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Trapezius - Low/Mid

Symptoms

TrP3 is often overlooked and causes neck, scapular and acromion pain, often key TrP inducing satellites in other muscles. TrP4 refers a steady burning pain down along and medial to the border of the scapula. TrP5 causes burning interscapular pain. TrP6 causes aching pain at the top of the shoulder. TrP7 causes goosebumps on arm and thigh.

Diagnoses

Tension headache, occipital neuralgia, cervicogenic headache, chronic intractable benign pain of the neck and/or back, bursitis, cervical radiculopathy, atypical facial neuralgia, temporomandibular disorder, all types of shoulder pain.

Actions & Function

Low trapezius retracts the scapula. Middle trapezius strongly adducts scapula. Low trapezius stabilizes scapula against anterior force of pectoralis minor, providing postural stability and preventing anterior shoulder syndrome. Middle strongly adducts scapula, stabilizing traction forces

Attachments

Above: 1. external occipital protuberance 2. along the medial sides of the superior nuchal line 3. ligamentum nuchae (surrounding the cervical spinous processes) 4. spinous processes of C1-T12 Below: 1. posterior, lateral 1/3 of clavicle 2. Acromion 3. superior spine of scapula.

Neurological

Not known to entrap directly.

Causes/Activation

Skeletal asymmetries in the lower body - LLI, small hemipelvis, short upper arms. These fibers are largely responsible for maintaining proper retracted scapular positioning against the anterior pull of serratus anterior and pec minor, against which they tend to be overmatched. The anterior muscles tend to dominate, leaving the low/ middle trap fibers with excess length and trigger points. For this reason, treatment must include the opposing fibers.

Relationships

Likely to develop with levator scapulae, supraspinatus, and rhomboids. Satellites may appear in temporalis, occipitalis, masseter, splenius, etc. Low/mid trap likely to induce TrPs in upper trap and sometimes, levator scap, and posterior cerivical muscles. Lower trap is both a satellite and a functional antagonist of serratus anterior, making it critical to treat these in combination.  Low trap is also a direct antagonist of pec minor.

Satellite Referral

The low trapezius commonly receives referral from serratus anterior, lat, and iliocostalis.  Low trap sends referral directly to high trapezius, posterior neck, suboccipitals, and across the top of the shoulder to supraspinatus.  Via satellite referral to high trap, low trap may cause satellite referral into a range of other muscles, including temporalis, and masseter. Unless this situation is properly recognized, treating extensive shoulder and neck pain can be confusing and ineffective.

Treatment

ISOLATION/CONTRACT: Have client retract their scapula for middle trap. For low trap, have them raise their arm off the mat, which triggers the lower trap as a scapular stabilizer. STRETCH: Abduct scapula for mid trap, protract for low trap.  However, it is more important to work low/mid trap into short as it is always too long due to anterior shoulder posture.

CTB Videos: Theory & Treatment

Low/Mid Trapezius

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