How to Release Scalene Trigger Points in the Neck, Shoulder, and Back


It might surprise you to learn that all the pain and discomfort around your neck, shoulder, back, and ribs originate from a small muscle group called scalenes, nestled deep inside your neck. But we have good news – pain relief is possible. Scalene trigger point therapy can be your effective pain management strategy for your upper body pain complaints.

Scalene trigger point therapy is a staple in massage therapy clinics, orthopedic facilities, and other clinical settings. They help physical therapists and health experts treat chest pain, back pain, shoulder pain, arm pain, wrist pain, and neck pain complaints, etc.

A seasoned physical therapist can release the scalene trigger point responsible for various body pains by tracing out the underlying causes and applying effective therapeutic techniques to rid the symptoms. 

In this guide, we’ll show you the importance of scalene muscles in the body and how to deal with symptoms emanating from them. We’ll also show you how best to treat your scalene muscles to keep them in tip-top shape.

Where are the Scalene Trigger Points?

The scalene muscles are a tripod-shaped group of muscles extending sideways and centrally from the neck to the ribs. They support your head and neck, allowing you to bend forward and tilt sideways. They also support the cervical spine, enabling upright posture. 

Inhalation also depends heavily on them since they raise your two upper ribs to accommodate your expanding lungs. That’s why they can sometimes be responsible for cardiac-like symptoms.

Now, each leg of the ‘tripod’ comprises a different scalene muscle group and has a different configuration of trigger points (the ground zero of pains). When overstretched and overwhelmed, these trigger points can light up, resulting in a variety of symptoms (e.g., radiating arm pain) that often spread to other parts of the body. 

Stress factors like vigorous activities, extreme coughing/sneezing, and panic attacks, can activate trigger points in these muscle pairs.

Let’s take a closer look at each of these muscle pairs and the symptoms associated with their trigger points: 

Anterior Scalene 

The anterior scalene muscle group is the outlier that protrudes out from the rest of the structure. It’s nestled between the SCM (sternocleidomastoid) and the neck vertebrae and enables you to rotate your neck. It’s also considered an accessory to breathing because it raises your first rib when you inhale. 

The most common symptoms that originate from anterior scalene trigger points include:

  • Two-pronged pain strokes around the chest region

  • Shoulder pain

  • Pain on the underside of the shoulder blade

  • Numb, painful, or tingling thumb or index finger

  • Difficulty breathing and chest pain

  • Thoracic outlet syndrome

Middle Scalene

Branching sideways between the anterior and posterior scalenes, the middle scalene muscle group lean sideways, resting on the shoulders rather than the ribs. Similar to the anterior scalene, movements in the middle scalene muscles help you rotate or flex your neck and also raise your ribs when inhaling. 

When activated, trigger points in the middle scalene can cause: 

  • Cold, numb hands

  • Pain around the hand and arm

  • Aneurysm in hand arteries

  • Thoracic outlet syndrome

Posterior Scalene

Lying almost flat and extended from the neck to the back of your ribs, the posterior scalene muscle group is nested right below your shoulder muscles. It also enables the flexing and rotation of the neck and supports breathing by raising the second rib.

With its unique trigger point configuration and positioning around the back, it’s associated with symptoms like:

  • Weakness and numbness around the shoulder and arm

  • Discomfort in the fingers

  • Upper back pain

  • Tiredness in the arm

What Causes Scalene Pain Complaints?

Scalenes are one of the most heavily utilized muscle groups – you deploy them every single time you breathe or move your head. Unfortunately, they’re also among those most susceptible to pain. 

Here are some stressors that can activate trigger points in scalene muscles:

Excessive Coughing

Every time you cough, you engage your scalenes. Coughing incessantly for long periods can weaken your scalene, making it difficult for your lungs to expand and process fresh air. As a result, you might find yourself coughing harder and harder unless you get a quick intervention. 

On your own, you can practice proper diaphragmatic breathing to reduce pressure on your chest. Diaphragmatic breathing revolves around moving out your belly, rather than your chest when breathing in. 

Poor Breathing

Labored breathing is often a symptom of underlying conditions like anxiety, panic attacks, emotional tension, etc. But scalene muscles can get overworked under these circumstances, further compounding breathing difficulties. 

People with chronic respiratory conditions like asthma, pneumonia, and bronchitis often struggle with scalene issues. People struggling with chest breathing – breathing in with their chests out – also seriously strain their scalenes.

Scalene muscles issues can also make you cough harder when you’re down with a common cold or allergies, with the muscles struggling to lift your ribs when you’re constantly coughing.  

Try practicing diaphragmatic breathing. It helps people distress when dealing with anxiety and crankiness. It’s also widely used to calm the mind and body during yoga and meditation.

Poor Body Posture

Poor body posture can lead to pain in various parts of the body, including the scalenes. People who sit in front of computers with their heads leaning forward for long hours often grapple with upper body pain complaints. 

You can also have improper postures that hurt your scalene muscles when doing house chores or other physically demanding work for long periods. In fact, any time your head isn’t in an upright position, you tax your scalene muscles. 

Always stay conscious of your body posture, no matter what you do, especially if you do something for long hours. The best posture always has your head held up in an upright position along with your spine, whether you’re sitting, standing, or walking. When lying down, make sure your head is properly aligned with your spine and lower parts of your body.  


If you’ve developed whiplash from a car accident, you can effectively mitigate the pain in your upper body by releasing scalene trigger points. 

Whiplash patients can gain relief through trigger point therapy, corrective exercises, and other therapeutics. 

Scalenes Self-Trigger Point Release Technique 

By now, you probably know enough to learn how to release scalene trigger points on your own. You know where the muscle groups are located and can carefully attempt releasing the trigger point on your own.


Note that it’s always safer to consult with a qualified physical therapist rather than venturing into DIY trigger-point release techniques on your own. That’s because there are many precautions you need to take to avoid causing fractures, nerve damage, or cardiovascular complications. 

A physical therapist applies clinical knowledge as well as well-trained eyes and clinically nimble fingers to probe scalene trigger points and mitigate them in patients. 

If you run into any complications while trying on your own, you need to seek medical attention immediately. Serious contraindications include:

  • Dizziness

  • Numbness

  • Diplopia (double vision or visual blackout)

  • Nystagmus (eyes moving sideways uncontrollably)

  • Speech difficulties (Dysarthria)

  • Eating difficulties

  • Nausea or vomiting

General Guidelines

Here are guidelines that’ll help ensure a successful release session: 

  • Clip your nails to avoid hurting your neck.

  • Use 1-2 fingers to make short, half-inch strokes; use a lacrosse ball or tennis ball to reach deeper spots.

  • Perform multiple strokes on each point throughout each muscle, and 10–12 strokes on tender spots multiple times a day.

  • When touched, trigger points shouldn’t be painful beyond 4 or 5 on a scale of 1–10.

  • Don’t press down on a spot that has a pulse.

  • Don’t stress about perfecting your move. Focus instead on just the basics, taking note of the precautions above and monitoring pain levels.

DIY Trigger Point Release Techniques

For Anterior Scalene Symptoms:

  1. Place your fingers between your neck vertebrae and the sternocleidomastoid (SCM) and pick out the rope-like muscle running from your ear down.

  2. Grab your SCM between your fingers and thumb of your opposite hand.

  3. Release your thumb and use the other fingers to pull the SCM a couple of inches towards the trapezius muscle.

  4. Press directly back to press your anterior scalene directly against your vertebral column and release pressure underneath your fingertips.

For Middle Scalene Symptoms:

  1. Repeat Step 1 above, this time starting right underneath your ear and pressing against a ‘bony knob’ on the side of your neck.

  2. Breathe in a few times to see if a muscle twitches below your fingertips. If it doesn’t then you probably haven’t picked the right spot.

  3. Use the same stroke as the anterior scalene technique all through the muscle, from the ear to the middle of the collarbone.

For Posterior Scalene Symptoms:

Place your middle finger underneath the intersection between the trapezius muscle and the collarbone.

Press downward and move your finger an inch toward your neck.


Once you start feeling a pleasant sensation around your scalene muscles by using this self-trigger point therapy, you can continue for as long as you need. However, it’s always best to leave it up to a qualified physical therapist. This reduces the risk of complications, increases your chances of success, and speeds up your recovery.

At Fit Club NY, you have access to tailored scalene trigger point therapy sessions with seasoned physical therapists. Call today or stop by our state-of-the-art Chelsea Manhattan, Williamsburg Brooklyn, or Astoria Queen’s clinics in New York City.

Share the Post: