Muscles
Scalene Trigger Points
Symptom Area: Head and Neck
Scalene Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. Three deep neck muscles that refer pain into the chest, upper back, shoulder and down the arm — frequent mimics of cervical radiculopathy.
Where you feel it
When the Scalene holds active trigger points, you usually notice it as back of arm pain, dorsal finger pain, front of arm pain, front of chest pain and front of shoulder pain. Where the pain spreads: Anterior chest, upper back between the scapulae, lateral shoulder, posterior arm and forearm, sometimes into the thumb and index finger. What often sets it off: Chronic upper-chest breathing, anxiety, persistent cough, sustained head rotation, carrying heavy loads.
Overview
Anterior, middle and posterior scalenes connect cervical transverse processes to the first two ribs. They are accessory respiratory muscles and side-bend the neck. Tight scalenes can contribute to thoracic outlet symptoms.
Trigger point locations
Multiple trigger points along all three scalenes, palpable between the SCM and the upper trapezius.
Referred pain pattern
Anterior chest, upper back between the scapulae, lateral shoulder, posterior arm and forearm, sometimes into the thumb and index finger.
Palpation & testing
Locate the lateral border of the SCM, slide posteriorly. Palpate gently — avoid sustained pressure over neurovascular structures.
Common causes
Chronic upper-chest breathing, anxiety, persistent cough, sustained head rotation, carrying heavy loads.
Self-care & clinical treatment
Diaphragmatic breathing retraining is the highest-yield intervention. Gentle stretching, postural work. Clinically: careful manual release, avoid aggressive needling due to brachial plexus proximity.
Treatment protocol
For Scalene, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: Locate the lateral border of the SCM, slide posteriorly.
Regional precaution for clinicians: In the neck and jaw, needle placement must respect the carotid sheath, the external jugular vein, the vertebral artery in the suboccipital region and the lung apex behind the lower scalenes and the medial supraclavicular fossa.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
Related articles
- Referred pain: why the spot that hurts is rarely the spot that needs treatment
- Burning pain between the shoulder blades at the desk: the trigger points that cause it
- Hands that go numb at night: the trigger points that imitate carpal tunnel syndrome
- The muscle behind a stiff neck you cannot turn: levator scapulae trigger points
- Dizziness when you turn your head: the neck trigger points that imitate a balance problem
- Waking up with neck pain: which trigger points your sleeping position keeps active
References
- • Travell & Simons, Vol. 1
- • Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2013;43(9):620-34
- • The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2017;47(3):133-49
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points — J Bodyw Mov Ther 2019;23(3):539-46
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm — J Pain Res 2019;12:1899-911
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response — Am J Phys Med Rehabil 1994;73(4):256-63
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
