Why Can I Only Sleep Sitting Up?
The Scalene Muscles
The scalenes are made up of 4 muscles: the anterior, medius, minimus, and posterior scalenes. These muscles are a common source of back, shoulder and arm pain. Trigger points in the scalenes are also known to cause headaches and may refer pain to the chest, upper arm, edge of the shoulder blade and even into the thumb. The scalenes assist in neck flexion (chin to chest) and lateral flexion of neck (ear to shoulder). They are activated when you breathe and they provide stabilization in movements such as lifting, pulling or carrying.
Someone with scalene trigger points will talk about their “shoulder” pain while rubbing the upper half of the arm. Sleep is often disturbed by this pain and relief will be found by sleep in a recliner or propped up on a couple of pillows. Scalene trpts will cause numbness and tingling in hands along with swelling especially in the morning all which result in a tendency to drop objects unexpectedly.
One can get scalene trigger points by doing the following:
- Accidental trauma
- Pulling or lifting
- Handling or riding horses
- Playing tug of war
- Competitive swimming
- Carrying awkwardly large objects
- Playing certain musical instruments
- Hard coughing
- Sleeping with the head lower than the feet (ex. when there is a rug under only the foot of the bed)
- One leg longer than the other
- A small hemipelvis
- Surgical removal of breast tissue
- Loss of upper limb
- Awkward leaning position when seated due to improper arm rest height
- Any deviation of a normal gait
Someone with scalene trigger points will tend to move their neck and arm restlessly. It is restricted when they move their ear to their shoulder and is painful in the last bit of neck rotation. To test for scalene trpts you can rotate your head as far as you can then dip your chin to your chest. If your neck cramps on the same side you turn it to or there is increased pain, you likely have trpts in the scalenes. You may get relief when you raise your arms above the head. Another test is the finger flexion test. Make a fist then straighten only the first joint closest to the hand. The top of your finger should be touching the bottom of your finger. If you cannot get it to touch, then you probably have trigger points in the scalenes. I will demonstrate these tests in the video below.
Scalene trpts may be confused with carpal tunnel syndrome, c5-6 radiculopathy or thoracic outlet syndrome. If one has trpts in the scalenes, it is also common to have trpts in the trapezius, sternocleidomastoid and splenius capitis muscles.
To fix trpts in the scalene muscles, there are several actions to take. #1. Get a massage!!. After that you will need to make sure you correct your posture, stretch, breathe correctly, and maintain body warmth.
Stretching is critical. I will show you specific stretches for your scalene in the video below. You can do these after applying heat for about 15 minutes to make them even more effective.
Breathing right is also very important. Can you believe you can actually breathe wrong!? You want to breathe into your diaphragm as well as your chest. Chest only breathers will most likely get scalene trpts. When you lie down put one hand on your stomach and one hand on your chest. The goal is to get the stomach and chest to rise simultaneously.
If you wear thick glasses and are always bending your head to read because of them, you may want to get the angle adjusted so you do not have to bend your head forward. When turning over in bed, try to roll the head on the pillow rather than lifting the head up. Provide an appropriate arm rest when driving or working. One that does not make you shrug your shoulders up. Do not under any circumstances try to hold the phone with your shoulder! If you like to read, make sure the reading light shines from above and not from the side to make you turn your head funny. Raising the bed frame will help scalene trigger points by helping venous and lymph flow. You could also try 2 pillows, but beware that that can cause other problems. Someone with scalene trpts definitely wants to avoid a springy (ex. rubber) pillow.
One last thing, if you tend to get trpts in the scalenes, you will want to make sure to keep the neck warm. Wear scarves or high necked sweaters.
Don’t sleep sitting up anymore! Watch this!