Name: Scalene Static Manual Release (Soft Tissue Mobilization)
Uploaded: 2023-04-26T01:02:54.000Z
Duration: 21 min 26 s

English captions

https://stream.mux.com/O3jO00TOzzeulkCHdEWM02i802rsJ5OH02kh3OlwdH9qNkI.m3u8

Learn the proper technique for scalene static manual release (a.k.a. soft tissue mobilization, ischemic compression, trigger point release) in this comprehensive step-by-step instructional video from the Brookbush Institute. This evidence-based video provides detailed guidance on assessment, positioning, tissue differentiation, and pressure application to address scalene trigger points, alleviate neck and upper thoracic pain, and improve breathing mechanics and cervical spine mobility. Ideal for clinicians and movement professionals, including physical therapy students, massage therapists, athletic trainers, and chiropractors, seeking to enhance their manual therapy skills for cervical spine rehabilitation, performance, and pain management.

Introduction to Manual Techniques for Licensed Therapists

Static Manual Release Technique for Scalenes

Identifying Anatomical Landmarks of the Scalenes

Considerations Regarding Surrounding Structures During Assessment

Practical Application of Scalene Release Techniques

Importance of Hands-On Training and Practice

Scalene Static Manual Release (Soft Tissue Mobilization)

This is Brent of the Brookbush Institute in this video we're bringing you another manual technique now if you're watching this video I'm assuming you're watching it for educational purposes and that you are a licensed manual therapists following the laws regarding scope of practice in your state or region that means athletic trainers chiropractors physical therapists osteopath licensed massage therapists you are likely in the clear to do these techniques personal trainers this probably does not fall within your scope of practice although you might be able to use the palpation portion of this video to aid in learning your functional anatomy in an educational setting supervised by a licensed manual therapists now before we place our hands on a patient or client it is important that we assess and have a good rationale for doing so and of course if we're going to assess then we should be reassessing to ensure that the manual technique we're using is effective and we have a good rationale for continuing to use that technique in this video we're going to go over static manual release of the scalenes that's the anterior middle and posterior scalenes I'm have my friend Melissa come out she's going to help me demonstrate now we're going to use the same four step process we've used for all of our static manual release videos in this case I want to start with step 4 and talk about patient or client position notice that I had Melissa come out and laid down immediately I have seen texts and videos that refer to scalene release in the seated position it's hard for me to believe that it would be easy to palpate or release these muscles in a seated position where the scalenes as well as the other lateral stabilizers of the cervical spine are going to have to remain somewhat active to stabilize the cervical spine in the head against the force of gravity if you have somebody laid down all this stuff relaxes which means now we can get our fingers in here so we can actually find the scalenes and get a good release now trying to differentiate the scalenes is not easy I see a lot of people just kind of going at the side of the neck and I feel like they're almost just hoping that the scalenes are in there but there's some other stuff in there too that we've already talked about some other videos like the levator scapula and the splenius cervicus so we need to figure out how are we going to differentiate these tissues well first let's start with identifying where the posterior cervical triangle is because I know that my scalenes are in there the posterior cervical triangle refers to a triangle that has the SCM as its anterior border so more so go ahead you lift your head so you guys have somebody turn their head away and then lift up towards the ceiling their SCM pops right out that's easy to find all right I'm to make sure I can feel that border I have it identified I know where it is and then this mass right here is your upper trap that's the posterior border and then the bottom of this triangle is actually just kind of a top of the shoulder girdle here so inside there is my scalenes all right first step done next is going to take a little functional anatomy knowledge so I know that my scalenes anterior middle and posterior come off the transverse processes of my cervical spine the transverse processes are not something that you want to jab at but you can palpate by gently kind of letting your fingers to press into the side of the neck and looking for what feels like bony spines almost okay they're kind of spiny don't press real hard but you'll notice that they definitely feel different than soft tissue transverse processes feel like they're not going anywhere no matter how hard you press soft tissue obviously you can kind of kind of almost feel like you're going to push through once you find those transverse processes we now have a good idea of where the origin of these muscles are the insertion is in the first and second rib now if you've never felt the first and second rib these aren't your first and second ribs and I know that seems a little counterintuitive but generally speaking the first two ribs underneath the clavicle or your third and fourth rib your first and second rib almost exists behind the clavicle they're much smaller right they almost exist in this space here just above the lungs really so how do I figure out where those first and second ribs are well the easiest thing to do is probably fine c7 spinous process that's the biggest spinous process at the bottom of the base of your neck right here all right so if I find that on Melissa and then I fall off laterally now what you're probably going to have to do is flex the neck towards the side your palpating so that the trap will calm down once again you'll feel something that is definitely not soft tissue that's definitely a bone right there and sure enough right there I'm going to go ahead and move this so they can scream now I wouldn't have to move her strap for any therapeutic reason i can i can get at her neck without moving that but i want you guys to be able to see kind of where my hand is if i push down right there that's definitely bone well that's my first rib that's my first rib and then if I know where c7 is I could go to t1 and try to see if I can palpate the second rib a little harder palpation there guys it's almost easier to just kind of step off inside the AC joint here right into a clavicle or acromion shelf if I get in there and kind of feel the second rib that is one of those points where it's really helpful to have some live education or a mentor or kind of demonstrate those two techniques because it's not easy to find those in the soft tissue here guys but with a little bit of patience and maybe a colleague who is little patient with you I think you guys will find them at the very least you know that there's this bony floor to this area right here at the top of the shoulder girdle that your scalenes attach to from the transverse processes and so hopefully you guys can kind of summarize that i'm looking for something inside of this posterior cervical triangle that goes from the bony spikes on the side of the cervical spine to the bony floor at the top of my shoulder girdle now going back to the bony spikes if i start up closer to her head and I go anterior to posterior kind of over but not into those bony spikes I should start to be able to identify some very vertically aligned fascicles and my scalenes are very vertical muscles based on what I just told you they attached to being the first and second rib and the transverse processes something like my levator scapula which also attaches to the transverse processes is going to have a little bit more of an angle going towards posterior if you're still having a hard time identifying these fascicles what you could do is use your two fingers right to palpate in this posterior cervical triangle but then have your client like push into that same palm a little bit with some lateral flexion right that'll get a bunch of stuff really active including the SCM on what you palpated earlier but then if they go into just a little bit of flexion which is lifting their head off the table you definitely would inhibit the levator scapula so now you know that as long as your posterior the scalene our posterior the sternocleidomastoid you're in the posterior cervical triangle and you're feeling vertical bands that's definitely your anterior and middle scalene all right so now that we found the anterior middle scalene we do have to talk for a second step number two which is what structures are around these structures that I could insullt abrade injure with compression we have the carotid artery let's let's stay away from the carotid artery we don't need anybody passing out on us I think you will find that if you gently apply pressure rather than just aggressively going in that you would find a pulse well before you would ever occlude an artery and there's nothing on the feeling a pulse but it is a good sign that you should probably press somewhere else remember that the carotid artery isn't very thick all you have to do is move a few millimeters in any direction and I think you'll be able to change your finger angle to still get it the same fascicles without occluding that artery the other thing you might want to stay away from is there are little beads in here which are lymph nodes you don't want to like take one of those beads thinking it's a trigger point and press it up against the transverse process thats a very bad idea we don't want to try to crush lymph nodes is going to cause inflammation could cause some symptoms but we don't want to deal with last your brachial plexus actually pierces between your anterior middle scalene and that's its normal course it comes out those nerve roots right and they all those various nerve roots combine to become the brachial plexus and it comes out between the anterior middle scalene goes underneath the clavicle and underneath the pectoralis minor and then feeds all the nerves to the arm right we don't want to push on the brachial plexus because a we can cause some nerve symptoms we don't want to cause tingling we don't want to cause something that's going to almost look like a radiculopathy we don't want to cause numbness or that nerve pain we don't want to push down on the brachial plexus and create that searing burning stretch i'm sure some of you have felt when you stretch a nerve we want to stay away from all that so if your client complains of any of those symptoms once again all you got to do is move a couple millimeters in any direction maybe change the angle of your thumb and you should still be able to get those same tissues so I know this is a lot of information guys which is why I'm glad this is on video you can put it on repeat a couple times but let's review you have posterior cervical triangle we know it's in there if I want to differentiate my anterior middle scalenes for my levator scapula which is probably the only other issue we have or maybe the the splenius cervicus I can use a little bit of lateral flexion and then flexion off the table to make sure I start there once I found those vertical fibers to find the densest fascicles and to find these trigger points tender points points of acute hyperactivity I'm going to do my anterior to posterior strumming since these are vertical fibers as I move from inferior or superior to inferior and our common trigger points are actually much closer to the ribs so I think what you guys will find is nine times out of ten rather than there being trigger points up in the middle of the neck they're much closer to the base of the neck and so I can actually feel here in Melissa that the tightest fascicles are right about there I don't feel a pulse any nerveyness you know nerveyness no little lymph node type feeling beads all right and then I can feel that it's a little denser there it gives me a little nodule all right so I can hold that for my 30 seconds to 2 minutes until i get a nice release guys an important thing to keep in mind here is I'm not pressing lateral to medial I'm actually pressing I have a little lateral to medial angle but I'm mostly pressing superior to inferior and so I'm pressing towards the rib the reason why that's important is pressing into the transverse processes is going to be painful and I think as soon as we stimulate pain once again it becomes very hard to get a release I know that this is not comfortable for Melissa but there's a difference between this and pinchy pain which just does not feel good now to find the posterior scalenes all you have to do is keep all that anterior to posterior strumming in mind but then think okay my posterior scalene goes from c6 c7 transverse processes down to my second rib so it's almost like that splenius cervicus pocket that we talked about in the splenius cervicus release video but rather than go towards the laminar trough back this way and towards the is process I'm going to go kind of out this way towards the second rib and the fibers are looking for are much more vertical this is good technique to pick up because posterior scalenes tend to get very overactive and I can just do the same thing again if I need it to if I needed to try to differentiate for example the posterior scalene from the anterior and middle scalene I could go lateral flexion into my palm so mostly pressing into the arm i'm using for release and then if she extends back into the table boom right all of a sudden her anterior middle scalenes calm way down and her posterior scalenes fire up just like with all your techniques guys take your time this is not a race your patient has no idea what you're doing your patient has no idea how long this is supposed to take I know you want to get a lot of work done but I used to hate when my mother said this but I'm going to tell it to you guys the quickest way to get anything done is to do it the right way the first time man I used to hate that but now it makes so much sense so take your time use lateral flexion use flexion and extension to help you differentiate tissues if you have to use the SCM technique of contralateral rotation an flexion to find the SCM great that's fine if you have to sit there and find c7 to find the first rib because you've never felt that before fine somebody has Anatomy that's a little different than you're used to somebody's a little maybe a bigger person or a more muscular person or much more slight than you're used to dealing with all these little cues knowing your functional anatomy and taking your time with your palpation will be your savior you can still get to all of these tissues just about anybody and you should be able to get to them comfortably without causing discomfort from impending a nerve or whatever just simply by keeping your functional anatomy in mind stay tuned for the close-up recap and this close-up recap of our scalene static manual release we're going to start by outlining that posterior cervical triangle most of you would lift your head real quick you guys can see there's SCM ok so this mass right here is the upper trap so we know we're going right in between the two in here this being the floor of that triangle now the first thing I'm going to look for is those transverse processes because what I don't want to end up on is end up back here where it's more likely that i'm going to release my levator scapula and splenii I want to find the origin of these muscles so that I can start doing my anterior to posterior strokes towards their insertion down on the first and second rib now if I'm having problems finding those muscles like they're not popping into my fingers I'm not feeling the strands or I think by chance I'm on either the levator scapulae or splenii I could have Melissa go ahead and kind of push into my hand here a little bit with lateral flexion and although the SCM puffs up pretty quick I know where I know thats my SCM if I have her then go into a little bit of flexion I know that the muscles behind my SCM that are puffed up from lateral flexion and flexion are my anterior and middle scalenes disflexion inhibits my levator scapula and splenii muscles so right there go ahead and relax Melissa right there I know I'm on nothing but scalene of course I can do my anterior posterior strokes here looking for the dentist fascicles once I find them I'm going to go ahead apply pressure now of course since I'm in the area of the neck I am keeping in mind do I feel a pulse am I getting any nerve symptoms does Melissa have any tingling or numbness does she have that searing stretchy pain of stretching a nerve am i on a lymph node does it feel like a like I have a little lima bean underneath my finger remember these densities inside muscle just feel like an increase in tissue density and might feel a little ball like but it's more just denser parts of the same structure that you're feeling now to find the posterior scalene is a little tricky I suggest going anterior middle scalenes first and then what you can do is ensure that you're down low enough that your lateral to c6 and c7 right because that's where your posterior scalene in our originates and then you can have your patient do lateral flexion into your hand again and extend back into the table and you'll feel those fibers pop out all right so if you know you're pretty close to anterior middle scalene come back on to where you think posterior scalene may be and then you confirm by doing lateral flexion and extension you're probably in good shape go ahead and relax and then posterior scalene definitely gets tight on a lot of people the common trigger points for all of these muscles guys are very close to the first and second ribs so right about where my thumb is that right at the base of the neck there is a common trigger point for anterior scalene that's up a little higher about midway up the neck but again these are all far more common down here and as I suggested in our further away shot supine is probably the best way to get this technique done this isn't uncomfortable for me I can get my arm behind my direction of pressure which is going to be down towards the rib right not into the transverse process down towards the rib and of course my my patient here is very comfortable as shes just lying with her head supported so there you have it knowing your functional Anatomy will definitely help your manual technique it'll help you differentiate structures so when you can place your hands where they need to be as well as make you aware of these sensitive structures around the tissue that you're trying to target things like nerves and lymph nodes and arteries make sure that if you're going to place your hands on a patient that you have done an assessment and have a good rationale for placing your hands on that patient and if you're going to assess make sure you reassess to ensure that your technique was effective and you have a good rationale for using that technique again now with manual therapy one-on-one live education is incredibly important please be looking for opportunities like workshops and mentorship and maybe even classes at your local university that can get you some one on one individual instruction or at least a live classroom instruction so you've had a chance to be critiqued and mentored by somebody senior to you with some experience in manual therapy techniques and before you bring the stuff back to your rehab fitness or performance setting please practice on colleagues there is no substitute for practice and it is going to take a while to get accustomed to some of the techniques that we show in these manual technique videos don't expect to learn them in two or three or even five minutes you want to have hours of experience under your belt working on various different body sizes and shapes so that when you do get that first paying client first paying customer and you're really trying to make a good positive impact really trying to promote better outcomes you feel comfortable with that technique I look forward to hearing about your outcomes and hearing your questions in the comments section of this video I'll talk with you soon you

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Manual release techniques for the commonly overactive muscles of the cervical spine. Soft tissue release techniques for the suboccipitals, sternocleidomastoid (SCM), scalenes, and cervical extensors (multifidi). Advanced soft tissue, massage, trigger point palpation, and mobilization techniques to inhibit antagonists. The reliability and validity of manual release techniques for forward head, shoulders elevate, neck pain, shoulder pain, headache, and upper body dysfunction.

Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors (Multifidi) (Cervical Dysfunction)

The scalenes can be palpated in the posterior cervical triangle.

The anterior border is the SCM, which may be identified by asking the patient to contralaterally rotate the head, and then lift the head off the table (flexion).

 , which may be identified by asking the patient to shrug against resistance.

The inferior border is the skin overlying the space between the 

The origin of the scalenes is on the transverse processes of C2 through C7, which can be palpated in the posterior cervical triangle, in-line with the mastoid process. The transverse processes feel pointy and are fairly sensitive; try not to press too hard.

The insertion of the scalenes is the first and second rib. The first rib can be palpated by finding the spinous process of C7 (vertebra prominens) and falling off laterally. Inching the fingers laterally will result in pressing into the hard, but springy 1st rib which continues into the space between the 

 and clavicle. It is helpful to ipsilaterally flex the neck to soften the 

The second rib is more challenging palpation and is likely best achieved by dropping inferiorly off the posterior aspect of the first rib. Additionally, the second rib may be palpated by falling off the most lateral aspect of the first rib, and pressing deeper into the tissues just medial the acromion shelf.

The scalenes can be palpated by running the fingers anterior to posterior over (not into) the transverse processes, in the posterior cervical triangle, feeling for fairly vertical fibers that run from the transverse processes to the first and second ribs.

 is also a vertical muscle with attachments on the transverse processes; however, the scalenes run vertically and inferoanterior and the 

 runs from the transverse processes in an inferoposterior direction (toward the scapulae).

 When trying to differentiate the scalenes from the splenii and 

 ask the patient to actively flex and laterally flex the neck. This will inhibit the splenii and 

 and activate the scalenes and SCM. The active muscles you feel during active flexion to posterior to the SCM (in the posterior cervical triangle, over the transverse processes) will be the anterior and middle scalenes muscles.

The carotid arteries are anterior to the scalenes. Although momentarily compressing or abutting these vessels while investigating the area is unlikely to pose any harm, obstructing or repeatedly abrading these tissues may be an issue. If you feel a pulse, change your hand position.

It is possible that you will feel the "bead" like lymph nodes in the lateral neck. Compressing lymph nodes into the transverse processes could be problematic. Again, if these structures are felt, adjust your hand position and work around them.

The brachial plexus passes between the anterior and middle scalene. Monitor your patient closely for signs associated with nerve irritation and radiculopathy. If nerve symptoms are noted, change your hand position.

The most common trigger points in the scalenes are closer to their insertion on the 1st and second ribs.

This technique is most comfortable with the patient lying supine and the practitioner sitting at the head of the table.

The practitioner slides the hand opposite the side of the treatment under the patient's head. This hand will be used to control the head and cervical spine.

Using the directions for differentiation above, the practitioner uses the thumb to identify the vertical fibers of the scalenes in the posterior cervical triangle. (Note, flexion and lateral flexion can be used to differentiate the scalenes from the splenii and 

The practitioner then "strums" the fibers from posterior to anterior looking for taut bands, starting with the superior portion of the muscle and working inferiorly.

Once a taut band is located, the length of the band is explored for a dense nodule, and consistent pressure is applied.

Generally, dense nodules in the scalene are found closer to the insertion, near the 1st and 2nd ribs.

The practitioner may move the head to control the amount of tension within the muscle and adjust the force to a superior to inferior direction, to aid in pinning and compressing the nodule and achieving a release.

Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Scalene Static Manual Release (Soft Tissue Mobilization)

Infraspinatus and Teres Minor Static Manual Release (Soft Tissue Mobilization)

Rhomboid Static Manual Release (Soft Tissue Mobilization)

Pectoralis Major and Subclavius Static Manual Release (Soft Tissue Mobilization)

Erector Spinae and Multifidus Static Manual Release

Levator Scapulae Static Manual Release (Soft Tissue Mobilization)

Splenius Cervicis and Splenius Capitis Static Manual Release (Soft Tissue Mobilization)

Deep Cervical Extensor Static Manual Release (Soft Tissue Mobilization)

Sternocleidomastoid Static Manual Release (Soft Tissue Mobilization)

Suboccipital Manual Static Release (Soft Tissue Mobilization)

Quadratus Lumborum Manual Static Release

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