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Trapezius Muscles Audio

Integrated functional anatomy of the trapezius/trap muscles. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Examples of common activation exercises, stretches, foam rolling, subsystems, and strength exercises for the trapezius/traps.

Trapezius Muscles

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This course describes the anatomy and integrated function of the trapezius muscles. The trapezius muscles are also known as the traps, trap muscles, shoulder blade muscles, upper back muscles, and/or are referred to individually as the upper trapezius (upper trap), middle trapezius (mid trap), and lower trapezius (lower trap). This muscle is the most superficial muscle of the upper back and is composed of more type I muscle fibers; however, the percentage of type I and type II muscle fibers are close to even. This muscle crosses the scapulothoracic joint, influencing motion of the sternoclavicular joint and acromioclavicular joint. The upper trapezius is an elevator, upward rotator, and anterior tipper of the scapula, the middle trapezius is a retractor and downward rotator of the scapula, and the lower trapezius is a depressor, upward rotator, and posterior tipper of the scapula. Additionally, the upper trapezius is innervated by the accessory nerve (along with the sternocleidomastoid) and plays an important role in stability and motion of the neck (cervical spine). This course also describes the role of the trapezius muscles in scapulothoracic arthrokinematics, fascial integration (thoracolumbar fascia), postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the trapezius muscles for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. neck pain, thoracic pain, AC and SC joint pain, trapezius muscle pain and trigger points, cervicogenic headache, thoracic outlet syndrome, accessory nerve dysfunction, trapezius muscle strain, scapular winging), synergistic function and motor control (e.g. trapezius muscle and rotator cuff muscle recruitment during arm elevation), and trapezius exercises and techniques for enhancing sports performance (e.g. upper body (arm) stability, strength, power, hypertrophy, etc.).

Brookbush Institute’s most recommended techniques for the Trapezius Muscles (see videos below):

Self-Administered Upper Trapezius Manual Release

A cadaver dissection of the trapezius muscle in relation to the latissimus dorsi

 Course Description: Trapezius Muscles

 muscle over the back of the neck, 1704, from Modern Latin trapezius (musculus), masc. adjective from trapezium (see 

So-called from the shape they form, as in 

 1706, "a trapezium," from Modern Latin trapezoides, from Late Greek trapezoeides, noun use by Euclid of Greek trapezoeides "trapezium-shaped," from trapeza, literally "table" (see 

). Technically, a plane four-sided figure with no two sides parallel. But in English, since c.1800, often confused with trapezium in its sense of "a quadrilateral figure having only two sides parallel and two not." (Etymology Online)

An image of the trapezius muscle with upper, middle, and lower fibers highlighted

This image was content published in a BodyParts3D/Anatomography website

Attachments & Innervation: Upper, Middle, and Lower Trapezius

The superficial trapezius muscles on the posterior side of the upper body

Posterior upper body dissection with the teres major, infraspinatus, latissimus dorsi and trapezius muscles showing

Where are the Traps Located?

The location and fiber direction of the upper, middle, and lower traps

Palpating the Trapezius Muscles

Introduction to the Trapezius Muscles

Upper: Elevation, upward rotation, and anterior tipping of the scapula. Ipsilateral flexion, extension, and contralateral rotation of the cervical spine (3,8,11, 20).

Middle: Retraction of the scapula (3,8,11).

Lower: Depression, upward rotation, and posterior tipping of scapula.

Note: Some texts note the potential for all portions of the trapezius muscle to contribute to retraction and upward rotation, and potentially combined contraction of all segments of the trapezius to contribute to head, neck, and thoracic spine extension (8, 11, 20).

Image of the upper body posterior muscles, nerves, and boney landmarks

Note how the accessory nerve (CN XI) continues inferiorly to invest in the lower portions of the trapezius muscle - http://drkamaldeep.files.wordpress.com/2011/05/image10.png

 AC Joint (10), reinforcement of the acromioclavicular ligament, stabilization of the scapula (acromioclavicular and sternoclavicular joints respectively), stabilization of the atlantooccipital joint, cervical spine, and thoracic spine.

 All segments of the trapezius muscle may eccentrically decelerate protraction and downward rotation. Additionally, the lower trap may eccentrically decelerate elevation and anterior tipping, and the upper trap may decelerate depression and posterior tipping.

The middle trapezius (with some assistance from the upper and lower trapezius) and rhomboids act synergistically during retraction.

The upper trapezius, lower trapezius, and 

 work synergistically during upward rotation of the scapula, with increasing contribution by the middle trapezius the more the arm is elevated.

The upper trapezius may aid the pectoralis minor and levator scapulae in anterior tipping of the scapula (this synergy plays a major role in 

The lower trapezius and serratus anterior act synergistically to posteriorly tip the scapula (this synergy plays a major role in 

An image of the traps running from the skull, spine, ribcage and scapula

The ligaments and connective tissue of the clavicle, sternum, and ribs

The facet joints, intervetebral discs, and vertebral body of the spine

Arthrokinematics

Trapezius Muscle Actions

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

Superficial/Investing Cervical Fascia and the Superior Nuchal Line:

 An interesting relationship to explore would be the shared fascia of the sternocleidomastoid (SCM) and upper trapezius. This sheath of the fascia extends just inferior to the superior nuchal line and expanding from external occipital protuberance medially to mastoid process laterally. This fascia is an expansion of the superficial cervical fascia, is invested by the ligamentum nuchae, and may extend superior to invest in the fascial origin of the occipitalis. As the sternocleidomastoid is often over-active and the upper trapezius under-active the relationship is puzzling, although in the extremes of forward head posture and cervical dysfunction the upper trap, SCM and the investing muscles of the ligamentum nuchae may all present with trigger points and increased tone.

As I combed through pictures and texts researching potential relationships, I did come to an interesting conclusion. The occipitalis and galea aponeurotica likely have fascial continuity with the structures mentioned above - despite all of the illustrations of the occipitalis and galea aponeurotica implying a fascial connection with the deeper splenii and sub-occipitals. The splenii and sub-occipitals are actually enveloped by a deeper layer of cervical fascia (prevertebral layer). How do fascial lines bypass the superficial fascia, the upper trapezius, and the ligamentum nuchae to affect tension in the prevertebral fascia? - Somebody e-mail Tom Myers, this one has me scratching my head.

The nuchal lines acting as attachment points for the trapezius and deep cervical flexor muscles

http://en.academic.ru/pictures/enwiki/78/Nuchal_lines.png

 The ligamentum nuchae in quadrupedal animals is known as the paddy-whack - fun fact of the day ;-) Four muscles insert into the strong ligamentous expansion of the posterior cervical spine known as the ligamentum nuchae (pictured above). This includes the superficial upper trapezius, as well as, the 

 minor, splenius capitis, and serratus posterior superior. This fascial sheath has also been found to have direct fibrous attachments with the spinal dura between the occiput and C1, and between C1 and C2 (17), which may have clinical significance in the treatment of cervicogenic headache. The splenius capitis and 

 minor have a tendency toward over-activity, and the upper trapezius may present as over-active (although less often) with trigger points. The same may be true of the serratus posterior superior (although difficult to determine due to the muscle's small cross-section, function and depth). Forward head posture would result in increased tension in the ligamentum nuchae - Could this increase in fascial tension stimulate receptors that facilitate the activity of investing musculature, and potentially the hypertonicity in cervical extensors noted clinically?

The trapezius, levator scapulae, scalenes, and deep cervical flexors attachment to the boney landmarks of the skull

 (1918) Anatomy of the Human Body (See "Book" section below)

, Public Domain, https://commons.wikimedia.org/w/index.php?curid=561537

: Certainly more research is needed investigating the complex relationship between the fascia and investing musculature at the cervicothoracic junction. The upper and middle trapezius share some common fascial tissue at their origin on the spinous process and ligamentum nuchae with the 

, splenius capitis, and serratus posterior superior, but what about deeper layers of the cervicothoracic fascia. The prevertebral layer of the cervical spine must extend inferiorly to envelop the extensors of the thoracic spine, but how intimate is this fascial layer with the more superficial cervicothoracic fascia. As this segment of the spine and the associated ribs have a complex role to play in the optimal motion of the scapula and shoulder, there could be a functional purpose for complex synergies. It has already been mentioned several times throughout this article that dyskinesis of the cervical and thoracic spine may result in altered activity and trigger point development in the trapezius muscles. Could there be synergistic subsystems at the cervicothoracic junction, analogous to those found crossing the lumbar spine and investing in the thoracolumbar fascia?

 Fascial continuity between the insertion of the trapezius muscle and the origin of the deltoids is actually one of the simpler relationships and stronger arguments for fascial lines if you consider these muscles relative to the scapulohumeral rhythm. Consider how elevation of the arm includes both activation of the deltoids and the trapezius to initiate upward rotation of the scapula. The strongest fascial connection is likely from the upper trapezius to superior AC ligament to anterior deltoid (10). A relationship that is highlighted every time we reach for something - shoulder flexion via the anterior deltoid accompanied by upward rotation of the scapula via the upper trapezius.

Fascial Integration

 by many clinicians, texts, and studies (1, 2, 4, 7, 8, 11, 15, 21). The 

 (1, 2, 5, 8) leading to some confusion on the effect this muscle may have on the 

 is most often long and under-active leading to excessive elevation, downward rotation, and anterior tipping of the scapula in both static and dynamic postures. Manual muscle testing (MMT) will often highlight marked weakness in those with shoulder, shoulder girdle, and thoracic spine pathology. Occasionally trigger points are noted, but these are relatively rare when compared and/or differentiated from 

 trigger points and/or arthrokinematic dysfunction of the lower thoracic spine resulting in facilitation of the lower traps.

 plays a similar role in postural dysfunction/movement impairment as the lower trapezius, resulting in a decrease in end range upward rotation during arm elevation and anterior tipping during postural assessment. Careful attention should be given to the relationship between the thoracic spine and middle trapezius. Dysfunction of one is often a sign of dysfunction in the other.

 in those with the extremes of shoulder girdle and cervical dysfunction, contributing to both extension of the upper cervical spine and anterior tipping of the scapula. However, it is 

more common to find the upper trapezius long and under-active

, leading to a decrease in scapular upward rotation and clavicular posterior rotation during arm elevation. Evidence of under-activity in the upper trapezius has been noted in a study by Scovazzo, who examined the muscle activity of freestyle swimmers with a painful shoulder - trapezius activity was shown to be reduced during all phases of the swimming stroke (15). In postural assessment (for example, the 

), under-activity of the upper trap generally results in elevation of the superior angle of the scapula (shoulder girdle elevation) around a fixed glenoid fossa - relative downward rotation. The elevation is actually due to the activity of the levator scapulae and 

, acting as overactive synergists for an inhibited upper trapezius. If the upper trapezius was the cause of the observable elevation of the shoulder girdle during assessment it would be accompanied by upward rotation.

Every joint motion is relative. That is one bone moves relative to the other.

Why do you keep referring to downward rotation of the scapula in UBD, when I clearly see the scapula elevate during an assessment?

It’s an optical illusion, kind-of… What you see is the superior angle (superior/medial corner) of the scapula elevate, but the glenoid fossa remains fixed. That is to say, downward rotation of the scapula can occur as it is traditionally taught – glenoid fossa moving inferiorly, or as elevation of the superior angle of the scapula around a fixed glenoid fossa.

The diagram below depicts a posterior view of the right scapula and humerus. The image on the left depicts downward rotation as it is “traditionally” taught, while the diagram on the right depicts relative downward rotation around a fixed glenoid fossa (downward rotation masquerading as elevation).

Note: scapular downward rotation around a fixed humerus is relative humeral abduction indicating a decrease in length of the supraspinatus and posterior deltoid.

A depiction of the upward and downward motions of the scapula

In a similar fashion to the example above, the forward motion often noted as protraction may be viewed as anterior tipping and protraction of the upper scapula alone around a fixed inferior angle.

The Upper Trapezius is one of the few "Jekyll and Hyde" muscles. That is, most muscles that have a propensity toward over-activity are almost always over-active, and those muscles with a propensity toward under-activity are almost always under-active. It would seem that despite my inclination to label this muscle long/underactive, the upper trapezius may play both roles. This is not unheard of, as some of the muscles of the core may also play both roles (for example, the Psoas).

Travell and Simons note the upper trapezius may be the most common site for trigger point development (8). In light of this evidence, it may be easiest to simply lump the upper trap in with the other over-active, trigger point laden muscles, but we cannot forget that long muscles can have trigger points too. What if the upper trap is acting like the 

 in Lumbo-Pelvic Hip Complex Dysfunction (LPHCD) - Long and Over-active. Consider how changing length/tension relationships results in decreased force production and efficiency, and the effect that may have on a long upper trap trying to resist gravity's pull on the entire shoulder girdle. Could trigger points be a compensation to overcome the loss in force production and maintain some level of scapular stability?

Last, there may be some confusion related to the source of trigger points. If you return to the "Relative Location" section of this article you may note that the upper trapezius lies over several muscles that are commonly over-active. Namely, the levator scapulae, 

, and supraspinatus, and that many clinicians have noted a resolution of trigger points with cervical and thoracic mobilization. Before one advocates release and stretching for a muscle that may be either under-active or over-active, it may be prudent to check other structures that may contribute to dysfunction.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

, the trapezius muscle plays no significant role.

 the trapezius muscle plays no significant role.

, all segments of the trapezius muscle may have a propensity toward under-activity and an adaptive increase in length. This implies that activation, integration, and strengthening techniques should be part of a human movement professional's repertoire. The upper trapezius may be over-active in those individuals with the extremes of cervical and 

 and additional techniques used to reduced tone and increase length (release and stretching) will be necessary for this segment of the muscle. Last, knowledge of cervical and thoracic mobilization techniques may be useful for long-term resolution of altered activity and length (see videos below).

The latissimus dorsi and trapezius muscles in a cadaver dissection

http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/sb4a-edited.gif

Signs of Altered Length/Tension and Tone:

Shoulder Girdle Elevation - Long/Under-active

Goniometric assessment of the scapula is unreliable, although observation of scapular movement during arm elevation may provide valuable information.

It is my humble opinion that many trigger points believed to be trapezius trigger points, are actually levator scapulae, supraspinatus, and rhomboid trigger points. Further, some trigger points in the trapezius are nothing more than satellite sites originating from the cervical and thoracic spine dysfunction (arthrokinematic facilitation).

Palpation results in tenderness and may result in radiating symptoms.

The trigger points and referral pain patterns of the trapezius muscles 

Comparison between the upper trapezius, levator scapulae, and rhomboid trigger points

 trigger points (listed from superior to inferior) with posterior deltoid trigger point marked on male subject:

Postural Dysfunction and the Trapezius Muscles

Prone Trapezius Activation on Stability Ball

 Eccentric PNF Catch and Throw

Upper Trapezius (Self-Administered) Static Release

Upper Trap Static Stretch

Self-administered Sternocostal Mobilization: Anterior to Posterior

Self-administered Thoracic Spine Mobilization: Rotation

Self-administered Spine Mobilization: Rotation (Open Books)

Exercises and Techniques for Trapezius Muscles:

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

Scovazzo ML, Browne A, Pink M, et. al.: The Painful shoulder during freestyle swimming. Am J Sports Med 19(6):577-582, 1991

Lawrence, R. L., Braman, J. P., Laprade, R. F., & Ludewig, P. M. (2014). Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. 

journal of orthopaedic & sports physical therapy

Dean, N.A. and B.S. Mitchell 2002. Anatomic relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region. 

Lind CS, et al. (2015). Quantification of trapezius muscle innervation during neck dissections: cervical plexus versus the spinal accessory nerve. 

Annals of Otology, Rhinology, & Laryngology.

Canella C, Demondion X, Abreu E, et al. (2013). Anatomical study of the spinal accessory nerve using ultrasonography. 

Tubbs RS, Shoja MM, Loukas M, et al. (2011). Study of the cervical plexus innervation of the trapezius muscle. 

Choi W, Cynn H, Lee C, et al. Shrug exercises combined with shoulder abduction improve scapular upward rotator activity and scapular alignment in subjects with scapular downward rotation impairment. 

Journal of Electromyography and Kinesiology

Lindman, R., Eriksson, A., & Thornell, L. E. (1990). Fiber type composition of the human male trapezius muscle: Enzyme‐histochemical characteristics. 

Lindman, R., Eriksson, A., & Thornell, L. E. (1990). Fiber type composition of the human female trapezius muscle: Enzyme‐histochemical characteristics. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Trapezius Muscles

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Course Description: Trapezius Muscles

Introduction to the Trapezius Muscles
3 Sub Sections

Trapezius Muscle Actions
1 Sub Section

Fascial Integration

Postural Dysfunction and the Trapezius Muscles

Exercises and Techniques for Trapezius Muscles:
7 Sub Sections

Bibliography

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Comments

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Trapezius Muscles

Related Courses:

Course Description: Trapezius Muscles

Introduction to the Trapezius Muscles3 Sub Sections

Trapezius Muscle Actions1 Sub Section

Fascial Integration

Postural Dysfunction and the Trapezius Muscles

Exercises and Techniques for Trapezius Muscles:7 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Trapezius Muscles
3 Sub Sections

Trapezius Muscle Actions
1 Sub Section

Exercises and Techniques for Trapezius Muscles:
7 Sub Sections