There is a strong culture within physiotherapy to blame a specific structure when things are sore and painful for our patients, be that a muscle, a tendon, a nerve, some fascial sling or even adhesions. The Upper Trapezius/Traps muscle is one such structure that gets an awful lot of blame for many things, but rather unfairly and incorrectly in my opinion.
I regularly hear physio’s telling patients that their Upper Traps are too tight or too ‘over active’ and the reason they have neck or shoulder pain. I hear them explaining they can feel the Traps are knotted and tense, and how it needs to be released, loosened and stretched. I also see and hear many therapists carefully choosing exercises to help reduce the upper traps work, so as not to over work or strain them them.
I think this nonsense and I think the exact opposite approach is needed for painful Upper Traps.
Most, if not all painful upper traps I see are not tight, knotted or short, yes of course they can ‘feel’ tight and tense, but they ‘feel’ this way because they are fatigued, over worked and unable to tolerate the positions and loads they are exposed too. Hence, I don’t think we need to be stretching or massaging upper traps, I think we need to be strengthening the hell out of them, which is completely alien and counter intuitive for most therapists and patients to hear.
I argue that weak, fatigued, load intolerant Upper Traps are often the culprit for a lot of shoulder and neck pains, and I argue that most Upper Traps need to be strengthened NOT stretched or massaged.
Lets first look at the anatomy and function of the Upper Traps to help us understand them a little better. The Trapezius muscle is a large flat muscle that is located on the back of your neck, top of your shoulders, and running down the middle of your spine. It is the most superficial muscle of the upper back and runs from the base of your skull all the way down to the middle of your back, see image below.
It is commonly described as having three portions, the upper, middle, and lower fibres. These sections are often described in the text books as having differing functions on the action of the shoulder blade (the scapula). The lower fibres are described as depressing it, the middle fibres retract it, and the upper fibres elevate and upwardly rotate it.
However, this is a very simplistic way to look at any muscle. Firstly, no muscle works in isolation, as all muscles work in synergy with others, and one muscle certainly doesn’t work just in isolated parts, albeit some parts working harder than others during different movements.
How a muscle affects movement is also not just due to its insertions and origins, but also the orientation and angle of its muscle fibres. This is what Johnson and Bogduk looked at in the Trapezius muscle in their 1994 paper here.
This study questions the commonly held thoughts and explanations of how the Trapezius functions for many, but despite this paper being over 20 years old these findings are still not that well known and so many myths about the Traps still exist.
Johnson and Bogduk describe the angle and orientation of the upper fibres of Trapezius are unable to create ANY significant elevation of the scapula when the arm is in neutral. They also show that the upper fibres need the assistance of the lower and middle fibres to upwardly rotate the scapula, highlighting that they do not function in isolation. They also found that the Trapezius muscle is insufficient to rotate or elevate the Scapula alone, instead it is its coupled action with other muscles such as the Serratus Anterior that does.
The action of the Serratus Anterior pulling the scapula laterally around the chest wall at about 30° of arm elevation is when the lower Trapezius muscles fibres first start to resist the movement, which then starts to cause the scapula to tilt into upward rotation. Once this upward rotation of the scapula has started then the upper Trapezius fibres further assist in its upward rotation and elevation.
So the Upper Traps fibres only really contribute to Scapula upward rotation and elevation once the arm is in abduction!
This I think has some implications on some the exercises and movements given by physios and trainers that are thought to influence the Trapezius muscle. For example does standard shrug when the arm is in neutral really work the Upper Traps that much? It doesn’t appear so!
Shrugs don’t work the Upper Traps!!!
Well they do, anyone who has shrugged will tell you they do. But its only really when the arm is in > 30° of abduction and the scapula has already started to rotate do they really kick in!
With the arm in a neutral position, another scapula elevator muscle is working, the appropriately named Levator Scapulae. However, as the Levator Scapulae also attaches onto the medial superior pole of the scapula, it also creates downward scapula rotation.
Now what about those studies showing ‘over activity’ in the Upper Traps and suggesting that we need to reduce it for shoulder problems such as those done by Ann Cools et al 2007.
Well as much as I respect and admire Ann Cools and her colleagues work, I think in regards to the Upper Trapezius they are mistaken to blame them and partly to blame for the large anti Upper Traps culture in physiotherapy.
First thing to consider is these studies look at the Upper Traps activity using surface electromyography or EMG, which can be a useful tool and give insight into a muscles level of activity during movement. But they do have issues, and are not infallible to error, and so information taken from such studies has to be used with caution.
For example despite normalisation procedures designed to limit the effect of cross talk between other muscles when using EMG equipment, there is always some, especially with surface EMG, and I suspect at the point often used for reading upper Trapezius activity it also picks up the Levator Scapulae activity underneath. I have a suspicion that Levator Scapulae cross talk maybe producing the so called higher EMG readings from Upper Trapezius.
I also think the EMG readings of the Upper Traps can be ‘misinterpreted’ as too high or ‘over active’ in those with shoulder pain and dysfunction due to another forgotten and overlooked action of this muscle!
A primary role of the Upper Traps are to distribute forces and loads away from the neck.
The majority of the Upper Trapezius muscle fibres actually attach to the distal third of the clavicle and due to the orientation of these fibres, when they contract they rotate the clavicle medially. This rotation of the clavicle compresses the sternoclavicular joint, and is a rather useful action.
In fact it’s a bloody marvellous action and is probably the most beneficial and often overlooked action of the Upper Traps. The compression of the sternoclavicular joint by the upper Trapezius allows forces and loads from the arm and shoulder to be transferred down through the collar bone, into the sternum, rib cage and axial skeleton. Pretty damn useful, and maybe good to know for those with over loaded neck issues?
How many physios give Upper Traps strengthening exercises for those with neck pains or problems?
Not many, most are often too busy with silly little underloaded Deep Neck Flexor exercises. Finally, as I said earlier, nearly all the Upper Traps I see clinically are struggling to cope with the loads and positions they have to endure. It is this struggling of a weak and fatigued muscle that I also think causes the ‘over active’ readings on EMG studies.
So instead of stretching, rubbing, poking sore and painful Upper Traps, lets get them stronger, more resilient, more robust.
It just seems daft to me to ask a muscle that wants to lift and elevate the scapula AND off load the neck to work less! Of course get the Lower Traps and Serratus Anterior working, but why not ALSO get the Upper Traps to stronger as well?
In my opinion and clinical experience when the Upper Traps become more resilient, more robust, and stronger it only seems help those I see with shoulder and neck pains, not hinder them.
I think more people need more Upper Trap exercises NOT Lower Traps
I regularly give out exercises with an ’emphasis’ on strengthening the Upper Traps to patients with long standing neck and shoulder problems who have tried everything else such as manual therapy, postural correction, stretching, scapula setting etc… without any significant benefit seen.
Often after 4-6 weeks of Upper Trap ‘focused’ work they begin to report less pain, less stiffness, less tightness in them. A common misconception is that stiffness and tightness means a muscle is stiff and tight, it can also mean its just tired and fatigued.
Some examples of exercises I use for Upper Traps are over head shrugs see picture below, I sometimes prefer the elbow a little more flexed so the arm isn’t too high in elevation as this can be a bit uncomfortable or un-achievable for some people
Another exercise that I often give is one I’ve lovingly called ‘Monkey Shrugs’ these are done by holding your arms down by your sides then sliding them up the side of your body, up to about waist height so your elbows are bent slightly out to the side. I then ask the patient to shrug from this position. This really targets the Upper Trap muscle as the scapula is already in slight upward rotation and the arm is in approx 30-45° of abduction.
Here is a link to some videos I have done of the monkey shrugs and overhead shrugs
Now these are just some of the Upper Traps targeted exercises out there and they may not be suitable for all, and there are other Upper Traps targeted exercises such as a simple Lateral Raise, Upright Row, Face Pulls, even the good old Y or W lifts, which have all been found on EMG studies to get high Upper Traps activity.
So in summary I hope I have given you some food for thought about the poor old Upper Traps muscle and that you will not be as quick to blame this poor misunderstood muscle quite so often, and maybe think twice before you dive in so quickly with massage, stretches or needles!
I hope you can see that by actually strengthening and improving the function of the Upper Traps it can help a lot of neck and shoulder problems, and that you might consider giving Upper Trap focused exercises for your patients more often.
As always thanks for reading
Happy healthy exercising
PS: NEWS FLASH, since writing this piece over a year ago there has been some research here supporting my opinions on the upper traps, hoooraaah! It shows that a modified shrugging action, with the arm in approx 30° abduction creates better scapula upward rotation but also greater upper and lower traps activity.