Therapist Notes include:
Syndromes and Conditions,
NMT protocols and more…
This post focuses on the therapeutic release of trigger points in the lower trapezius through massage and bodywork. It includes soft joint mobilizations, treatment sequencing, and classical neuromuscular protocols. It is separated from the other sections of the trapezius as it has a very different function. Also, because of its location and the difficulty of treating it, different techniques are commonly employed.
Innervation of the Trapezius Muscle
The trapezius is a complicated muscle in several ways. First, it is innervated by the spinal accessory nerve, which is, in itself, an unusual structure. In addition, it has three distinct sections. Each section has a very different role in suspending the scapula over the rib cage. Furthermore, irritation of the trapezius is reputable for creating regulatory problems that drive people into anxiety, fight, and flight. It’s trigger points feed the sympathetic ganglion, make tags intolerable, and more.
The spinal accessory nerve innervates the trapezius muscle. 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 four cervical nerves. Also, some sites report of innervation of the trapezius by the ventral rami of the third and fourth cervical vertebrae.
This structure implies that the first five vertebrae can contribute to the innervation of the trapezius. Consequently, the upper cervical area needs evaluation and treatment before treating the trapezius directly. If you have the training, start by treat the occiput, temporal bones, and fascia around the Jugular foramen. Follow up with the treatment of the suboccipital area, upper cervical vertebrae, and then continue 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 protocol has internal and external approaches to mobilizing the atlas.
This classical neuromuscular massage protocol releases restrictions in this area.
If you have the training, evaluation, and treatment of the deep anterior neck muscles is helpful. This area is delicate should only be approached by properly trained therapists.
Continue the bodywork with treating the lamina groove.
First, pay extra attention to the cervical lamina. Consequently, this releases pressure on the origins of the spinal accessory nerve origins. As well, it is essential to balance the atlas, which impacts the emergence of the spinal accessory nerve at the jugular foramen. The mobilization of those first five vertebrae will make the rest of this treatment more comfortable and more effective. Also, because there is the innervation of the trapezius from the posterior cervical rami of C3 and C4, pay particular attention to those vertebrae.
Afterward, pay extra attention to the local joints from T4-T12. Make sure that the rib heads are mobilized. These joints are local to the trapezius and impact it proprioceptively.
From another perspective, the lamina groove protocol should precede the trapezius protocol. The trapezius protocol does not include treatment of this area. It is required, however, to address the origin of the muscle. Furthermore, the lamina groove protocol releases any fixations in those vertebral joints that proprioceptively govern the trapezius.
This is a classical neuromuscular massage protocol routine for treating the trapezius while the client is prone. This position exposes the lower trapezius so that it is easier to access.
See the notes below for variations that focus on one of the two tragetd trigger points.
When the complaint is a 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.
Compressions focus attention on the lateral border. This technique can be awkward for the novice therapist or with an especially taut band. A rolled towel can raise the shoulder and lift the lateral edge for a better grip.
Ice-and-stretch is a great help to release this border. However, ice is not relaxing for the client and often avoided. It can be challenging to release it with simple glides. Therapists often resort to other techniques like scraping, cupping, or positional release.
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.
Often, the trigger point along the lateral border is released first. Afterward, 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.
This trigger point needs to be gently and thoroughly worked until it softens. aggressive work can leave it more aggravated than before.
The trapezius muscle is complex. So, work the lamina groove beforehand to mobilize mid-thoracic and mid-cervical vertebrae. This preparation removes proprioceptive feedback that activates the trigger point. Afterward, this section will release more quickly and comfortably.
This muscle is can be overpowered by pecs and can stay aggravated when pecs are overdeveloped. Self-care can be an important part of resolving the tension in the lower trapezius. Refer clients to these exercises.
This site is undergoing changes. Starting in early 2020, we began improving the format. We are also adding more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We appreciate your input and feedback. You will see us adding posts and updating older posts as time permits.
Weekly Featured Post
This post shows you how to press out the trigger points and stretch the infraspinatus muscle. It’s a small muscle on the back of the shoulder but creates a number of problems, including:
- shoulder pain when sleeping
- loss of grip strength
- upper neck pain
- pain along the inside edge of the shoulder blade
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.
*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read. The result will also be more accessible and
will include more patterns with better self-care. In the meanwhile, there may be inconsistency in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.