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Why is it that all of our patients seem to have “tight” and “overactive” upper trapezius.
A deep ache and constant tightness in the upper trapezius is a common complaint amongst most people and as well as leading to direct discomfort in the muscle, it may also contribute to headaches and neck pain.
But does everyone have tight upper trapezius or is it perhaps a secondary symptom of a larger underlying problem.Upper trapezius tightness and overactivity definitely does exist. We tend to see this a lot in heavy lifters such as weightlifters, powerlifters and cross fitters who have these big jacked up upper traps due to the huge amounts of pulling and pressing movements they do in the execution of their particular lifts.
The upper trapezius primarily works as an upward rotator of the scapular in the last phase of shoulder elevation and abduction, it assists the levator scap to elevate the scapular (but the scapular needs to be already in some upward rotation), it supports the weight of the arm and scapular as our arm is holding something (like heavy groceries or 200kg on the deadlift bar) and it also laterally flexes the neck and works to stabilise the neck when large forces are imposed on the head and neck. All of these movements are involved in most of the powerlifting/Olympic lifts/ Cross Fit moves seen by these athletes.
But what about Sally the secretary who seems to always have a tight upper trap but does not have the same imposed loads as a heavy lifter. Maybe the upper trap is compensating for something or it is trying to protect something. Below are a few reasons why someone may have tight feeling upper traps but in fact have weak traps that are just simply trying too hard.
A Patient could be trying to hide or protect something and what they may be trying to protect is a cervical nerve root injury of a brachial plexus injury.Injury to the nerve bundle will feel worse when it is placed on stretch as the traction of the arm will tug on the nerves and may create nerve pain ad radiculopathy. One way we can alleviate the pain is to contract the upper trap to lift the scapular and release some of the traction. This is a common finding in research that looks at how the upper traps fire during an upper limb tension test for the nerves. As the nerve is manually stretched in the test, the upper trap picks up its activity to perhaps protect the nerve and take some stretch away. This happens in healthy people as well as injured persons.
So someone with a nerve root problem may in fact increase the upper trap to protect. This has been studied for decades and I have included a reference of a recent study on this exact phenomenon(1).
The upper trap should only really come in to shoulder elevation movements in the last phase of movement when the arm is approaching a vertical position. It does this to elevate the scapular and clear the acromion process away from the head of the humerus. If it comes in too early and is active too early, then perhaps it is compensating for weakness in other upward rotators such as the serratus anterior.
The pec minor is a downward rotator of the scapular. As the arm is being lifted and the scapular is upwardly rotating, the pec minor needs to relax. If the pec minor is overly tight and hypertonic, it will try and pull the scapular back down again. So the upper trap along with the serratus anterior will have their work cut out to try and fight this downward drag. Again this is a compensation.
So before you go ahead and deep tissue massage a patient’s “tight” upper trap or dry needle the muscle to relieve the tone, have a think about WHY the muscle is so active. You may get better results treating the neck for a nerve root irritation, or strengthening the serratus anterior or maybe loosening the pec minor instead.
1. Matthews et al (2012) Upper Trapezius Activation during Upper Limb Neural Tension Test-1 in Karate Players. Ibnosina Journal of Medicine and Biomedical Sciences. 173-178.
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Injury, Trauma & Spinal Rehabilitation Specialist