Understanding Trigger Points – Neck tension when wearing a heavy coat

An interesting post for people with upper neck pain when carrying a bag in one hand or tension when wearing a heavy coat.

This trigger point creates a focus of pain in the upper neck with tension down the side of the neck toward the shoulder. It is associated with a trigger point in the middle trapezius at its high point above the superior angle of the scapula.

Client’s Description

referral - trapezius - upper - C6People come in complaining about pain in the upper neck. The pain that extends down toward the shoulder is often described as tension. They describe things that aggravate it but seldom are able to describe the incident that created the injury. There are other trigger points that produce pain in that area, so I always ask more questions to narrow it down before I start the physical examination. 

When asked when it bothers them the most, they may say that it bothers them while carrying a travel bag in each hand. They may also complain that it bothers them while holding the shoulders up to type on a desk that is too high or hold the top of the steering wheel. Athletic people may complain that it bothers them when carrying dumbbells during exercises like lunges. I’ve also had this pattern when I carry a child on my shoulders for a while.

sore neckLess athletic people and people with sensory processing disorder seem pleasantly surprised pleased when I ask them if a heavy coat bothers them. They are glad to find someone who understands their sensitivity instead of dismissing it. (This is opposed to the sensory defensive clients that are looking for heavy pressure from clothing to calm them) This aggravating tension can make it difficult to focus when shoulders are not properly supported at the computer.

Self Care

You can often get some relief by using ice and stretch, first along the upper neck and then along the middle trapezius. This section of muscle is often chronically tight, leathery and part of a bigger postural problem. Your therapist can offer lasting relief by mobilizing local joints and re-balancing posture.

Therapy Notes


This middle section of the trapezius (shown here in red)  is active in retracting and lifting the of the scapula. Middle traps are notorious for being tough and leathery. The right approach usually involves restructuring posture so that shoulders naturally hang in the right place.

The trapezius is complex, and this section releases more easily when the lamina groove has been worked to release the multifidi. Make sure that you catch the upper cervicals first they balance the head and will be key in moving it back, so that middle trapezius is not pulling the shoulders back to counterbalance. Then, mobilize the vertebrae in the upper thoracics and lower cervicals. The shearing that happens at C6/C7/T1 support the trigger points in this muscle. The upper thoracics are key here but can be difficult to mobilize with working the spine above them. Also, mobilize the acromioclavicular joint.

Similar Patterns

Click on these categories to see if there is a referral pattern that better describes your concerns.

tags-neck tags-upper-neck tags-top-of-shoulder tags-upper-back  



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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