a therapist must be exceptionally careful and also – it’s actually a blooming tender area – or at least can be!
In addition – the brachial plexus, which is a huge network of nerves extends from the spinal chord (C5 – C8 and T1) through the neck, over the first rib and into the axilla (armpit). The plexus then extends down the arms and splits into various nerves which are responsible for the nerve supply to both the left and right arms’ skin and muscles. (There are a couple of muscles not included but this will be saved for another blog!)
A set of muscles that I see regularly in Clinic – and suffer with myself – are the group called the Scalenes. There are 3. Posterior, Medial and Anterior Scalenes. Each come in pairs and with one set located either side of the cervical spine.
The anterior scalene can bend and rotate our neck when acting only on one side of the neck but working with it’s matching pair on the other side, together they flex your neck (think chin to chest). This muscle, because it attaches to the first rib, lifts that rib and aids in breathing – inhalation more specifically. To find the anterior scalene and work with trigger points and tension, it is first necessary to move the sternocleidomastoid muscle out of the way. Tricky for the therapist sometimes, but so worth the effort for the beautiful soul lying on the table!
The medial scalene is literally in the “middle” – hence the name medial. Like its partners – it can work alone or with it’s other half on the other side of the neck. On it’s own, it lifts the first rib to flex and laterally flex the cervical spine (think ear to shoulder – it’s just the technical term for us in the know!). It is also considered a muscle that helps with breathing. When working as a pair, they contract to flex the neck.
These two scalene muscles form a triangle which is called the scalene triangle (for once something named obviously in anatomy!). The brachial plexus, as briefly mentioned above, passes through this triangle. As a result - when there is tension in the scalene muscles, this can cause impingement of the nerve branches leading to numbness in the shoulder, arm or hand, tingling, burning (usually in the arm/hand), weakness or an inability to left or extend your wrist and general difficulty moving the arm and shoulder.
The third pair of this muscle group is the posterior scalene is found nearer the back (posterior) of the neck. When one of this pair contracts, it flexes and rotates the neck, but together – it works with many other muscles to flex the neck – i.e. move the chin to the chest. Again, as this muscle inserts on to the second rib and lifts it during inhalation, it is an accessory breathing muscle.
There are many reasons for the scalene muscles contracting and becoming tight. These include:
· Torticollis (wry neck)
· Forward head posture and Dowager’s Hump – something that is increasingly evident in our population today from poor posture and looking at mobile phones so much. This alone has huge postural issues for the spine and pelvis (await another blog on this one!).
· Respiratory problems
· Whiplash
· Stress
· Overuse
· Fatigue
· Untreated trigger points
Trigger points in each scalene pair are multiple. However, it is the anterior scalene that is the biggest culprit in the group! As mentioned, to access this, it is first necessary to gently move the SCM out of the way. Trigger points in this muscle group can cause symptoms of pain in the chest region, pain on the medial border of the scapula, shoulder pain and pain, numbness or tingling in the thumb or index finger. Breathing difficulty can also be a symptom of a contracted scalene. Cardiac symptoms can often be misdiagnosed – however, this must ALWAYS be ruled out if there is severe chest pain!
There are a number of ways to treat these problematic muscles and these include:
· palpation and compression of trigger points
· dry needling
· myofascial release
· heat
· massage
· stretching
At Trayah, following careful assessment, a 60-minute treatment can be performed on the neck alone. However, it is common to also include the pectoralis major and minor region (a key area for brachial plexus impingement), shoulder and arm as – believe it or not – they are all connected!
The key is that fascia connects it all and, as a therapist, it is imperative to THINK LOCALLY AND ACT GLOBALLY!!