David R. Beatty and Camilia Makyhoun

David R. Beatty, DO, Professor of Osteopathic Principles and Practice, WVSOM

Camilia Makyhoun, Assistant Editor, WVSOM Class of 2016

Wednesday, March 13, 2013


Palpating for scalene muscle tension (WVSOM)
Neck pain going down the arm can be from a pinched nerve in the neck, which deserves evaluation by a health professional to determine cause and severity. More often, neck and arm pain are from muscle tension at the top of the shoulder without or with mild nerve compression (thoracic outlet syndrome) that can be safely treated with self-administered manipulation. The exercise routine provided below addresses the three musculoskeletal causes of thoracic outlet syndrome, namely scalene or pectoralis minor muscle tension and first rib elevation.

DOCTOR'S NOTE: Seek evaluation by a health professional if your neck and arm pain are associated with neck injury, arm weakness, fever, night sweats, weight loss, shortness of breath, cough, chest pain, or palpitations.

Left scalene position of ease (WVSOM)
  1. Lie on your back with the head resting on a pillow;
  2. Allow the head to roll to the side of neck pain;
  3. If pain is still present, add a second pillow under your head;
  4. When pain is reduced, rest in that position for 2-5 minutes;
  5. Slowly roll to one side before getting up;
  6. Proceed to the SCALENE STRETCH;
  7. Use this position of ease 2-4 times a day or as needed for pain relief.

Right scalene stretch (WVSOM)
  1. Sit with your back straight and the hand on the side of arm pain holding onto the chair;
  2. Hold the top of your head with the other hand;
  3. Allow the head to slowly fall away from the side of pain as far as it will comfortably go;
  4. Take a few deep breaths and stretch for 10-20 seconds, letting the weight of the arm move the head rather than pulling. Stop the stretch if arm pain and/or numbness get worse;
  5. Repeat steps 3-4 with the head bent slightly backward;
  6. Proceed to the PECTORALIS STRETCH;
  7. Do this stretch 1-4 times a day.


Pectoralis stretch (WVSOM)
  1. Kneel with your hands flat on the floor slightly in front of your head;
  2. Slowly squat back toward your heels as far as you can while keeping the hands in place and allowing the chest to drop down toward the floor;
  3. Take a few deep breaths and stretch for 10-20 seconds. Stop the stretch if arm pain and/or numbness get worse;
  4. If no increase in arm pain and/or numbness after stretching, proceed to the FIRST RIB MOBILIZATION;
  5. Use this stretch 1-4 times a day.

Left rib 1 mobilization
  1. Sit with one hand firmly holding the top of the other shoulder at the base of the neck on the side of neck and arm pain;
  2. Slowly move your head in a circle, bending away from the hand, forward, toward the hand, backward, and away from the hand again;
  3. Repeat 3-5 times as one smooth movement until you feel the first rib move;
  4. Do this mobilization up to twice a day.

1 comment:

  1. Very interesting and helpful guidelines! I will absolutely follow these to prevent the neck and arm pain and increase muscles strength.
    physiotherapist bergen county , back and neck pain bergen county , low back pain bergen county , chiropractor bergen county