Why do Scalene Muscles Hurt?

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Written By Dr. João Arthur Ferreira

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Scalene muscles are a group of three muscles located in the neck region. They run from the neck to the first and second ribs. These muscles are responsible for lifting the ribs during breathing and rotating the neck.

The scalene muscle group is a set of muscles that is found on the side of the neck and lies deep to the sternocleidomastoid muscle. It has three divisions or branches, namely, the anterior, the middle, and the posterior.

The scalene muscles are used frequently in day-to-day activities and can cause pain and discomfort when they become strained or overused. This muscle group functions to flex the neck to either side and also to raise the ribcage during inhalation. A neurovascular bundle exits the cervical spine between the anterior and middle branches of the scalene.

In this article, we will explore the causes of scalene muscle pain, the symptoms to watch out for, and treatment options available.

Understanding the Anatomy of Scalene Muscles

Scalene Muscle Anatomy For Medical Concept 3D
Scalene Muscle Anatomy For Medical Concept 3D Illustration

The scalene muscles consist of three pairs of muscles, including the anterior scalene, middle scalene, and posterior scalene.

These muscles play a crucial role in respiration and neck movements.

The anterior scalene muscles attach to the first rib, while the middle and posterior scalene muscles attach to the second rib.

When these muscles become tight, they can compress the nerves and blood vessels that run through them, leading to pain and discomfort.

Contraction of the scalene group produces lateral flexion of the neck when the rib is stabilized and also inhalation by raising the first and second ribs. The ipsilateral upper trapezius assists the scaling group during lateral flexion, while the sternocleidomastoid, pectoralis major, and minor assist the scalenes during inhalation.

Conversely, the contralateral scalene and upper trapezius oppose the scalene during lateral flexion, and the intercostal muscles oppose the scalenes during inhalation.

Causes of Scalene Muscle Pain

There are several reasons why scalene muscles can become painful. Here are some of the most common causes:

  1. Poor Posture

Poor posture is one of the primary causes of scalene muscle pain. When the head and neck are in a forward position, the scalene muscles are constantly under tension, which can lead to muscle fatigue and pain.

  1. Repetitive Movements

Repetitive movements, such as those performed in activities like tennis, golf, or typing, can cause overuse injuries to the scalene muscles. Over time, this can lead to pain and discomfort in the neck and shoulder region.

  1. Trauma

A traumatic event, such as a car accident or a fall, can cause injury to the scalene muscles. The muscles can become strained or torn, leading to pain and discomfort.

  1. Stress

Stress can cause muscle tension, which can lead to pain in the scalene muscles. When the body is under stress, it tends to hold tension in the neck and shoulders, which can lead to pain and discomfort in the scalene muscles.

Trigger Points – Common cause of Scalene Pain

Trigger points, as clinically defined, are any painful points that develop within muscle tissue.

They can be classified as either active or latent, and are characterized by specific clinical symptoms.

  • Active Trigger Points: An active trigger point can result in spontaneous and referred pain, leading to tightness in the muscles, weakness, and a pain or motor phenomenon when compressed. Stimulating an active trigger point may cause a local twitch response of muscle fibers compressed within the patient’s pain tolerance.
  • Latent Trigger Points: In contrast, latent trigger points are clinically inactive with respect to spontaneous pain, meaning they are only painful when touched or pressed on. They may have all the clinical characteristics of an active trigger point, including a taut band that increases muscle tension and restricts range of motion.

Symptoms of Scalene Muscle Pain

The symptoms of scalene muscle pain can vary from person to person. Some people may experience mild discomfort, while others may have severe pain that affects their ability to perform everyday tasks. Here are some of the most common symptoms to watch out for:

  1. Neck and shoulder pain: Pain that radiates from the neck and shoulders down to the arms and hands.
  2. Difficulty breathing: Compression of the nerves and blood vessels that run through the scalene muscles can cause difficulty breathing.
  3. Headaches: Pain that radiates from the neck and shoulders to the head.
  4. Tingling and numbness: Numbness and tingling in the arms and hands.

People with active trigger points in the scalenes typically experience:

  • Persistent aching chest pain
  • Two-finger-like pattern pain between the shoulder blades that concentrates in the area just medial to the superior angle of the scapula
  • Superficial anterior shoulder pain
  • Pain on the anterior and posterior part of the upper arm that often disturbs their sleep
  • Pain on the radial side of the forearm that skips the elbow and travels down the thumb into the index finger
  • Numbness and tingling in the arm, hand, and thumb
  • Edema or puffiness in the hand, especially in the morning

These symptoms make it necessary to identify and treat the trigger points in the scalene muscle group.

Factors that may active or perpetuate trigger points

Some factors that may activate or perpetuate trigger points in the scalene muscles include automobile accidents, strong pulling movements such as playing tug-of-war, swimming, carrying heavy objects, coughing, scoliosis or lower limb length inequality, and limping because it causes a distortion in the client’s posture. Identifying and addressing these factors can help prevent or reduce the occurrence of trigger points in the scalene muscles.

It is important to note that active trigger points in the scalene muscles can be misdiagnosed as carpal tunnel syndrome, C5-C6 radiculopathy, and thoracic outlet syndrome. Hence, a proper diagnosis based on the specific symptoms is necessary to ensure appropriate treatment and management of the condition.

Alleviating Scalene Muscle Pain

Treatment for scalene muscle pain typically includes a combination of rest, physical therapy, medications, and lifestyle modifications.

Rest is recommended for the initial 48 hours after the onset of symptoms, followed by physical therapy to restore range of motion, reduce muscle tension, and improve strength.

Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and corticosteroids may also be prescribed to reduce inflammation and manage pain.

Lifestyle modifications such as avoiding activities that cause pain and focusing on posture correction and ergonomic modifications can also aid in recovery.

In cases of severe pain or injury, surgery may be necessary.

Initial treatment options and management include:

  1. Stretching

Stretching is an effective way to alleviate scalene muscle pain. Simple stretches, such as the chin tuck and neck rotation, can help to release tension in the muscles.

  1. Massage

Massage can help to alleviate muscle tension and pain. A professional massage therapist can target the scalene muscles to release tension and provide relief.

  1. Heat Therapy

Heat therapy can help to relax the muscles and alleviate pain. A heating pad or warm towel can be applied to the neck and shoulder area for 15-20 minutes at a time.

  1. Cold Therapy

Cold therapy can help to reduce inflammation and alleviate pain. An ice pack can be applied to the affected area for 10-15 minutes at a time.

  1. Pain Medication

Over-the-counter pain medication, such as ibuprofen or acetaminophen, can help to alleviate scalene muscle pain.

  1. Posture Improvement

Improving posture can help to alleviate scalene muscle pain in the long term. Sitting up straight, keeping the head and neck in a neutral position, and taking frequent breaks from sitting can help to reduce tension in the muscles.

Benefits of Physical Therapy for Scalene Pain Rehabilitation

  • Reduced Muscle Tension: Physical therapy techniques such as massage, stretching, and joint mobilization can help reduce muscle tightness and tension in the scalene muscles, as well as other areas of the neck. This can improve range of motion, reduce pain, and reduce the likelihood of further injury.
  • Pain Management: Physical therapy can help reduce pain levels in the scalene muscles and the surrounding area. Techniques such as ultrasound, electrical stimulation, and cold and heat application can be used to reduce inflammation and decrease pain levels.
  • Improved Strength and Mobility: Physical therapy can help improve strength and mobility of the scalene muscles and surrounding areas. A physical therapist can design an individualized program of exercises, stretches, and strengthening activities tailored to the patient’s specific needs.
  • Improved Posture: Poor posture can lead to or exacerbate scalene muscle pain. Physical therapy can help correct misalignments of the spine and neck, helping the patient become more aware of and maintain good posture.
  • Improved Coordination: Physical therapy can help improve coordination and balance of the head, neck, and shoulders. Exercises such as balance and vestibular activities can help improve coordination and reduce the risk of further injury.
  • Reduced Risk of Injury: Physical therapy can help reduce the risk of further injury to the scalene muscles. Techniques such as active stretching and strengthening exercises can help improve flexibility and strength, reducing the risk of strain or other injuries.

Medications for Scalene Pain

Some drugs commonly used to treat acute and chronic pain include:

DrugPharmacological ClassDosage
AcetaminophenAnalgesic (non-opioid)325-1000 mg every 4-6 hours
DipironeAnalgesic (non-opioid)500-1000 mg every 4-6 hours
TramadolOpioid50-100 mg every 4-6 hours
BuprenorphineOpioid0.3-2 mg every 6-8 hours
AmitriptylineAntidepressant10-75 mg daily
GabapentinAnticonvulsant100-1200 mg daily
DuloxetineAntidepressant30-120 mg daily
NaproxenNSAID220-660 mg every 8-12 hours
CelecoxibNSAID100-200 mg daily
IbuprofenNSAID200-800 mg every 4-6 hours
KetoprofenNSAID50-150 mg every 8-12 hours
PiroxicamNSAID10-20 mg daily
LidocaineAnalgesic2-4% topical solution
TizanidineAnalgesic2-8 mg every 6-8 hours
CapsaicinAnalgesic0.025-0.075% topical solution

Frequently Asked Questions

What is the best way to prevent scalene muscle pain?

Maintaining good posture, taking regular breaks when performing repetitive tasks, and avoiding sleeping in awkward positions can help prevent scalene muscle pain.

Can scalene muscle pain be a sign of a more serious condition?

In rare cases, scalene muscle pain can be a sign of a more serious condition, such as thoracic outlet syndrome. If you experience persistent pain and discomfort in the neck and shoulder area, it’s essential to consult a healthcare professional for a proper diagnosis.

How long does it take to recover from scalene muscle pain?

The recovery time for scalene muscle pain can vary depending on the severity and treatment of the condition. Generally speaking, most people can expect to recover within a few weeks to a few months when receiving appropriate treatment.


Scalene muscle pain can be caused by several factors, including poor posture, repetitive movements, trauma, and stress.

The pain can cause a variety of symptoms, including neck pain, shoulder pain, headaches, and difficulty breathing. Fortunately, there are several ways to alleviate scalene muscle pain, including stretching, massage, heat therapy, cold therapy, pain medication, and posture improvement.

By following these treatments, individuals can alleviate scalene muscle pain and improve their overall quality of life.

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Physiatrist, M.D. Pain Center of University of São Paulo

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