Therapy Notes – Upper Trapezius

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.


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 5 vertebrae will make the rest of this treatment easier and more effective. Cross-fiber friction of the attachment of 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 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.


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 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. Sometimes, this can be treated by inserting the small T-bar or a firm thumb tip into the space between the clavicle and scapula, pressing into the trap and biceps attachment.

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.

There are several trigger points that refer pain in the upper neck with some sort of tension in the shoulder. The client is usually very sensitive to having the cowl of the trapezius squeezed or really craves it. This section of the upper trapezius will release more easily with longer-lasting results if local joints are mobilized beforehand.

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 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.