Scalenus Anterior, Medius, and Posterior (The Scalenes): Learn Your Muscles

Scalenus anterior, scalenus medius, and scalenus posterior are commonly referred to as your scalenes. These muscles are responsible for such important actions as nodding your head, looking side to side, and helping you take a deep breath. If they are too tight, their shortness may cause neck, shoulder, or even arm pain.


The origin of scalenus anterior is on the anterior tubercles of the transverse processes of the 3rd-6th cervical vertebrae. This may sound complex, so let’s break it down.

cervical vertebrae

Thanks to The Art of Medicine.

In my previous post on the cervical spine, I explained that the transverse processes of the cervical vertebrae are the parts of that vertebrae that stick out to the left and right sides. There are little notches on the front of the transverse processes–the anterior tubercle and the posterior tubercle. So, the anterior scalene starts on a little notch on the side portion of the 3rd-6th cervical vertebrae.

anterior, middle, and posterior scalenes

Thanks to Mark Giubarelli for the image.

Scalenus anterior inserts in a ridge on the surface of the first rib.

The scalenus medius originates on the posterior tubercles of the transverse processes of the 2nd-7th cervical vertebrae. Now that we understand what exactly the “posterior tubercles of the transverse processes” are, this explanation of the origin is easier to understand. The medial scalene inserts on the top edge of the first rib.

Scalenus posterior originates on the posterior tubercles of the transverse processes of the 4th-6th cervical vertebrae. In case you haven’t noticed, this origin is within the origin of the medial scalene. The insertion for the posterior scalene is on the outer surface of the second rib. This is right behind the attachment of the serratus anterior.


When all three scalene muscles work together on both sides, they help bring your head to your chest. This is called flexing your neck. Also, they raise the first two ribs when you deeply inhale.

When all three scalene muscles work together on one side, they turn your head to the opposite side of the working muscle. Also, they bring your ear closer to your shoulder on the working side.

So, let’s say that your right scalenes are working. Their activation causes your head to turn to the left. They would also cause your right ear to lower toward your right shoulder.

Common Dysfunction

Dysfunctional scalenes cause neck, shoulder, and arm pain. Undoubtedly, you understand how tight muscles located in the neck could cause neck pain. You might be a little more unsure of how tight neck muscles could cause shoulder or arm pain.

Well, as with real estate, it’s all about location, location, location. The scalene muscles happen to be located by crucial arteries and nerve bundles. So, when these muscles are tight, they could end up applying pressure to your subclavian artery or a bundle of nerves called your brachial plexus.

Restoring or Maintaining Health

If you believe that you may have injured your scalenes, contact your doctor. Your doctor can order all of the necessary imaging, medicine, and therapy to help you heal and get you nodding your head again.

For those who are wanting exercises to stretch and strengthen the scalenes, here are some suggestions. Whether you’re looking for Pilates exercises or yoga poses, remember that you want to practice exercises that involve a slightly tucked chin or looking to the side. (There aren’t many poses in either practice that involve moving your ear toward your shoulder, but if you can find some, you can do those, too.)

  • Head nods.
  • Ab prep.
  • The Hundred.
  • Truly, any ab exercise where your head lifts off the mat would be appropriate to strengthen the scalenes.
  • Triangle pose. Make sure that you really pay attention to the placement of your head as you rotate. Don’t let it be forward of your body.
  • Navasana.
  • Practice Warrior 1 and Crescent lunge to lengthen and stretch the scalenes.
  • Carefully massage the front of your neck. Remember, you’ve got blood supply and nerve bundles in there!

More Information

I consulted [easyazon_link identifier=”1623170206″ locale=”US” tag=”custpilandyog-20″]The Concise Book of Muscles[/easyazon_link] by Chris Jarmey. Recently, the book was revised and is in its third edition. This is a great resource with clear pictures and information on muscle use.

I also consulted my [easyazon_link identifier=”1878576003″ locale=”US” tag=”custpilandyog-20″]Flash Anatomy Muscles Flash Cards[/easyazon_link]. If you really enjoy anatomy and want a tool to help you locate specific muscles correctly, I highly recommend these flash cards. I turn to them any time a client comes in with pain. Also, they are my diffinitive answer for any questions I may have about the location or use of a muscle.

What’s your favorite way to strengthen your scalenes? Let us know in the comments below.

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About Sarah Stockett

Hi, I'm Sarah! I'm a certified Pilates and yoga instructor with a passion for pain relief. I believe you can use simple exercises to relieve your aches + pains. AND, I believe I can teach you how.