NMT Protocols – Scalenes Supine

Scalenes are a sensitive and, often, complicated treatment approach. There are a number of things that need to be done so that the treatment is effective, longer-lasting and more comfortable for the client. Here is a proven approach:

Forward head posture and thoracic outlet syndrome are often predicated on a binding atlas. Most often, The atlas is anterior and rotated. This can usually be addressed easily with static pressure, strain- counter-strain techniques or, possibly, neuromuscular work.

Freeing up the atlas will make the other joints in the cervical vertebrae easier to mobilize. Static pressure, strain-counter-strain or a good lamina groove protocol all work well. Palpate the trigger points in the cervical lamina groove before and after treatment to evaluate the effectiveness of your treatment. C7 is often sheared anteriorly on T1. Don’t miss addressing this critical area.

Many sources cite an elevated rib as perpetuating scalene trigger points. These are easy to address with static pressure. They may have been freed up if the lamina groove routine extended into the thoracic area or other forms of treatment at the base of the neck. IT is convenient to address the sternoclavicular or glenohumeral joint while mobilizing ribs.

Here’s a 3-page pdf with a detailed neuromuscular treatment protocol from The Classical Workbook of Neuromuscular Therapy.

Need to brush up on your anatomy before you look at this routine?


This routine is from The WorkBook of Classical Neuromuscular Therapy, which was created at the ASHA School of Massage and used to train thousands of therapists over more than 15 years.

These routines are intended for mindful review by Bodywork Professionals and are not appropriate as self-care for non-professionals. Self-injury could occur.

Click here for the growing list of protocols that are available online.

This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.

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Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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