Therapy Notes – Upper Trapezius

The upper trapezius acts more like an extra head of sternocleidomastoid than other extrinsic back muscles. It is often part of a larger problem with high-tight shoulders. Integrative Neuromuscular Massage involves addressing the other elevators of the shoulder girdle, especially the serratus anterior. Many therapists don’t treat these areas because it is inconvenient, awkward, and difficult on the hands.

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.

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

Great illustrations of the three section are in this post about the anatomy of trapezius.

Evaluating and releasing other elevators of the scapula is important. Make sure that you include the extrinsic chest muscles, especially serratus anterior. Here’s an overview of the extrinsic chest muscles.

In the extrinsic back muscles, rhomboids, levator scapula, middle and upper trapezius also need to be considered.



Treatment Sequencing

Open the Nerve Flow, Release the Upper attachments

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

Continue with treating the cervical lamina groove.

The mobilization of those first five vertebrae helps to further work the spinal accessory nerve. Also, some of the nerve feed of the trapezius comes out of the posterior rami fo the mid-cervical. Consequently, it will make the rest of this treatment more comfortable and effective.

Cross-fiber friction of the attachment of upper trapezius along the nuchal ligament is also helpful in releasing the belly of the muscle.


Distract the AC Joint. The NMT protocol has a step for separating the joint with the small T-bar, but this is gentler and more effective.

This is especially important for releasing the lower trigger point along with the cowl of the trapezius.

The fibers of the upper trapezius run more laterally than vertically. The raise the shoulder by hinging the clavicle on the manubrium. Mobilize this joint before working the belly of the muscle.


The classical neuromuscular routine for trapezius does not include the treatment of the medial attachment. So far, the cranial and cervical attachments have been addressed in this sequence. The lamina groove routine addresses the rest. It is also an excellent way to relax the client. The tedious work along the spine releases tension throughout the system.

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

There is a special technique here for treating the cowl of the trapezius. It offers focused attention to the upper and lower trapezius. Admittedly, it is tedious and takes practice but can be worthwhile when those areas need more than glides.



When the complaint is a headache at the temple with s stiff neck, make sure to check for a mild separation in the AC joint or tension around the shoulder. Insert the small T-bar or a firm thumb tip into the space between the clavicle and scapula, pressing into the trap and biceps attachment. Gentle traction of the joint to release can release proprioceptive tension before working the muscle.

This trigger point is considered to the most common trigger point in the body but is sometimes overlooked as the source for a stiff neck when the headache at the temple is not there.

Several trigger points create pain in the upper neck, with some tension in the shoulder. The client is usually very sensitive to compressing the cowl of the trapezius or seems to crave it. Before the protocol, mobilize local joints. Following that, the upper trapezius will release more easily with longer-lasting results

This trigger point is often associated with clients that have sensory integration disorder.

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 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.

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. 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.

error

Enjoy this blog? Please spread the word :)