I agree with Kevin in first ruling out more sinister pathologies such as an apical
tumor. Manipulation of the upper cervical region "if it's manip. lesion and
there is no brachio plexius irritation, will reduce the hyperactivity at the
scalene
faster than anything else "in most" in my experience.
Most people I see with scalene hyerfacilitation (which is most) have the classic
upper crossed and lower crossed imbalance. Release of the hyperactive scalene
will only come with coactivation of the inhibited antagonists "PNF". Perform a
release
of the scalene while the patient INTENSELY coactivates the downward scapular
depressors. It is critical that pure scapular depression is performed with no
retraction
or protraction. These inhibited muscles can be better facilitated by putting 3-4
tennis
balls in a sock and used on each side. I call it "downward chest expansion" or
Charles
Atlas chest.
Scalene inhibition in my experience will occur only when the patient can
adequately
facilitate this inhibited muscles in a functional way and this adaptive posture
corrected. The adaptive shortening and scar tissue of the scalenes must be
released as
well as any hyper irritable "nerve knots" and TPs. The lower crossed imbalance
will also
have to be corrected for a permanent correction of the chain dysfunction. The
patient is
probably an upper chest breather, is either tense or sits alot.
I'll stop know, Hope this helps
Best of luck
Keith
Keith A. Zenker D.C.
Santa Cruz, CA
[log in to unmask]
[log in to unmask] wrote:
> Patient with scalene pain and SCM insertion pain. No history of trauma, pain
> increases with shoulder abduction. Patient describes pain as being behind the
> SC joint. Came back today after home program of mild scalene stretches with
> increased complaints of pain. I am having trouble figureing etiology of pain.
>
> Steve Marcum PT, CSCS
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