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Trapezius - High

Symptoms

TrP 1 consistently refers pain unilaterally upward along the posterolateral aspect of the neck to the mastoid process, and is a major source of "tension neck ache”. May also extend to the side of the head at the temple and may include the angle of the jaw. “Question mark headache”.

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

Elevation of the scapula via the clavicle, side flexion of the head and neck, turning the head away at end range. Bilaterally, extension of the head and neck. Assists in carrying heavy weights, raising the clavicle and assists serratus anterior fibers in upward rotation of the scapula. Recruited during high demand breathing. 

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, but may contribute to entrapment of the occipital nerve in the underlying splenius capitis just below the occiput.

Causes/Activation

Likely to remain engaged during times of stress, participating in the “fighter’s reflex” elevating the shoulders. Maintains shoulder position when working on a computer with no elbow support, which can perpetuate dysfunction in high trap due to chronic overload. Heavy bags, straps, coats can cause overload.  Satellite referral from low trap will cause TrPs and engagement in high trap.

Relationships

Likely to develop with levator scapulae, supraspinatus, and rhomboids. Satellites may appear in temporalis, occipitalis, masseter, splenius, etc. Close neurological relationships with other cervical muscles and SCMs.

Satellite Referral

The high trap fibers are subject to satellite referral from the low/ mid trap. Iliocostalis referral may reach these fibers. May cross-refer with levator, splenius cervicis. May cause satellite referral into a range of other muscles, including scalenes, temporals, masseter, splenii, semispinalis, occipitals, and rhomboids as well as infra and supra. Unless this situation is properly recognized, treating extensive shoulder and neck pain can be confusing and ineffective. The high trap itself is often the end of a chain of satellite referral from serratus anterior, iliocostalis, lat and others.

Treatment

Because high trap is subject to many outside influences in terms of functional and satellite relationships, we spend far less focus on it than on low/ mid trap. Our treatment is focused on relaxing the upper fibers so they don’t interfere with other neck muscle ROM. EPS and vibration are preferred. CONTRACT: Bring the shoulder toward the ear with head facing away. STRETCH: Turn head to the working side, sideband away with a strong element of forward flexion.

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High Trapezius

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