Therapy Notes – Lower Trapezius

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

Effective relief starts with an understanding of the anatomy.

About the coloring of the illustrations…

The trapezius is a complex and hanger of the pectoral girdle. You can read more about it in this post on anatomy of the trapezius muscle.


The trapezius muscle is innervated by the spinal accessory nerve. Nerve fibers come off of the first 4-5 segments of the spinal cord and travel inside of the spinal canal back to the cranium before they exit via the jugular foramen. As they extend inferiorly, they join with fibers of the first 4 cervical nerves. This means that the first 5 vertebrae contribute to the innervation of the trapezius and should be assessed before treating the trapezius directly. If the therapist is trained in treating the occiput, temporal bones, and fascia around the Jugular foramen, this is the place to start. Follow up with the treatment of the suboccipital area, upper cervical vertebrae and then, continue on to the more local joints and trigger points.

Mobilization of a dysfunctional atlas is key to balancing the cranium on the neck and normalizing the spinal accessory nerve. This routine has internal and external approaches to mobilizing the atlas.

Start with cranial work around the jugular foramen. This includes mobilizing the atlas and releasing the suboccipital muscles.

Continue with treating the lamina groove.

First, pay extra attention to the cervical lamina. The mobilization of those first 5 vertebrae will make the rest of this treatment easier and more effective.

Also, pay extra attention to the local joints from T4-T12. Make sure that the rib heads are mobilized.

This is a classic routine for treating the trapezius while the client is prone. This exposes the lower trapezius so that it is easier to access.


When the complaint is pain in the upper neck with a sore shoulder there is usually a stiff band running along the border of the trapezius between T12 and the scapular root.

After local joint work, this sensitive strip of muscle may relax with a little swipe of ice or hot stone when it is an acute injury from a jerk of the shoulder. This is not a typical case.

This muscle is can be overpowered by pecs and can stay aggravated when pecs are overdeveloped. I had clients who suffered chronically from this trigger point. One was a negotiator who would tighten his chest and lean onto his elbows at the conference table. Releasing this trigger point directly only offered temporary relief. We had to balance his chest and back with regular stretching and bodywork and on his chest to get lasting relief.

Clients are less likely to report burning and itching unless the area was a problem in previous treatments, so this trigger point often goes unreported and treated with topical creams.

When the previous pattern in lower trapezius is treated, the client may return with another lower trapezius pattern that creates burning along the edge of the shoulder blade. Treatment of that trigger point, before it becomes active can prevent this return visit.

The trapezius muscle is complex and this section releases more easily when the lamina groove has been worked to mobilize the mid-thoracic vertebrae.

See the Self Care sections for exercises and stretches that can help when the problem persists after treatment.


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.


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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.

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