Upper Trapezius – Massage Therapy Notes

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, the spinal accessory nerve, which is an unusual structure, innervates the upper trapezius. 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. Its 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 spinal cord segments and travel inside 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 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.

Anatomy – Throacic Outlet

The anatomy of these structures is important to understand the syndrome. This post walks through the structures one at a time.

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 the 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.


Integrative Treatment Sequencing

Mobilize the Atlas

Atlas mobilizations will loosen the entire cervical structure. It’s particularly important because of the structure of the spinal accessory nerve, which innervates the trapezius.

I like the intraoral mobilization but some therapists and clients are not comfortable with that and prefer using the transverse processes. This post has pages from the manual for evaluation and mobilization of the atlantooccipital joint.

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. Make sure to catch the upper attachments of the trapezius.

Treat Cervical Attachments and more…

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 of the mid-cervical. Consequently, it will make the rest of this treatment more comfortable and effective.

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

More Local Joint Work

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.

Free the Hinge

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


The Rest of the Trapezius…

Additional Cervical Work

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.

Detailed Trigger Point Work

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.


Temple Headache

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.

Upper Neck Tension

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.


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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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