Therapy Notes – Levator Scapula

Therapist Notes include:
Anatomy review,
Syndromes and Conditions,
Assessment notes,
Treatment Preparation,
NMT protocols and more…

Start by Understanding the Anatomy.
About the coloring of the illustrations…

There’s a funny twist in this muscle and it has a number of statistically significant anomalies. Take a look at this post on the anatomy of the levator scapula muscle.

Successful neuromuscular therapy for the levator scapula is largely based on, first, resolving upper cervical problems. In most cases, it is a process of gently working the underlying joints loose from top to bottom. Afterward, the gentle release of the muscle with heat, ice, massage, and stretching requires patience and sensitivity to the client’s condition.

The Levator scapula, like quadratus lumborum, is a small muscle that balances movement between larger muscles and produces debilitating pain when aggravated. It is essential to deal with the governors of this muscle before treatment. Also, like quadratus lumborum, treatment of this muscle often jostles and breaks up fixations in the related vertebrae. Treatment of the cervicals with a lamina groove routine or METs makes the levator scapula more comfortable to release.

Although levator scapula primarily elevates the scapula, it is most indicated by pain when rotating the head toward the affected side. It does produce pain during elevation as well.

The practitioner may have difficulty with several aspects of treatment. Glides on the muscle often create a knot when pressing the twist toward one end. Because this muscle is often poorly illustrated, this “knot” is often confused for a trigger point. Moreover, the Levator scapula itself can be hard to isolate underneath the traps. The insertion on the deep aspect of the scapular border can be challenging to reach and very sensitive to treatment.

Forward-Head Posture

The role of Forward-Head Posture in tension with the levator scapula becomes more apparent when viewed from laterally. SCM, suboccipital muscles, and scalenes all need to be addressed to bring the head back over the shoulders.


The atlantoaxial complex is usually anterior when the levator scapula is laden with trigger points. Mobilizing the atlas and axis is critical to shifting the head back over the pelvis and releasing the perpetuating tension on the levator scapula.

Several muscles attach to the upper cervicals and can perpetuate the displacement of the atlantoaxial joints. This post will help to mobilize and balance those structures so that the direct work on levator scapula is more accessible, more comfortable for the client, and longer-lasting.

For effective treatment that lasts, it is critical to mobilize the upper cervical structures. This is a classic case of head rotation that is restricted to a muscle that traverses the atlantoaxial joint.

This post has the routine from The Workbook of Classical Neuromuscular Therapy for your review.

Is Your Neck Extra Stiff and Painful?

Sometimes, turning your head is strongly limited by pain. This indicates that more than one of the muscles that creates a “stiff neck” is involved. Check out these posts on a stiff neck.

In this case, if the problem does not resolve with home care, consider professional help from your bodyworker. They will offer quicker relief, have longer-lasting results, and keep you focused on effective self-care.

Do You Have Forward-Head Posture?

This muscle is often overstretched and over-powered by Forward-Head posture. As the head moves forward, the opposing muscles become short and strong. Consequently, this muscle becomes overstretched and tight. Once the head has become imbalanced over the torso, this muscle fights to rebalance posture.

If you have Forward-Head Posture, review this collection, especially the self-care suggestions for changing your environment and the exercise Tuck, Tilt, Turn, and Lift.



This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


Weekly Featured Post

Is the pain from
degenerative discs or
trigger points in the muscle?

This post discusses the differences in pain from disc problems and pain from trigger points. Who should you see to help with your pain?

Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.

Question? Comment? Typo?
IntegrativeWorks.com
(404) 226-1363
integrativeworks@gmail.com

*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read, more accessible, and
to include more patterns with better self-care. In the meanwhile, there will be inconsistency in formatting, content, and readability until we get the old posts updated. Please excuse our mess.