Trigger Points – Pain in the upper back, index finger and thumb

The scalene muscles produce several different problems from the torso into the arm and hand, but this is the most common complaint.

Client’s Description

referral - scalene - posterior1People complain about pain just inside of the shoulder blade, and in the thumb, and index finger. It isn’t always pain in the hand; sometimes it is tingling like it is “falling asleep” or “going numb.” Sometimes, they have pain or tingling when reaching out with the hands near shoulder level as when driving, or cutting hair.

The pattern does not usually occur in full, as illustrated, but as part of that pattern. As the illustration indicates, the pain. Tingling and “numbing” is most likely to occur in the areas of darkest red. When there are stiff, swollen hands, the sensations around the index finger and thumb are a greater focus, although the tension behind the shoulder is usually there. If I press into this muscle at the base of the neck, the client almost always describes sensation between the shoulder blades and down the arm.

These trigger points also create pain in the front of the chest and may produce shooting pains through the chest. If you have chest pains, see your doctor first before looking at releasing these trigger points to relieve the symptoms.

There are exceptions, but people are usually not clear about how this occurred, It is most often created by breathing while leaning forward, as when one works on a laptop while sitting, as I am doing now. The scalenes go from being assistive breathing muscles to being the primary respiratory muscles as the lift the upper ribs and collarbone to inhale.

When they identify an activity, it usually involves an activity where they are seated with the arm in from of them as when they are driving with the arms at 10 & 2, working while slumped forward, rowing or activity that created heavy breathing. These muscles get involved in assisting with heavy breathing as when sprinting or climbing stairs. People with this problem complain of tingling in their hands while huffing and puffing. This can also be a sign of thoracic outlet syndrome.


Self Care

First, look at this post on breathing exercises, it is useful for both retraining your breathing pattern and loosening rib heads that are fixated.

Secondly, there are some standard stretches for releasing tension on scalene muscles. Try these common scalene stretches.

Therapy Notes

Scalene muscles look like guy wires on the side of the neck but are more like the ropes that support hoops that go around a column. When the rib head gets elevated, it is difficult to get lasting relief.

Most neuromuscular therapists release the rib head with static pressure on the attachment of the muscle to the rib. Rib heads should be released early in the treatment so that the trigger points will release if the muscle bellies are worked directly.

As seated activities become more common in daily routines, forward head posture and scalenes become a more common focal point of treatment.  This position trains the body to over-use assistive breathing muscles. Head-forward posture also creates shearing at the base of the neck, which perpetuates scalene trigger points.

Similar Patterns

Click on these categories to see if there is a referral pattern that better describes your concerns.

Scalenes overlap most areas in the upper torso and upper extremity. Here are the most common areas where people complain of scalene referral:

tags-thoracic-outlet-sydrome tags-torso-into-arm tags-hand tags-upper-back tags-chest   

referrals - scalenes - anteriorWhen scalene muscles refer to both the front and back of the thorax as well as down the arm, it produces chest pain with sensations up and down the arm. It is similar to the sensations created by a heart attack. If these symptoms arise, it is imperative to see a doctor first to rule out a cardiac problem. I have seen clients that have these symptoms but have been cleared by their doctor beforehand. The received relief from symptoms when the scalenes were treated.line - black


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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