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Trapezius Muscle – December Newsletter

Muscle of the Month: Trapezius

Jesse Dupre, DPT

Trapezius Muscle DiagramThe trapezius is a large muscle spanning from the upper back and into the neck. It is a relatively flat muscle with a diamond like shape, and it spans multiple joints. It has many attachments with origins at the nuchal line at the back of the skull, the nuchal ligament that runs centrally down the neck and the spinous processes of the thoracic spine, and insertions at the spine and acromion process of the scapula (shoulder blade), as well as the clavicle (collar bone).

Because of the size and location of the muscle, the fibers are arranged in various orientations, with the upper fibers angled downward toward the shoulder, the middle fibers running horizontally toward the shoulder, and the lower fibers running upward toward the shoulder. This means that functionally, the trapezius can be broken up into the upper trapezius, middle trapezius, and lower trapezius.

All of the parts of the trapezius provide stability for the scapula work to adduct the scapula (pull toward the spine) and upwardly rotate the scapula. The upper and lower trapezius also act to elevate (pull upward toward the ear) and depress (pull downward away from the ear) respectively. The upper trapezius is also active when side bending the neck to the same side, or rotating the neck in the opposite direction.

Coordinated recruitment between the trapezius and other groups including the serratus anterior and pec minor, and balanced recruitment within the three parts of the trapezius are important for proper shoulder function. It is not uncommon for people to have strength imbalances where the upper trapezius is much stronger than it needs to be compared to the middle and lower trapezius, with a natural tendency to overuse the upper trapezius. Weakness or inadequate recruitment of the middle and lower trapezius with overuse of the upper trapezius can affect scapular mechanics and have been associated with shoulder pain and subacromial impingement. Poor scapular mechanics and overuse of the upper trapezius can also have and detrimental effect at the neck, causing excessive compressive forces and muscle tension at the cervical spine.

While a strong upper trapezius is not necessarily a bad thing, it is important to use or strengthen the trapezius in a way that promotes proper strength and tension balance. While there are specific exercises that can help with this, it is not always necessary to learn an entirely new set of exercises. Changing the focus on some common exercises, including standard rows, lateral raises and others can increase activation of the middle and lower trapezius, and help strengthen the trapezius to work more effectively as a whole.


References:

  1. Castelein B, Cools A, Parlevliet T, Cagnie B. Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated?: A case-control study with surface and fine-wire EMG. J Electromyogr Kinesiol. 2016 Dec;31:136-143.
  2. Struyf F, Cagnie B, Cools A, Baert I, Brempt JV, Struyf P, Meeus M. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol. 2014 Apr;24(2):277-84.
  3. Michener LA, Sharma S, Cools AM, Timmons MK. Relative scapular muscle activity ratios are altered in subacromial pain syndrome. J Shoulder Elbow Surg. 2016 Nov;25(11):1861-1867. (Photo: John Fiore, Mission Mountains)

snow capped mountains purple sunset

Understanding Joint Mobilizations

Sarah Menhennett, PT, DPT

Joint mobilizations fall under the treatment category “manual therapy”. The American Physical Therapy Association’s “Guide to PT Practice” defines manual therapy techniques as “skilled hand movements and skilled passive movements of joints and soft tissue and are intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. Techniques may include manual lymphatic drainage, manual traction, massage, mobilization/manipulation, and passive range of motion.”1

Most patients are familiar with the massage aspect of manual therapy, but many are less familiar with joint mobilization techniques. A joint mobilization targets the capsule of the joint itself through the use of a carefully graded force provided by therapist’s hands (occasionally with the addition of a strap to provide better leverage) in order to move the joint into the specific direction of dysfunction. This dysfunction may present as pain or stiffness. Joint mobilization techniques can be particularly beneficial to improve motion and decrease pain when it is determined through thorough evaluation that the symptoms are located in the joint itself, rather than solely in the surrounding tissues. Why might a physical therapist choose a joint mobilization over a technique like massage? Oftentimes as a result of injury, there is both joint and soft tissue involvement. Your therapist will likely end up using multiple types of manual therapy throughout the course of treatment.

There are many different types of joints in the body with varying degrees of movement. The following picture illustrates familiar joints in the body. The ball and socket joints of the shoulder and hip are two of the most mobile joints in the body, whereas the hinge joints of the knee and elbow are relatively stable joints. Knowledge of the joint type and the way it moves guides the selection of a joint mobilization direction. In addition to the normal (physiological) directions that your joint moves such as flexion and extension of the shoulder, there is also a small amount “accessory” movement that occurs at the joint which if affected can limit your available movement. One example of this is that when you lift your arm up (shoulder flexion), the ball portion of the ball and socket joint of your shoulder glides slightly downward. This downward motion is important to allow for full motion as you elevate your arm overhead. If this glide is limited, a therapist may provided gentle pressure on your shoulder down toward your feet while they elevate your arm to restore this motion. Similar “accessory” movement joint mobilization may be performed to other joints as well to decrease pain and restore normal motion.

How does it work? Why do I move better and have less pain after having a joint mobilization performed? There a few different theories behind the success of joint mobilizations. The most basic explanation is that the passive movement of the joint improves the mechanical properties of that joint which results in less restricted movement. Another theory that has been supported by research is called the “neurophysiological effect”. Research demonstrates that areas within the central nervous system are stimulated by passive joint mobilizations, resulting in decreased pain.2

It is important to note that pain and stiffness in a joint may be a symptom or result of compensations due to another issue rather than the root cause of the problem. Physical therapists are trained to look at the whole body and interactions between various structures of the body. They constantly assess and reassess to determine the main issue and adjust their treatment strategy accordingly. There is no one size fits all treatment approach for joint mobilizations or other manual techniques, even for the same diagnosis.3 Your therapist will select a specific joint mobilization to address your unique symptoms. This will often be combined with other manual therapy techniques and specific corrective exercises which may address flexibility issues, muscle imbalance, weakness, balance problems, poor body mechanics or posture. It is critical to follow up with any prescribed home exercises in order to maintain the gains made through the manual therapy technique.


References:

  1. American Physical Therapy Association. (2014). Guide to Physical Therapist Practice. DOI: 10.2522/ptguide3.0_38
  2. Schmid, A., Brunner, F., Wright, A., & Bachmann, L. M. (2008). Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation. Manual therapy, 13(5), 387-396.
  3. Bialosky, J. E., Beneciuk, J. M., Bishop, M. D., Coronado, R. A., Penza, C. W., Simon, C. B., & George, S. Z. (2018). Unraveling the mechanisms of manual therapy: modeling an approach. journal of orthopaedic & sports physical therapy, 48(1), 8-18.

Photo: John Fiore, Rocky Mountain Front, Bob Marshall Wilderness

Photo: John Fiore, Rocky Mountain Front, Bob Marshall Wilderness