Source: http://saveyourself.ca/articles/perfect-spots/spot-04.php

Myofascial trigger points (muscle knots) in this area cause an astonishing array of problems through the neck, chest, upper back, arms and hands!

Massage Therapy for Neck Pain (and Much More)

Perfect Spot No. 4, in the scalene muscle group of the throat

by Paul Ingraham, Registered Massage Therapist (Vancouver)

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The inevitable legal disclaimer: the legal hazards of publishing health care information are extraordinary, so I have to make it clear that this document contains no medical advice, and expresses my opinion only. I am not liable — I’m really not! — for the consequences of anything you do with this information. Click for More …

If you have a particularly stubborn and/or severe neck crick, you may prefer to start with this article instead: Save Yourself from A Crick in the Neck (Neck Pain and Stiffness)!

Perfect Spot No. 4 is in what I call the Anatomical Bermuda Triangle, filled with the mysterious scalene muscle group. Massage therapists have vanished while working in the anatomical Bermuda Triangle, never to be seen again.

A strange muscle group

Seriously, this is a strange area. The scalenes harbour trigger points with some of the strangest effects in the body. The mechanism for this strangeness is the phenomenon of referred pain, in which the nervous system has trouble locating a trouble spot and you end up feeling pain in a spreading pattern, instead of feeling it only where the trouble is.

Referred pain effects are par for the course with most muscle pain and other internal pains, but the scalene muscles produce unusually complex and large patterns of referred pain, patterns that vary more between people than the patterns produced by other muscles, and patterns that can even vary dramatically from day to day in the same person.

But scalene trigger points can also have effects on your voice, on swallowing, on emotions, on sensations that sweep through the entire head, the sinuses, hearing, and teeth. I have found scalene trigger points to be obviously clinically relevant to conditions as seemingly different as:

• a professional singer with a mysterious degradation of quality in his voice (helped by releasing scalene and other throat trigger points)
• at least two patients with severe chronic sinus infections that they’d actually had surgery to try to correct (one of them virtually cured by scalene trigger point release alone, the other significantly helped)
• several people with severe cases of what I call “brick back,” where the space between the shoulder blades feels so stiff and stuck that it’s like there’s a cinderblock there instead of bone and muscle

Massage therapists have vanished while working in the anatomical Bermuda Triangle, never to be seen again.

Scalene trigger point effects are so elaborate and seemingly out of proportion that they are almost always making at least some contribution to do with anything else that goes wrong in the whole region — like organized criminals, scalene trigger points can be counted on to mess up the area. Anterior scalene in particular is a trouble-maker, I find, causing and complicating many other problems in the area.

A strange muscle group indeed!

The scalenes fan out from the neck bones to attach to the top of the rib cage, behind the collarbones. The group consists of three muscles, the anterior, middle and posterior scalenes. They generally attach to the sides of the neck vertebrae at one end, and to the uppermost ribs at the other end. Thus, they pull the head from side to side. And although they certainly move the neck, they are also breathing muscles, because of the way they pull up on the ribs.

And here’s some more weirdness that makes this group rather interesting: in some people — quite a few, actually —at the lower end, the scalene muscles even reach between the ribs and attach directly to the top of the lungs!

The scalenes as a group are not hard to find, although they are intricate in their details. The scalenes simply fill the space between three obvious structures: your collarbone, your trapezius muscle on top of your shoulder, and the long v-shaped throat muscles (sternocleidomastoid).

Perfect Spot 4 is as much a method as it is an actual location. By massaging the scalenes in a certain way, you are likely to produce sensation and stimulation which is both interesting and useful, without risking some of the nastier (sharp, burning) sensations that scalenes can also produce.

Place your partner lying face up on a bed, with his or her head in the corner of the bed. Sitting above, hold your fingers flat and place your fingertips in the hollow of the triangle. Your fingertips are fairly far inward. Your hands are angled, pointing downwards and inwards at the sternum. Now press down and perhaps a little bit inwawrds with a fairly broad pressure on the ropy muscles that fill the triangle. By using a broad pressure, you can fairly easily stimulate some trigger points without having to worry about being too accurate.

Is there any danger, massaging in this seemingly vulnerable area?

Many people are concerned about the possibility of impinging blood vessels or nerves. Don’t worry about: if you touch the carotid artery or the jugular vein, there’s no missing the intensity of the pulse, and you simply back off. Smaller vessels are simply not a concern, and nerves — even nerve roots — are remarkably robust, and generally tolerate far more pressure than most people realize.

Are there “other things” in the throat? Well, the trachea and voice box are certainly more brittle and delicate structures — but they are also quite obviously too central to be pushing on them when doing scalene massage. No one will tolerate careless pressure on these parts! And there really just isn’t anything else you need to worry about.

You can also feel free to explore in the anatomical triangle with your fingertips: it is a rich minefield of trigger points, many of which may be worthwhile and interesting. Just be aware that if you get into detail in this area, you may well encounter trigger points that feel hot and burning and nasty — not really at all the kind of trigger point you want to mess around with for fun.

As I’ve already suggested, sensation produced by massage in this area can be unpredictable, strange. The broad pressure is likely to produce the most straightforward possibility: a peculiar but more or less pleasant deep ache spreading into the head, chest, back, and or arm. But be prepared for anything!

One possibility with scalenes to be aware of is that it doesn’t always feel good at first. Posterior scalene in particular is grouchy, and even the gentle approach to Perfect Spot No. 4 may feel kind of hot, nasty and vulnerable at first. But if you persist respectfully, there is a good chance that the sensation will go from hot to warm, and begin to spread. Spreading is a good sign that it’s going well, and it will start to feel like scratching an itch you didn’t even know you had.

If you don’t get any results with this point, come and see me. Don’t worry: I can show you where it is! I know the Anatomical Bermuda Triangle like the back of my hand.

A surprising relationship between the scalenes and tennis elbow

The scalene muscle group has surprising importance to a condition called “tennis elbow” or lateral epicondylitis, which commonly afflicts typists as well as racquet sports players. It is generally characterized (by its name!) as an inflammatory condition, but it is probably not that simple.1 It is likely that myofascial trigger points, particularly Perfect Spot No. 5 in the muscles of the forearm, play a significant role in tennis elbow.

And Perfect Spot No. 4 seems, in turn, to significantly affect Perfect Spot No. 5. Travell and Simons write, “Scalene muscle trigger points are frequently the key to [treatment of] forearm extensor digitorum trigger points.”2 This is a great example of an odd benefit to treating Perfect Spot No. 4. For more information, see Massage Therapy for Tennis Elbow and Wrist Pain.