Ep 303 - The Attachment Disorder of the Scalenes: “The Rebel MT” with Allison Denney

0:00:00.4 Speaker 1: This episode is brought to you by Rebel Massage Deep Tissue Body Butter. Crafted because oil is too slick and lotion absorbs too fast. These organic, professional-grade bodywork butters give you the grip you've been looking for. The best techniques in the world can get lost without the right product to support them. Try the Get a Grip version for more specific, focused work, or the Total Meltdown version for that grip with a little extra glide. Made by a massage therapist for massage therapists. Head over to rebelmassage.com to get your grip today. 

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0:00:48.6 Speaker 2: The scalenes have an attachment disorder, which is a good thing in the grand scheme of things. You wanna know that the muscles that are responsible for your breathing are working hard at what they do. But you know how attachment disorders go. Too much attachment equals limited flexibility and a few other problems, which can create even more problems. The scalenes, though, have a big job which can weigh on them like the list of things that need to get done before the holidays hit. And it takes a toll on how they function. We've seen the fallout, a crick in the neck, limited range of motion, and all the versions of Thoracic Outlet Syndrome under the sun. But I want to break down these little ropes of respiration and talk about what having too much responsibility is really all about. The scalenes live in a part of the body that is riddled with very important components. You most likely know them. The brachial plexus, the subclavian artery, and the internal jugular vein, to name a few. And these are just a few that are actually in direct contact with the scalenes. But as the body does, one thing is connected to another and these things pull and tug at other things and all the parts that are not in direct contact get sucked into the vortex too. 

0:02:08.3 S2: For example, some tight scalenes can pull on the transverse processes of a vertebra and slip that vertebra out of alignment, which can tilt the head ever so slightly to one direction which can shorten and tighten the tissues deep to the base of the skull, which can cramp the eustachian tubes, which can clog a sphenoid sinus, and suddenly you're snoring at night and you can't figure out why. But let's backtrack a bit. Without considering the downward spiral that is somewhat inevitable, the scalenes, like any other skeletal muscle in the body, have actions that they create when they contract. For the most part, these involve moving the head and neck into various positions. I will elaborate on these in a bit. But they also lift the ribs. Not like they lift the ribs out of a funk and into feeling better about themselves, but they are actually attached to the first and second ribs and elevate them during inhalation. Dangling down from the side of the cervical spine, they grab onto the ribs like they are fishing and caught a big one. When they pull up and try to secure their catch, they tire themselves out. Okay, I guess it's not quite like that, but after years of pulling the first two ribs up to expand the rib cage so that the lungs can inflate, they get exhausted. 

0:03:26.7 S2: So they call in the troops for a little assistance. And by troops, I mean connective tissue. And by connective tissue, I mean fibroblasts. Like any muscles attaching to any bone, it is the connective tissue that is the glue. And connective tissue being of the sort that loves connection so much that it proliferates to make it stronger, kinda like when Spider-Man slings some extra web to prevent a building from falling down, that grip gets strong. This is where a healthy attachment becomes an attachment disorder. Too many fibroblasts equals chronic problems. So what do we do with this information? Well, to quote a massage therapist I'm really good friends with, if you know your anatomy and you know your physiology, the techniques will come. If we look at the scalenes, we must first take a dive into the posterior triangle of the neck. This curious section of neck anatomy reveals quite a bit of relational turmoil. Its borders consist of the sternocleidomastoid in the front, the anterior flap of the upper traps in back, and the clavicle at its base. And its push and pull on the skull is so intriguing that I did an entire episode on it a few months back. I'll leave a link to that episode in the show notes. But for this one, I wanna go beyond the borders and into the triangle itself. 

0:04:48.3 S2: As one might explore the inner workings of a black hole, except it's not that severe because no one is gonna turn into spaghetti if they palpate the scalenes, examining the posterior triangle of the neck reveals some incredible anatomy. If we think about it as simply as the neck is the passageway or the wormhole, if we're sticking with the space theme, between the head and the heart, there has got to be some important stuff in there. And the scalenes not only live there, but directly interact with a lot of those elements. Superficial only to the longest coli muscle cuddling up to the front of the cervical spine, and the anterior and posterior intertransversary coli muscles creating Morse code-like dashes connecting the transverse processes of the cervical spine, the scalenes are pretty deep. But they're not impossibly deep. The triangle is moderately exposed, save the skin and fascia of course, so we can access the scalenes, but navigating with caution is indeed important. Side note, I sometimes think that the red flags bodyworkers become aware of scare them to the point of not being able to work with confidence, or worse, not being able to work at all. So please heed this advice with the balance of a trapeze artist. Understand what can go wrong, but use this knowledge to your advantage. 

0:06:10.8 S2: There are three scalene muscles, anterior, middle, and posterior. If I describe their origins and insertions in detail, this episode would get boringly long. So instead, I want you to think about them like this. All three of them originate with varying design on the transverse processes of C2 through C7. Towards the front of the side of the neck, the anterior scalene drops down to connect to the first rib. At the actual side of the neck, the middle scalene also tumbles down to grab onto the first rib, only a little closer to the spine. And then towards the back of the side of the neck, the posterior scalene falls even farther to grasp the second rib. None of these reach out beyond an inch or two of the spine, otherwise we would look a little more like a threatened king cobra. This might make necklace wearing a tad difficult. So the three of them work together like pistons in a car engine, constantly contracting and relaxing to create a lot of the cool movements a head and a neck can do. If the three of them are working on one side of the body but not the other, or unilaterally, they flex the head and the neck to the same side and rotate the head and the neck to the opposite side. So if the right scalenes are contracting, your right ear would drop to your right shoulder, or your nose will point to the left. If all six of them are working together on both sides of the neck, or bilaterally, they flex the head and the neck so that your chin drops to your chest. 

0:07:40.4 S2: And here's the pièce de résistance, they elevate the rib cage during inhalation, which is the exact action I have been referring to this whole time. There is no doubt that the flexion and the lateral flexion and the rotation and all the combinations therein that are happening as you move your head around to try to be a part of this world we live in are really cool. But the elevation of the rib cage is not only cooler, it's necessary. Although we would not choose this, not tilting and turning our heads and necks is something we could live with. But breathing? Not so much. Not that all of the breath is relying on the scalenes ability to lift the first two ribs, but like the downward spiral I referenced previously, not being able to breathe fully can create a lot of dysfunctions that can quite literally lead to a domino effect of internal breakdowns that I would not wish on anyone. So the gravity of life demands more from the scalenes than most other skeletal muscles, and their attachment disorder becomes completely understandable. In the same way though that managing someone who is too attached to a thing or a person or an idea can be challenging, forcing them to let go can often result in them gripping even tighter. 

0:08:58.1 S2: As body workers, we often believe that digging deeper or stretching longer is the answer to all things. But it is more nuanced than that. As in life, finding balance where there is imbalance is the key. Try this. With your client supine, shrug their shoulder up to their ear and ask them to relax into this position. Use one hand to support under their shoulder and palpate the clavicle on that same side. If you use your hand that is under their shoulder to lift it up away from the table, you'll notice more space between the clavicle and the ribs. This can help you locate things, but you will want to rest it back down to the table to do your work. From here, curl your fingers around the clavicle superiorly until you feel the connection of the anterior and middle scalenes onto the first rib. You can use your thumb to grab the clavicle and gently shift it around in its space. This will allow for some anatomical breathing room. But once you have found the scalenes and their grip onto the ribs, ask your client to take a few deep breaths, reminding them with every inhale to breathe in more deeply and with every exhale to let all of the air out of their lungs. Then, without fear of judgment, literally thank your client's scalenes for the hard work they do lifting the rib cage and moving the neck into curious positions. 

0:10:17.1 S2: And then, gently sink in. You can hold this nurturing compression until you feel things soften. You can draw delicate little circles or lines and encourage the connective tissue to not be so connected. Or you can use your hand that is holding your client's shoulder to move the related structures around just a bit so that they begin to understand their relationships to each other. An old habit is hard to break, so this may take some repetition. Over the course of one session or many sessions, repeat this work and offer the scalenes permission to let go. No two clients are alike as no six scalenes are alike. Don't fight the attachment and expect that it will surrender to your power. Bring softness and support to these little worn down muscles. Movement always comes easier with the supportive cushions of ease and gratitude. But note and fun fact, when doing my added research about king cobras to make sure I was referencing the right snake, I read that the hood at the head of the snake that a terrified mouse might see before getting eaten by said snake is not just a cool trick of the skin, it is actually an extension of the snake's ribs and bones that can flex and move in ways that we humans can only dream about. Whether or not this is your dream is up to you. But I have to say, if I could flex and move my ribs and bones like that, I might have a lot of fun scaring people at parties. 

0:11:45.8 S2: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you want to get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L-M-T@abmp.com. I always want to hear your questions, comments, suggestions, or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage Dabblings. 

0:12:36.6 S1: Members are loving ABMP 5-Minute Muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP 5-Minute Muscles delivers muscle-specific palpation and technique videos, plus origins, insertions, and actions for the 83 muscles most commonly addressed by bodyworkers. ABMP Pocket Pathology, created in conjunction with Ruth Werner, puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members, log in at abmp.com and look for the links in the Featured Benefits section of your member homepage. Not a member? Learn about these exciting member benefits at abmp.com/more.