斜角肌：呼吸和胸椎

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Scalenes: Breathing & The Thoracic Spine

by Patrick   on February 21, 2011

A lot has been made over the past year about breathing and thoracic spine function and rightfully so!  Breathing is essential to life and appropriate breathing patterns are a key component of a healthy movement system and the thoracic spine is a region of the body that has interplay and influence on four other regions in the joint by joint approach to looking at movement – lumbar spine, ribs, cervical spine, and scapula – as Charlie Weingroff discussed in his new DVD, Training = Rehab, Rehab = Training.
Caught in the middle of this struggle to achieve better breathing patterns and improved thoracic spine mobility are the scalenes, three little muscles that take their attachments on the cervical spine and first and second ribs.

• Anterior Scalene: The anterior tubercles of the transverse processes of C3-6 to the first rib
• Middle Scalene: The posterior tubercles of the transverse processes of C2-7 to the first rib
• Posterior Scalene: The posterior tubercles of the transverse processes of C5-7 to the second rib
  

As I noted in a previous blog article regarding breathing one of the issues with an upper chest breathing pattern is that accessory muscles, such as the scalenes may become overactive, as their attachments onto the first two ribs offer them the role of assisting the rib cage in a cranial direction.
In this situation, the entire rib cage and movement of the thoracic cavity/spine may be negatively impacted, as Rolf states:
“When extensor posterovertebral muscles lose tone, flexors (including scalenes) shorten and thicken.  The head is then displaced forward, and the contour of the neck is permanently modified.  Since the appropriate length of these muscles contributes to lifting of the two upper ribs, the countour of the ribcage is also influenced.
Originally, rounded shoulders are formed by lifting and shortening the trapezius, levators, and sternocleidomastoid.  The resultant stresses are transmitted to anterior and middle scalenes and distort the ribs into which they insert.  Freeing the scalenes allows ribcage and scapulae to fall into a more appropriate girdle pattern, thus lessening tension in the neck.  Muscles of the neck and shoulders are part of the mechanics of respiration.  In normal breathing, the shoulders widen with every inspiration.  The relaxation accompanying this widening allows the shoulders to drop appreciably.” (Rolfing: Reestablishing the Natural Structural Integration of the Human Body for Vitality and Well-Being. pgs, 239-241.)
An additionally consideration for the scalene muscles would be the idea that we should screen the neck or “clear the neck” when evaluating upper extremity problems dealing with the shoulder and arm (Note: In Charlie’s DVD he mentions that if the neck mobility is restricted and not normal it would have a profound impact on the entire motor system, not only the shoulder).
The scalenes influence on the shoulder and arm lies in the fact that the brachial plexus, the nerves and vascular structures that serve the shoulder and arm, leaves the cervical column between the anterior and middle scalene.  Increased tension of the scalene musculature, more specifically the anterior and middle scalenes, will negatively influence the brachial plexus potentially leading to dysfunction in the shoulder and arm region.
Where to start
As you can see from the above information, the scalenes have a rather large impact on upper extermity, cervical spine, and thoracic function.  It is important to not overlook these muscles when issues in this region are present.
A good place to start, in my opinion, would be to evaluate breathing and begin to re-teach appropriate breathing strategies should you feel this to be necessary.  By improving breathing function and decreasing the tone/tension of the scalene muscles we may get an immediate result in the other regions of the body or, at the very least, improved breathing patterns will allow us to address those other regions more directly – especially with regard to regaining thoracic spine mobility – hopefully yielding a better result.  I think of good breathing and diaphragm function as being the first thing to address in terms of hierarchy due to its fundamental importance.
Soft tissue strategies and other manual approaches can be used to treat the scalenes as well and I have found working on the scalenes to be rather helpful in addressing some of the above issues with clients.  Trigger points in the scalenes will tend to run from the shoulder down the lateral aspect of the arm and towards the thumb and index finger, sometimes mimicking carpal tunnel type syndromes.  An additional trigger point referral pattern, which is often forgotten, is to the medial aspect of the scapula on the same side of the scalene you are palpating.
Wrapping up
The scalene musculature plays an integral role in the function of breathing and the rib cage ultimately affecting thoracic spine movement.  Because breathing and thoracic spine mobility are essential to a well-tuned movement system, the scalenes should be one of the muscles assessed and if necessary treated due to their influence over both of these structures.



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