Anatomy Angel: Scalenes

Dooley Noted: 11/23/2016

The scalenes are often a misunderstood and mistreated group of muscles with hugely impactful clinical importance.

The anterior scalene starts its course where its synergist, the longus colli, ends: at the anterior tubercles of transverse processes (TPs) of C4-C6. This muscle then anchors itself to the first rib.


The middle and posterior scalene often blend in fibers as one large mass of muscle, posterior to the middle scalene. If the bellies are discernible, then middle scalene will reach from C1-C3 anterior tubercles of TPs to the first rib. The posterior will start much like the anterior scalene but will end up on the second rib.


Due to their positions and fiber directions, these muscles concentrically work best as neck flexors and lateral flexors, when the rib is fixed.

If the neck is the fixed point of movement, they can easily be used as accessory muscles of respiration, raising the upper ribs.

These muscles must only be used as temporary muscles of respiration, since the decrease in thoracic pressure is minimized for inhalation if they are used to elevate the rib cage. Their eagerness can create abdominal stability problems, leaving the core musculature inactive and creating possible spinal stability problems.

Even more problematic is the overstretching of especially the anterior scalene.

As this muscle fixes into a locked long position, the client loses the ability to neck flex. As the extensors go unopposed, the result can be intense posterior neck muscle activation and subsequent headaches, scapulothoracic dysfunctions, and even migraines.

In the worst case scenario, the locked long scalenes can create neurovascular compromise. The subclavian artery, which feeds the entire upper extremity, is wedged between the anterior and middle scalenes. Posterior to the artery is the brachial plexus nerve roots and trunks, which innervate the entire upper extremity.


Thus, when the scalenes are mismanaged, particularly in a locked long position, they can stretch themselves right across this neurovascular bundle, potentially creating whole hand numbness and circulation impediments.

But it may not start off that dramatic.

The first sense usually to be lost is dorsal column-mediated in the spinal cord. The patient may lose vibration sense, which may or may not be recognized by the patient. Long before the patient experiences numbness, they may experience a quick change in proprioception (position sensing), which means the muscles lose perceived strength due to motor control insufficiencies.

This can be tested with “OK” grip testing at the hand, with median nerve and ulnar nerve supplying much of the thumb and pinky sides of grip, respectively.


If both the thumb side and pinky side of one hand only is diminished on testing, the person may be prone to scalene inhibition (stretch-weakening), leading to neuropathic signs.

The person will also have a stretched-out look to the neck and possible lateral flexion neck bias to the OPPOSITE side.


The person will have a tendency to have hypertonicity on both sides, but actually feel consistent discomfort on the stretched-out side (the same side as neuropathic symptoms).

The additional caveat as they may feel the need to stretch the neck on the already stretched side, exacerbating the stretch across the neurovascular bundle.

When testing grip, the test will likely improve upon coronally stretching the OPPOSITE side, which shortens the stretched-out side in this plane. This takes the stretch tension off the compressed neurovascular bundle, resulting in better circulation and nerve conduction.

If the person has whole-hand numbness, the numbness will likely dissipate upon lateral flexion to the side of issue, if the scalenes are the problem.

The scalenes are rarely locked bilaterally short at the neck. Even people with forward head carriage are typically righting the head to the horizon, taking the upper and mid-cervical segments into extension (an upper scalene stretch position).

However, the scalenes become bilaterally short at the rib when scalenes are used for quiet breathing. The symptoms include a tight, tense neck with loss of intra-abdominal pressure building. This can show up in cases from migraine to tension headache to low back pain.

Consider better movement coordination of the scalenes, and consider these observations before you administer manual stretch therapy to what may potentially be the wrong side.

As always, it’s your call.

– Dr. Kathy Dooley

P.S. Case Study Sample:

Active adult, age 29

Symptoms: neck tension on LEFT at TPs
C4-C6, no numbness

Signs: locked long left neck, locked short right neck in coronal plane

Testing: grip loss in both him and pinky with you OK testing on left hand only

Treatment: release of RIGHT side scalenes in coronal plane stretching resulted in return of grip power and motor control on thumb and pinky side of left grip.

Sorry, comments are closed for this post.

Testimonials

Read what Dr. Dooley's clients & colleagues have to say.

Jesse Connor, LMT, NKT

Hands down the most influential person, educator, healer that I will ever meet in my ife. If every physician had her dedication, this world would be a better place.

Bruce Fink

Executive Vice President Enterprise Lighting Sales, New York City, NY

“Twenty years ago, while doing a mile repeat workout as part of my training for a marathon, I felt a sharp pain in my groin. Over the twenty years since, the pain grew more and more persistent and often would radiate up through my hip and into my lower back. I tried many things to help this pain that consistently hampered my training, until about one year ago when I met Dr. Kathy Dooley. I stopped running for over six months at one point as a recovery method, only to have this sharp pain return after less than two weeks of running. At that point I stopped running completely, but continued to do cardiovascular exercise on elliptical trainers and exercise bikes, but the pain continued to get worse. I went to many different doctors. An orthopedic surgeon told me that if I continued to run, I would ultimately need a hip replacement. An OD checked my skeletal system and could not find anything, but

suggested that I have a surgeon check for a hernia, because it may be the intestine getting pinched by atorn portion of the muscle. I went to the surgeon and I did have a triple hernia operation. This did not fix the groin, hip or back problem. I went to chiropractors and found that that did nothing at all. In 2010 I did an all-day strenuous hike. By the time I got off the plane home, I could barely stand up straight. A friend convinced me to go see one more chiropractor. I had nothing to lose, so I went to see Dr. Dooley. She told me that my groin, hip and back were not the problem, but the symptoms. The problem was twofold, one part being

my groin and hip and the other my lower back. My glutes were not firing on time and consequently, the small muscles in the groin and hip were working to compensate for them. The groin, being the smallest of these, would pull first and if I was not smart enough to stop running when that bothered me, my hip flexors would go next. The lower back was just as interesting to me. In thinking that my hips were not strong enough and that was why it hurt so much, I did an over abundance of hip strengthening. Well, my hips got so tight that they could not swivel appropriately, so my lower back was compensating. This was the reason that my back kept giving out. Dr. Dooley gave me a number of exercises to get my glutes to fire on time and to

loosen up my hip flexors. Within a month, I was running pain free most of the time. I signed up for the 2013 LI Half Marathon for the first time in ten years, with Dr. Dooley’s help.”

Heather Davis, BSc

Doctor of Chiropractic Candidate

“As if being a Neuroanatomy and Gross Anatomy student of Dr. Kathy Dooley wasn’t enough of a pleasure, I have the opportunity to encounter Dooley Noted blogs every day. Discovering not only the topic of the next blog, but learning what knowledge bomb the great and talented Dr. Dooley drops for her followers is always my pre-class early morning highlight. Daily familiarizing oneself with the vast amount of chiropractic, medical, nutritional, biomechanical, and general life tidbits occupying themselves in such a brilliant mind lends us a glimpse of the inner workings of a bona fide juggernaut.”

Tyler Kowalski, MSc, DC

“I truly have enjoyed reading your Dooley Noted posted every day.  They give you fun facts and great health advice.  They also inspire you to be a better doctor, and encourage you to live your life to the fullest.”

Eric Rojals, MPT

University of Barcelona

“I have to admit that I have been Dooley-ed. It was during my two month recovery from a shattered pelvis when I found through internet a bunch of movement specialist speaking about how to move better. Things are not easy, and my fracture was pretty bad. But I learned to walk again. It was during my recovery that I started to read the Dooley Noted blogs.Dr. Dooley belongs to NKT practitioners group and her statements on the forum are always brilliant. It’s like, how the hell does she knows that?! It was then when I started to receive these boosting daily pills pf Dooley Noted, and I am now a Dooley Noted junkee. It helps me to wake up in the morning earlier despite the weather to walk as a warming up for my gym rehab exercises. If you are not aware, Dr.Dooley is a kind of vampire that doesn’t sleep. I use to get up at 7am and I receive Dooley notes at 10am. In Spain we have 6 hour gap with NY, so I always think: Is she really writing at 4am? So I have no excuse to be lazy in the morning! Dooley Noted blogs also help me to have commitment with myself, to not look for excuses to not do my exercises, my research, my diet. They remind me to take care of my patients as they were my family, to learn everyday, to let go my fears and not punish myself that I didn’t catch a faulty movement in a patient. And the most important thing, she always appears to me when I am in front of an escalator, as if to say, ‘DON’T EVEN DARE!’ Dooley Noted reminds me everyday that I have to be passionate about my family, my wife, my friends, my job, my life. I don’t want to stop drinking this medicine! “

Christina Ippolito, DC

Co-creator of the Functional Anatomy and Fascial Tensegrity seminar series

“Dr. Dooley has been a mentor of mine since I began my chiropractic career. The enthusiasm, charisma, and motivation that she brought into the anatomy lab inspired me to learn everything I possibly could about the human body and human movement. I would not have the opportunities I have come across without her guidance and the example she sets to never stop learning. She continues teaching other and me through Dooley Noted blogs,  and she is a constant spark and reminder to always do my best in life. She inspired me to want to start teaching, in hopes that I may affect people’s lives the way she has affected mine. I am lucky to call her both a colleague and friend, and I look forward to learning from her and teaching with her for years to come.”

Perry Nickelston, DC, FMS, SFMA

Owner, Stop Chasing Pain, and Pain Laser Center

‘Dr. Dooley is the shining example of a gifted healer who makes the world a better place. She is a dear friend, mentor, teacher, and true giver in every sense of the word. One of my favorite ways of learning is via her inspiring and entertaining ‘Dooley Noted’ blog series. One ‘Dooley Note’ can change your life. Read it. Live it. Share it. I sure do.’

Marc Andresen

CPT, CK-FMS, RKC/SFG

“I found out about Dr. Dooley, who just earned her RKC  and set up an appointment with her. The courtesy, knowledge, attention, and professionalism she exhibited are not commonly seen in the medical profession. NKT and the RKC are fortunate to be represented by her.
My visit was not pain-related. I was looking to ‘clean up’ some movement before stepping up to RKC II. Previous PT’s didn’t understand this – how can you fix something that doesn’t hurt? With Kathy’s experience in both organizations, she understood without questioning and proceeded with treatment. I left her office, got home, found my homework (emailed from Kathy), and got one of the best workouts in some time. Even hit a clean pistol squat, which I’d been working at for some time.
I could go on and on, including her willingness to analyze video of my kettlebell swing.  I’d refer anyone I know to Dr. Dooley.”

Wesley Schwartz, DC

Owner and chiropractic physician, Schwartz Chiropractic Center

“The Dooley Noted blogs provide me with daily food for thought and lots of positive energy that I pass on to help my patients. Sharing this knowledge makes a great ripple effect, where one little stone of knowledge can touch many people and change their lives in a positive manner.”

Kimberly Ford, Bsc

Program Coordinator for State of Indiana, Bureau of Developmental Disabilities

“The biggest thing that Dr. Dooley taught me is to try and be healthy. That is a big deal considering I’ve never tried to be healthy before. My focus was always wanting to lose weight, but there are a lot of unhealthy skinny people out there. Some of the things that I strive for specifically that she taught me are: increase muscle mass, don’t just exercise-move more throughout the day, stretch like my dogs do, eliminate artificial sweeteners, and everything in moderation.”

Danny Fetzner

Assistant Head Gymnastics Coach St Louis Gym Centre

“I had the privilege of spending 6 years with Kathy Dooley by my side. I used to be extremely introverted until she walked into my life. As I began spending more time with her, I realized the absolute infectious personality that seemed to emanate from her. To me, it was overwhelming at first. She could start a conversation with anyone; find a topic of interest and speak for any length of time. Her cheerfulness seemed to be contagious, and her energy and excitement are never-ending. Honestly, I was quite envious! Over the years I observed her and made subtle changes to myself. The way I approached a person, or just the simple way of attacking each day started to change. I am truly a different and better person because of Dr. Kathy Dooley. She inspired me in countless ways to achieve, and to never ever “settle” for something other than amazing.

She has always been enamored with the body. The countless hours I have spent watching her work to benefit other people’s health or train to benefit her own health (eating right, lifting, running, etc) has taught me so many things as well. I coach gymnastics for a living, and find myself using tidbits of information from her everywhere. She is an absolute wealth of knowledge when it comes to the human body, and if you care at all about your body or the health of anyone you come in contact with, then you better consider yourself extremely lucky to have her influence in your repertoire. I know I do.

I can’t tell you how much I enjoy Dooley Noted blogs, and I look forward to it every day. I learn so much from those posts, just as I have learned a lifetime of knowledge that I use every day by merely having her in my life! The best thing to me about Dooley Noted is that every single person can benefit from it in some way. Be it something personal we as readers could fix mentally/physically, or the constant encouragement and inspiration about anything we could possibly think to achieve…Dooley Noted does it all. With each post Dr. Dooley has taken the knowledge and strength gained from experience, and turned it into wisdom.”

David Weinstock

creator of NeuroKinetic Therapy seminar series

“I liked Kathy before I ever met her in person. Our interaction via social media was then exceeded by having her as a student. Her brilliant mind, engaging presence, and joy for life make her an exceptional teacher and practitioner. Her dedication to and enthusiasm for NeuroKinetic Therapy will be essential in disseminating this information into the medical world.”

Ann Kokinda

Practice Manager Manhattan Spine and Sports Medicine

“I have learned how to breath properly by watching my pets and mirroring their stomach breathing.

Dr. Michael P. Willemse

Chiropractic Physician Advanced Healing & Pain Relief Center, LLC

“I’ve learned more from Dooley Noted then I do from CEU seminars.”

David Mc Gettigan

GSR, NKT, Bowen Technique Practitioner

“After connecting with Dr.Kathy Dooley online I quite quickly found that she posted everyday about a wide and diverse range of topics all relating to health, performance and humanity. Her play on the the phrase “Duly Noted” was clever but I don’t think that it was by chance that she found herself posting “Dooley Noted” each day. Some people have a commitment, a passion and a drive to help others and to empower
people that are less well informed or less able. Dr. Dooley’s information has been priceless, not only for me, but for my patients, athletes, family and friends. She transcends her role as a doctor of
chiropractic and holds herself up as a beacon for people that shows them that you can have all the things you want in life if you are willing and ready to go and get them.”

Sharla Ahrens

“I never skip past Dooley Noted posts.  These tidbits are both educational and inspirational, good reminders on how to take care of all aspects of your well-being.”

Tsvetan Vassilev

NKT, SFMA

“Dr. Dooley is fire. It burns brightly to light your way and warms your soul. Dooley Noted is an honest appraisal of the genuine human spirit. One that knows hardship, but is not discouraged by it. One that knows friendship and cherishes the act of bonding. One that knows fun, but is not spoiled by it. And most of all – one that has the courage to reveal itself.