Shortening of the anterior and middle scalenes increases scalene muscle diameter and compresses the interscalene triangle and its contents. The interscalene triangle can be widened by mobilizing the first rib in the direction of exhalation and reducing restrictions and overuse of the scalene muscles.
Scalene Soft Tissue Mobilization and Stretching
Restrictions in the anterior and middle scalenes may be reduced through soft tissue mobilization techniques, including trigger point and myofascial release techniques, and stretching (Vanti, 2007). Following are examples of stretches that may be performed manually and by the patient:
Manual Scalene Stretch
In addition, manual stretching for scalenes may incorporate hold-relax techniques (Vanti, 2007).
Self Stretch for Scalenes
To stretch the left scalene muscles, the patient grabs the seat of the chair with his left hand and leans slightly to the right. He laterally flexes his head to the right and rotates his head toward the left so that he is facing the ceiling. The position should be held for 5 to 10 seconds. The patient then relaxes and then repeats the stretch 5 times (Lindgren, 1997).
Encouraging diaphragmatic breathing will help to reduce hypertrophy and spasm of the scalenes and overreliance on accessory respiratory muscles (Hooper et. al., 2010).