So what’s the honest truth behind the upper traps? Compared to many other muscles, it’s admittedly pretty polarized. It’s not like the biceps brachii or glute Maximus, which are frequently trained with intention and celebrated when developed. Even though its anatomical function is hugely important, it’s generally not valued in conversation at the gym, a massage therapy practice, or a physical therapy clinic. Rather than appreciate the many anatomical advantages it provides us, we’re more likely to demonize and point blame at it. We massage it, manually “release” it, stretch it, and dry needle it — all in hopes to release some of the muscle tones there. And trust us: we have no doubt that you’ve heard that “you carry all your stress in your traps” (said every clinician who ever palpated or worked on your neck and shoulders). Well, like most things in the musculoskeletal/rehabilitative/performance world, the upper trapezius deserves a deeper dive than the few insults you’ve probably heard thrown at its way. After all, it’s not nice to talk behind someone’s back. So we’ll go ahead and talk about the back instead: read on to learn the truth about tight upper traps.

 

Anatomy of the upper trapezius

The trapezius is a large diamond-shaped muscle along your upper back. It is categorized into “lower, middle, and upper” segments based on the location, function, and muscle fiber orientation. In specific, the upper fibers originate on the base of your skull and then descend horizontally to their insertion on the lateral third of the clavicle, acromion, and scapular spine of the scapula. Based on these attachments, the upper trapezius is a powerful scapular elevator and assists with cervical extension and side bending (1).

upper trap anatomy

The anatomy of the upper trapezius is highlighted in yellow. Screenshot from Essential Anatomy 5.

During functional movements, the trapezius muscle works in conjunction with several other stabilizers to assist with appropriate shoulder joint movement.  A simple task such as raising your arms overhead is actually a complex balance between stability and mobility. For example, flexing your arm 180 degrees requires the synchrony involved with “scapulohumeral rhythm” which occurs in a 1:2 ratio. If 60 degrees of movement occur at the scapula, 120 degrees occur from the rotation of the humerus at the glenohumeral joint (2). Easy enough math, right?

 

Do Something About Your Upper Trap Related Neck Pain!

neck mid back rehab program tight upper traps the prehab guys

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The fine details lie in the intricate balance of muscular control and “force couples” that interact to promote appropriate movement and stability for a joint. Considering joints as an axis over which force is exerted, force couples are a pair of forces that are equal in magnitude, parallel, and oppositely directed (3). A prime example of coupling is that of the trapezius and serratus anterior. The muscle pulls created by each segment work alongside one another to upwardly rotate and stabilize the shoulder blade during overhead movement.

For example, when the upper trap is contracted, it exerts a force to elevate, retract, and internally rotate the collar bone. The internal rotation of the collar bone compresses the sternoclavicular joint, the joint at the front of your chest, which creates increased stability and tolerance to load for the shoulder. Once the collar bone is retracted, the lower and middle trap can exert an external rotational force on the shoulder blade. This external rotation is important because another muscle, the serratus anterior, is simultaneously exerting an internal rotational force. These opposite forces help stabilize the shoulder blade by matching one another while the shoulder blade moves upward (4).

This balancing act helps with overall shoulder stability that is necessary for isolated movements, such as simply reaching overhead, or complex tasks such as throwing, pushing, or lifting.

For an excellent visual of scapulohumeral rhythm and the various force couples involved, see this great video by Muscle and Motion on their YouTube Channel here. Appreciate the function of the upper trapezius at 0:34, enabling overhead movement with some help from the supraspinatus, deltoid, lower trapezius, and serratus anterior.

As you can appreciate, the upper trapezius is but one player in the ensemble of musculature to produce overhead movement. As with most things, it’s easy to overlook when everything is going well. But what happens when we develop an impairment here? There’s a long list of “syndromes,” “impairments,” “pathologies” or generic “soft tissue dysfunctions” that get thrown around in the field. Sifting through the verbiage and being intentional with how you view “tightness” or discomfort at your upper trap is just as important as how you treat it.

 

The misunderstood upper trapezius: Unfairly prosecuted

So for one reason or another, you’ve developed some discomfort at your upper traps. Regardless of how we label this, it’s frustrating and uncomfortable. Perhaps you’ve been told you have bad posture. You may have even been led to believe that your upper traps are the sole reason for this. Maybe your trapezii are uncomfortable enough that it’s contributing to your tension headaches. While one, or all, of these different accusations, may hold some truth, we’d encourage you to view your discomfort from a broader perspective. The upper trapezius can certainly contribute to musculoskeletal complaints, but a strong reframing of the mind can help enhance the interventions you seek, or that are provided, by a musculoskeletal healthcare provider. Let’s debunk some of the more common accusations together.

Should You Be Trying To ‘Stretch Out of Your Neck Pain’?

 

Poor Posture

So, what does it mean to have “poor posture?” We probably think we can spot it a mile away, conjuring ideas of a rounded back, craned neck, and forward shoulders. While for some that may be spot on, for others this can be an advantageous position. Consider the posture of an Olympic cyclist: their backs are rounded, their neck extends up to see the course ahead and their shoulders are forward. Yet they are able to compete at an elite level. So what gives? The message behind this is that posture and positioning are not the sole drivers of pain and dysfunction.

poor posture tight upper traps the prehab guysWhat may be considered poor posture in one population advantageous for another? Would you really tell cyclist Justin Widhelm to stop rounding his back here?

More important than posture alone, is the activity performed, or lack thereof, in that position. The cyclist trains the muscles surrounding the neck, back, and shoulder area to have enough endurance to sustain his or her “poor posture” through the entirety of a race. This means that there is support coming from all sides of each joint so one muscle group is not being overworked.

On the other hand, often times the general population (who may sit slumped throughout the entirety of a work day) relies on specific muscle groups (such as the upper traps) while neglecting to strengthen the antagonist’s muscles. Maintained strength imbalances like these, over long periods of time and when left unchecked, can probably influence dysfunction or pain later on. Therefore, it’s important to understand that muscular endurance within a posture is more important than the posture itself.  

Outside of the generic description of “poor posture,” a syndrome was coined decades ago to better define posturing largely influenced by dysfunction of the upper trap. That forward head, rounded shoulder positioning that we have all become accustomed to after a movie marathon or a long day at the office was previously coined “upper crossed syndrome.”

READ MORE: THE MYTHS SURROUNDING POSTURE

perfect work desk posture the prehab guys

 

Upper Crossed Syndrome

Before you get too concerned, remember that a “syndrome” is just a collection of symptoms rather than a hard diagnosis. While upper crossed syndrome does outline some helpful treatment variables to address in your strength or rehab programming, I’d caution you to hang your hat on this as the sole reason for your upper trap or neck discomfort. Traditionally, the signs and symptoms of the upper crossed syndrome include “weak” cervical flexors, rhomboids, and lower trapezius alongside “tight” pectorals, levator scapulae, and upper traps. Despite the multitude of contributing factors and muscle groups, most people directly highlight the upper traps in this syndrome — likely because they are perceived to be the most painful. But as we’ve outlined, there are several muscles involved in this syndrome. It’s a disservice to the upper trapezius to push all of our focus upon it. Rather than villainizing the upper trapezius, appreciating some general treatment themes in this syndrome can provide yield.

upper cross syndrome tight upper traps prehab guys

The traditional illustration demonstrates upper crossed syndrome. Image from Human Kinetics, 2010.

What does weak mean?

The term “weak” is a bit of an umbrella term because we often don’t formally, or objectively, quantify weakness but rather use the term to encompass inefficient, poorly trained or underutilized musculature. For instance, overworked pectorals are likely to overpower rhomboids, especially in a seated posture over time (thanks to gravity).

As stated before, the function of the upper trap is to elevate and stabilize the shoulder joint through different ranges of motion. It is not to maintain constant shoulder elevation. Think about if you’ve ever had a stressful situation and you started clenching your jaw — odds are the side of your face will hurt, and in some cases, a headache can even develop. Does that mean that the masseter muscle is causing all your problems? Likely not. But it is a secondary effect of the initial stress you’ve encountered. Unintentionally, the masseter has been asked to work in an inefficient and sustained manner, performing a function it wasn’t made to do. The same concept applies to the upper trapezius. When used appropriately it’s an efficient, helpful, and strong muscle. However, it can often take more burden than it’s intended to, especially if there is a problem somewhere else along the chain, or if other stressful lifestyle factors are present.

But interestingly enough, tightness and weakness may be one and the same.

 

What does tight mean?

Tightness is a tricky term. In its literal definition, we’ll use this term to describe the length of a soft tissue that’s limiting the range of motion. As an overtly generic example, imagine tight hamstrings that limit your ability to bend forward and touch the ground while keeping your knees straight. In everyday layman’s terms, it’s a sensation of stiffness or tightness one may experience secondary to a hard workout, or moving out of a position held for an extended period of time.

When present in its literal definition, soft tissue tightness affects other structures surrounding it and can lead to abnormal posture, poor length-tension relationships, and overall strain on postural muscles. In layman’s terms, sensations of tightness can develop from two situations: (1) a muscle group is being overworked (see “overactivated trap” section below) or (2) a muscle is being underutilized, in turn, leading to weakness. The analogy we like to discuss with our patients is comparing a strong weightlifter to a weak, sedentary person. If both were asked to play tug of war, odds are the strong weightlifter would easily dominate, whereas the weaker individual would be gripping on for dear life. This intense gripping and contraction illustrate how weak muscles need to work much harder than strong muscles, ultimately leading to symptoms of tightness and pain. Therefore, it is important to highlight that sometimes muscles that are “tight” can actually benefit from proper loading because, in reality, they are “weak”. This can help ensure that they are strong enough to perform the tasks you are asking of them.

 

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Overactive Upper Trapezius

When we are in any prolonged posture or position, we are inevitably exerting force across the muscle fibers of the involved musculature. Typically, our postural musculature is often in sustained contractions, where it’s not shortening or lengthening. All musculature holds some degree of muscle tone, which is a good thing to have. Whether it’s at the upper trapezius (keeps our heads upright and from falling flat onto our desk while doing computer work), or the pelvic floor (keeps us from being incontinent), it’s a built-in feature of the human body that saves us a lot of trouble.

However, sometimes we can have “increased tone” in our musculature. This can either be pathological (like hypertonicity or spasticity in folks that have cerebral palsy or other neurological conditions) or simply a symptom associated with a training-related soft tissue dysfunction (a garbage-bag term used to capture a variety of different muscular ailments like tightness, soreness or tenderness to palpation). When we’re talking about an “overactive upper trapezius,” we’re talking about the latter of these two.

Like many things in the musculoskeletal realm, there are no normative values for muscle tone in a healthy population. However, clinicians will make general observations based on movement observations, range of motion limitations, and soft tissue palpation. Sure, there is probably some value here: we can make some general assumptions based on the three of the aforementioned and make treatment recommendations. And while there are some very specific manual techniques we can use to make an immediate impact, the long-term resolution is building higher load tolerance, lifestyle changes, and stress management.

Upper Trap Stretch

Purposeful strength programming, some basic home soft tissue interventions (lacrosse ball “release,” percussion-like massage guns, foam rolling), general awareness, and a bit of experimentation can help mitigate these symptoms. It’s important to note what might help you manage symptoms at your upper trapezius might be very different from someone else with the same complaints. The success of soft tissue quality interventions is typically very individualized.

 

Upper Trap Soft Tissue Mobilization

Sample Neck Rehab Program Exercise

The main take-away here we’d like you to remember is that an “overactive upper trapezius” is a fairly generic term. There’s no way for your clinician to truly assess the activity of your trapezius, or compare it to, whatever “normal” is considered anyway. Appreciate that the term “overactive” is probably synonymous with a “weak” or “tight” upper trapezius.

 

Shrug – Band

Also, appreciate the detriment of telling a patient their muscle is overactive: it immediately paints a mental image that discourages ever pursuing any form of strength training in that muscle. In turn, patients let the “overactive” muscle decondition further, making their original symptoms even worse. It’s a positive feedback loop.

feedback loop prehab guys

Another term we throw around in the musculoskeletal world is the “trigger point.” You’ve probably had one at some point, either self-diagnosed or recognized by a clinician.

 

Upper Trapezius Trigger Points

Physical therapists are often frustrated by the term “trigger point.” It lacks a clear definition, and it’s often overused and incorrectly. While many argue over the specifics, a trigger point is typically appreciated to be a hyperirritable spot in skeletal muscle that’s associated with hypersensitive palpable nodules in taut bands (5). In layman’s terms, it’s a spot on a muscle that hurts when you press on it. However, it’s important to differentiate a trigger point from a tender point: trigger points often refer to pain, while tender points only cause local pain on compression (6). Diving into semantics even deeper, one should understand the difference between active and latent trigger points. Active trigger points are hyperirritable spots in skeletal muscles that are actively contributing to painful or negative sensory experiences that generally prompt patients to seek treatment. Latent trigger points are hyperirritable spots in the musculature that weren’t necessarily bothering someone in everyday life — rather, they were found on the exam while palpating for soft tissue dysfunction.

If interested in learning about the theories about what causes a trigger point, see this clinical commentary here. It’s written a good friend Casey Unverzagt (7). It’s a bit beyond the scope of this blog, but Casey does an excellent job sifting through the weeds and providing clarity on these terms.

Now, there is some supportive evidence that “trigger points” of the trapezius can consistently reproduce pain referral patterns with palpation. The majority of this evidence comes from Dr. Travell and Dr. Simmon’s work, which was admittedly published in the early ’80s (8). Regardless, it is still used as foundational knowledge in classwork attended by physical therapists, chiropractors, and massage therapists studying soft tissue interventions like dry needling and “release” techniques. For example, trigger points of the upper trap can commonly refer to a “Ram’s Horn” distribution and trigger tension headaches as seen in the picture below (8).

trigger points tight upper traps

A referral distribution for the upper trapezius from Travell and Simons. The black “X’s” show the origin of an upper trapezius trigger point, where the red coloring shows the most common pain referral pattern when the trigger point is compressed (8).

The important message I want you to leave with is that latent trigger points are not clinically relevant — unless you want them to be. I can promise you that if I dig around into the upper trapezius soft tissue of any patient that comes into the clinic, regardless of the reason they’re coming in, I can find a latent source of upper trapezius discomfort. So should you seek treatment for soft tissue dysfunction that only hurts when a clinician searches, and then finds it? Even if it didn’t hurt prior? I would argue not, but some clinicians would claim otherwise.

I’m a firm believer that one should not “search” or “check” for pain. In other words, placing a joint in a precarious or awkward position to see if it hurts or poking around in a muscle belly for latent pain. Life generally doesn’t present scenarios that will realistically reproduce this pain. Rather, seek treatment when you’re actively experiencing pain and need guidance. This is how physical therapy and soft tissue interventions should be utilized. (Outside of preventative or risk reduction programming).

LISTEN: HOW THE BODY INTERPRETS PAIN

chronic pain tight upper traps the prehab guys

 

Closing thoughts

The upper trap often gets characterized as the “bad guy.” It’s guilty until proven innocent. If you’ve found yourself considering the upper trapezius as the source of your pain, I don’t doubt that it’s probably having some influence. But as with most pain in the musculoskeletal realm, you’re likely experiencing pain that’s multi-factorial.

Remember that it functions as a dynamic stabilizer and assists with shoulder and some neck movements as part of a complex system. Although we often complain about the tightness we feel, without the strong stability and elevation from the upper trap, we would open ourselves up to a slew of other problems like our heads suddenly slamming into our desks, our steering wheels, or our oatmeal during breakfast. Much like life, scapular rhythm is about balance and the upper traps are a key component of that equation. And much like all musculature, it should be trained purposefully and appreciated for its function.

Unfortunately, we typically don’t train it with intention. Rather, we are quick to back upper trapezius pain into a corner with labels like poor posture, upper crossed syndrome, an overactive upper trapezius, or an upper trapezius trigger point. Rather than throw blame, we challenge you to instead develop a comprehensive treatment plan primarily focused on purposeful strengthening and intermittent high-yield soft tissue interventions to manage your symptoms. If the demands of life are exceeding the ability of your upper trapezius, there is likely a need for improving its load tolerance through strength training. This in turn will blunt sensations of tightness that come secondary to weakness, ultimately enabling you to better handle the tasks of what life demands from you.

Now supplied with some new information, a new perspective, and some purposeful loading, you and your health care professional will be able to mitigate and manage some of the symptoms you may have previously blamed on the well-intentioned, but often ill-accused, upper trapezius.

 

Take Control of Your Neck Health!

neck mid back rehab program tight upper traps the prehab guys

Neck and Mid-back pain truly lets you know how connected the movement system is. It can create discomfort not just in that area but can refer uncomfortable sensations down the arms, around the ribs, or even wrapping around the head. This can be resolved by improving neural mobility, and postural control, and strengthening the unique muscles in this region.

 

References

  1. Ourieff, Jared. “Anatomy, Back, Trapezius.” U.S. National Library of Medicine, 26 July 2021.
  2. Scibek, Jason S, and Christopher R Carcia. “Assessment of Scapulohumeral Rhythm for Scapular Plane Shoulder Elevation Using a Modified Digital Inclinometer.” World Journal of Orthopedics, Baishideng Publishing Group Co., Limited, 18 June 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3377910/.
  3. “Force couple.” Medical Dictionary. 2009. Farlex and Partners https://medical-dictionary.thefreedictionary.com/force+couple
  4. Camargo, Paula R, and Donald A Neumann. “Kinesiologic Considerations for Targeting Activation of Scapulothoracic Muscles – Part 2: Trapezius.” Brazilian Journal of Physical Therapy, Associação Brasileira De Pesquisa e Pós-Graduação Em Fisioterapia, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849087/.
  5. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: A systematic review. Arch Phys Med Prehabil. 2001; 82: 986-992.
  6. Yap, E. Myofascial pain – an overview. Ann Academy of Med. 2007; 36: 43-48.
  7. Unverzagt C, Berglund K, Thomas JJ. Dry needling for myofascial trigger point pain: A clinical commentary. IJSPT. 2015; 10(3): 402- 418.
  8. Travell JG, Simons DG. Myofasical pain and dysfunction: The trigger point manual. Lippincott Williams and Wilkins. 1983.

 

About The Author

Christopher Lefever, PT, DPT, SCS, CSCS, USAW

[P]rehab Writer & Content Creator

chris lefever the prehab guys

Originally from Reading, Pennsylvania, Chris graduated with his bachelor’s degree in exercise science and a doctorate of physical therapy from Slippery Rock University. He afterward completed a sports physical therapy residency at the Memorial Hermann IRONMAN Sports Medicine Institute. He later completed a division 1 sports physical therapy fellowship at Duke University where he worked closely with Duke football, basketball, and lacrosse. He returned to Houston afterward with Memorial Hermann to help develop an emerging division 1 sports physical therapy fellowship. Present-day, he practices with the sports medicine team at the United States Olympic and Paralympic Committee in Colorado Springs, CO. Chris is a board-certified sports clinical specialist (SCS), and certified strength and conditioning specialist (CSCS), and certified in dry needling. He has a particular interest in post-operative rehabilitation of the athletic knee, shoulder, hip, and elbow.

 

 

Olivia Rowland PT, DPT, SCS, CSCS

Olivia completed her physical therapy program at Duke University and has been moving around the country since then. After completing a Sports Residency at the University of Wisconsin and then working in private practice in Charleston South Carolina she is now the inaugural Fellow for the United States Olympic and Paralympic Committee in Colorado Springs, Colorado. She is a board-certified Sports Clinical Specialist (SCS), CSCS, and Level 2 dry needle certified.  She enjoys working with all athletes but has personal experience with volleyball, rowing, and equestrian sports.

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Chris Lefever

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