If the scalenes are tight and over engaged, what is weak?
 

I think we all know by now that forward head posture contributes to TOS symptoms. Your scalenes start to do more work and get tight. So if we somehow inhibit the scalenes to disengage something needs to pick up the slack.

Right?

So the question is, what neck muscles, posterior muscles I'd gather, need to be strengthened?

I've been watching videos today on exercises that are best for a pinched nerve. All of these videos show one movement over and over:

* The double chin exercise

Now last time I had an episode I did start doing this pretty frequently. The symptoms disappeared and I stopped doing that exercise.

I'm wondering if maybe this kind of strengthening and others could help give the scalenes a break.

KY

My pt is having me strethem my muscles in the back of my neck in preparation for my scalenectomy.

How so?

I would think if you were to lie on the floor face down and lift your head up repeatedly and then with resistance, that would do the trick.

No takers?

I'm guessing the muscles you have to strengthen here are your cervical extensor muscles. Usually if there is a muscle imbalance you have to loosen one muscle, but strengthen the other. In this case, loosen scalenes and tighten the extensors.

I think I'm not the only one who has noticed that loosening the scalenes is no small feat. But maybe if you strengthen the extensors it becomes easier.

One exercise I've read for this is to lie prone on your stomach, keep the head neutral, lift your forehead off the floor by an inch and hold for a few seconds. Repeat.

Going to try it today.

The one you mention above really works for scalenes! For the head to be in neutral, place a towel folded flat under your forehead, pillow under your stomach and lift the forehead about an inch off the towel and hold for 30 seconds and do 3 repetitions at any given time. You can start with fewer second holds and work it upto 30 secs. The hold is important!!!

Interesting -- I am wondering if you guys have a link with more description that you can share ??

Did this work for you?

I've got to think that you have to strengthen those muscles so you can give the scalenes a break. Once they feel like they're not needed as much maybe they'll give a little.

I just did 4 sets at the gym on a bench. Raised my head to neutral position, held for 5 seconds, repeated for 15 repetitions.

I must say I'm a bit flared up right now.

I don't know if strengthening is the best way to go if you are still having pain levels higher than 3 or so..

If you can get the scalenes released & relaxed it will be easier to bring the shoulders back where they should be.

*make sure any possible trigger points are resolved too*

The way I understand it. Can't recall where it saw or read this... but it made sense to me.

tight frontal muscles (scalenes etc) = over stretched upper back muscles

So trying to strengthen an overstretched muscle will only make the front muscles clamp down more..


This is a loose plan similar to what my chiro & the best PTs did for me.. I also spent a lot of time doing self care at home..

These steps all take time, may even take months or longer for best outcome..

1. check & treat any trigger points ( can't stretch or relax a muscle fully if there are trigger points in it.)

2. the tight muscles must be relaxed /resolved before the next step
*may require ultra sound, low level laser, IF stim, massage, deep tissue work... probably need a pro for this part so you can be relaxed and passive for best results.

3. If low pain /symptoms you can slowly add some light activities & light strengthening ( back off if any increase in pain or symptoms)

4. If all goes well slowly add more activities and as always be aware of posture and possible overdoing of activities..

5. Keep hydrated- to keep those tissues moist and to flush out the toxins..

6. If after time you feel normal, wait another month or 2 before fully getting back into normal mode.. often we feel better but will have a set back due to overdoing..


If you have high pain it will take longer to see improvements.

If you have a direct nerve compression vs slight impingements and sticky tissues/muscle, this may not help much.
Or if there is internal scar tissue, I don't enough about it's properties.


Years ago a DC posted this, it only takes a slight bit of pressure or resistance on a nerve to make it complain.

I lie flat on my back with a pillow under my head. Then with my chin slightly tilted down (move you chin up and down doing this at first to find the appropriate tilt) then push your head back slightly into the pillow, maybe half an inch or so, then relax, and repeat. Once or twice per day, fifteen or twenty reps.

It is the neck extendor muscles that you would want to strengthen. Live strong has another exercise for these muscles, I just tried it, it is more difficult, but seems to engage more of these muscles.

I just received the same advice from an "Applied Kineasiologist" in the Boston area and he more or less said the same thing to me among other things.

He noticed that my left shoulder, on the same side I'm seeing TOS symptoms, was much higher and more forward than the right shoulder. He then went on to poke and prod my muscles and told me that my left pec minor was super tight vs. the right. He even put my finger on each so I could see the difference. Same goes with the muscle just beneath the clavicle. These are two key areas of compression. These two muscles are pulling the shoulder bone forward creating less space in the thoracic area.

He then went on to test my back muscles. Compared to the healthy right side, my lats, rhomboids, and infraspinatus were all weak. If healthy, these muscles would pull that shoulder bone down and back into the socket...also creating more space in the thoracic area.

His instructions were to massage the tight areas for 2-3 weeks. NO STRENGTHENING YET. Then, focus on strengthening the lats and rhomboids.

Not sure if anyone else is in my boat, but it's worth a shot if you think you are tight in front, and loose in the back.

I have the same thing. On my 'bad side', my shoulder is much more forward and slightly raised compared to my other side.

I have often wondered whether Botox in the pec minor would be a good diagnostic tool for me...

What I can't figure out is what caused this?

For one, I battled a left shoulder injury for a year + and recently had surgery in November, so the weakness could be explained by that...and that mess caused the compression.

Or, my anatomy and my predisposal for TOS caused the compression and thus the weakness.

Hell if I know.

Weak core
Mouth breathing
Weak longus colli

The trap muscles are weak.

I do know this much, if the main stabilizers of the scapula (serratus anterior. Lower trap, and Sub Scap ) arent firing properly or you cant seem to get them activated properly and they are a weak as a result of this , the body will over naturally look for other way to move the scaps. It will then start over compensating and start recruiting the Upper trap and Levator scap to move the scapula. This will then cause those upper muscles to be over used and trigger points form in those muscles which can then send referred pain into anywhere all the nerve rout ( arm , shoulder , neck, fingers - anywhere along the nerve route ) and it will slowly "drag" the scaps upwards abnd scapula instability is created, and thats how symptoms and pain are caused.

If the scaps arent moving the way should be , You must re train those neural pathways and start activating the muscles that are "asleep" so to say.

Has anyone looked at the way your scaps are moving ? I know that years of gym work and to much anterior weights and not enough posterior chain work did it for me, I then re trained myself out of that and restored normal function of the scaps. And have been pain free since.

I had a minor flair up a few weeks ago which lasted a month but that was only because i was smashing the gym very vigorously 6 days a week, not stretching and well just getting back into old bad habits. The result of this was TOS type symptoms yet again, and they way i overcame this again was by stopping all the body building type trainings and focusing again on activation of the Serratus , lower trap and the rest of the posterior stabilizers.
3 - 4 weeks of physio mixed with that and i am again pain free. back to normal gym routine.

IF the scaps are the issue, then u must retrain them to work properly again or the symptoms will keep coming back.

If something else is the issue , like a extra rib or ect then i cant help anyone there. All i know i have beat this twice now and the technique that worked was neuro -muscular retraining.

i forgot to mention that tight anterior muscles like the pec minor all contribute to that scap instability, because its essentially playing a "tug of war" with your scaps and the stabilizers and posterior muscles. Then the scalenes get involved and its all down hill from there.
In saying that though once u start correcting this and things start settling back into place it has a flow on affect and you get better alot quicker then you thought.

Hellothere,

I think you are on the money and over the last week I've been heading down this path.

I have first been beating the heck out of pec minor and subclavius muscle to loosen up what's pulling my shoulder forward. Next I've been trying to "awaken" the rhomboids, lower traps, and serratus via the following:

* Scap squeezes -- no weight for 30 seconds, light cable rows with a 3 - 5 second squeeze. Focus is on isometric work vs. pulling a lot of weight.

* Scap pushups and pushup holds -- this is essentially leaning against a table edge and holding the pushup position when down.

* Prone cobras

My symptoms aren't as severe as a week ago. They are still there, but hoping continued focus gets rid of this.

KY

But how to correct it? my pec minor and scalpula are bad. My traps seem worse than my scalenes usually.

can you be specific on exercises to do? Thanks,JKL