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Integrated functional anatomy of the levator scapulae. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises, foam rolling, neck releases, and stretches for the levator scapulae.

Levator Scapulae

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes the anatomy and integrated function of the skeletal muscle, levator scapulae (a.k.a. levator scapula, levator scap, scapulae muscle, levator muscle, lev scap, LS, etc.). This muscle originates from the transverse processes of the cervical vertebrae 1-4 (neck), inserts into the superior angle of the scapula (shoulder blade), and is innervated by cervical nerves 3 and 4, and the dorsal scapular nerve. This neck and shoulder blade muscle is composed of a near-even proportion of type I and type II muscle fibers with a slight bias toward type I muscle fibers (based on the composition of the similar upper trapezius muscle).

This muscle crosses the scapulothoracic joint (scapula), influencing motion of the sternoclavicular joint and acromioclavicular joint, via the scapula (shoulder blade). The levator scapula is an elevator, anterior tipper, and downward rotator of the scapula. Additionally, this muscle contributes to cervical lateral flexion, upper cervical extension, and cervical ipsilateral rotation. This course also describes the role of the levator scapulae muscles in scapulothoracic arthrokinematics, fascial integration, head posture and 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 integrated function of the levator scapulae 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 therapy (e.g. levator scapulae pain, shoulder pain, neck pain (chronic pain), poor posture, especially forward head posture, levator scapulae syndrome, shoulder impingement syndrome, referral pain to the shoulder), synergistic function and motor control (e.g. levator scapula and rhomboid muscles, both innervated by the dorsal scapular nerve, contributing to downward rotation of the scapula during motion of the pectoral girdle and upper limb), and levator scapulae specific techniques (e.g. levator scapulae active release, static manual release, levator scapulae stretch, levator scapulae active stretch, levator scapulae manual release (massage), and neuromuscular re-education for enhancing shoulder and shoulder girdle motion). Note, this muscle is commonly addressed during sports massage.

Brookbush Institute’s most recommended techniques for the Levator Scapulae (see videos below):

The levator scapula attaching on the skull

Levator Scapulae - http://classconnection.s3.amazonaws.com/228/flashcards/504228/jpg/heaposmusmhnlevator_20scapulae_20m_1351523887828.jpg

 Course Description: Levator Scapulae

Introduction

 “a lifter,” from Latin levatus, past participle of levare “to raise” (see 

 “shoulder blade,” 1570s, Modern Latin, from Late Latin scapula “shoulder,” from Latin scapulae (plural) “shoulders, shoulder blades,” perhaps originally “spades, shovels,” on the notion of similar shape, but animal shoulder blades might have been used as scraping tools in primitive times, from PIE *skap-, variant of *skep- “to cut, scrape” (see 

Attachment and Innervation

The 3rd cervical nerve arising between the scalenes

Attachment & Innervation: Levator Scapulae

Relative Location

A cross-section of the cervical spine including the levator scapulae

Where is the Levator Scapula Located

Palpation

Palpating the Levator Scapulae

Introduction to the Levator Scapulae

Actions

Cervical Spine: Extension, lateral flexion, and ipsilateral rotation (8, 11)

Scapula: Elevation and downward rotation (8, 11, 19, 21).

Attachments of the levator scapulae on the neck, head, and shoulder blades

 Stabilization of the cervical spine and scapula.

 Upward rotation and depression of the scapulae, and flexion, contralateral flexion, and contralateral rotation of the cervical spine.

 work synergistically during elevation of the scapula.

 work synergistically during downward rotation of the scapula

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

The levator scapulae may assist in cervical extension along with the 

, splenii, semispinalis, longissimus cervicis muscle of the 

 muscle group, the posterior scalenes, and the multifidus, rotatores, interspinalis, and intertransversarii.

The levator scapulae may assist in cervical lateral flexion, along with all of the ipsilateral muscles of the cervical spine.

Rotation of the cervical spine is the result of a complex synergy of muscles including the ipsilateral levator scapulae, contralateral 

, ipsilateral sternocleidomastoid, ipsilateral scalenes, and contralateral extensors (listed above)

Arthrokinematics

The articular surfaces of the SC joint and scapula in the frontal plane

The levator scapula attaching from the cervical spine to scapula

Levator Scapulae Actions

Fascial Integration

 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.

The fascial web between two muscle fascicles

The fascial network between fascicles of a muscle - http://www.selfcare4rsi.com/images/fascia.jpg

Origin: The levator scapulae share an attachment on the posterior tubercles of the transverse process with intertransversarii posterior at C1 - C4, the splenius cervicis at C1 - C3, the longissimus cervicis at C2 - C4, and the middles scalenes at C3 and C4. All of these muscles have a propensity to become short/over-active and are separated from the 

 by the prevertebral (deep) layer of the cervical fascia. (Further evidence, that the levator scapulae and 

 may adopt contrary changes in muscle activity in 

. Practically, this may imply that via fascial relationships in the cervical spine, the levator scapulae acts synergistically with a group of muscles known as the "lateral cervical muscles". In essence, the motor behavior and recruitment patterns of the levator scapulae may be more similar to the scalenes than the 

 at the cervical spine. Clinically, this would seem to be the case, as lateral flexion is often the first range of motion lost, the last range of motion to return, and levator scapulae trigger points and over-activity are very common, and often occur in conjunction with scalene trigger points and over-activity.

Insertion: The superficial layer of fascia of the levator scapulae runs nearly continuously over the root of the spine of the scapula to invest in the fascia of the 

. This is noted by Tom Myers and is included in the Deep Back Arm Line (6). Both muscles have a propensity toward over-activity and the treatment of both is often necessary for long-term resolution of trigger points, over-activity, and length changes in either structure. Further, the nearly adjacent insertions of the 

 minor and levator scapulae may also imply a fascial relationship. Both muscles are generally over-active in 

, as both muscles will contribute to elevation of the superior/medial angle and downward rotation of the scapula. Interestingly, both of these muscles are also innervated by the dorsal scapular nerve.

The deep back arm line running continuously between the levator scapulae and supraspinatus

The Deep Back Arm Line - Notice the continuity between the levator scapulae and supraspinatus. http://api.ning.com/files/omkt7cwbhXICNyvLoGl93*LlNJWZtjoMpX*mws1oEW9P1*Q4d4MAEXeGQa2BqT-OLbIT22AQQ8ksHAwcH5STUWLJOovk3gJ2/ScreenShot20140310at12.45.56PM.png

Behavior in Postural Dysfunction

 by many clinicians, texts, and studies (1, 2, 4, 7, 8, 11, 18, 21).

The levator scapulae is most often short and over-active contributing to excessive anterior tipping and downward rotation of the scapula in those with 

. Trigger points in the levator scapulae are among the most commonly noted trigger points in the human body (8, 22), and it is my opinion that much of the "tightness" and trigger point pain credited to the upper trapezius by patients, is actually due to activity, length changes, and trigger points in the levator scapulae and supraspinatus (see "Fascial Integration" above). It is my hypothesis that the levator scapulae become synergistically dominant for an inhibited 

 may often be attributed to an inability to effectively upwardly rotate the scapula due to less than optimal length/tension relationship and overload from over-coming the increased activity of the levator scapulae during arm elevation. Clinically, I have found release and lengthening of the levator scapulae is often sufficient to reduce soreness in both muscles.

 in those with the extremes of the 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. See the article on the 

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 the levator scapulae play no significant role.

The levator scapulae plays a significant role, contributing to the closure of the facet joints, a reduction in both passive and active rotation (often in both directions), a reduction in passive contralateral flexion, and often causing pain when active flexion is attempted to the same side (8). Many clinicians have noted facet joint dysfunction often results in active trigger point development and altered activity of the levator scapulae (7-9, 12, 18). As mentioned above (in "Arthrokinematics") the levator scapulae seem to "act" as a lateral cervical muscle relative to the cervical spine and is often paired with over-activity of the scalenes. Resolution and normalization of levator scapulae activity is dependent on not only release of the levator scapulae, but release of all associated structures, mobilization of stiff facets, optimization of cervical arthrokinematics, and postural re-education.

Note: The levator scapulae may be viewed as the bridge between 

 and Cervical dysfunction, having a role in both scapular mechanics and cervical mechanics with resulting changes in length and activity affecting both.

, the levator scapulae has a propensity toward over-activity and an adaptive decrease in length. This implies that release and lengthening for the levator scapulae should be part of a human movement professional's repertoire. Further, cervical mobilization techniques may aid in optimizing length and activity of the levator scapulae and should be part of the repertoire of any licensed professional (PT, ATC, DC, DO) treating upper body and cervical pathologies.

Signs of Altered Length/Tension and Tone:

Cervical Lateral flexion - less than 35 - 45º

Apley's Scratch Test (Inability of the top arm to reach the contralateral superior angle of the scapula)

Palpation results in tenderness and may result in radiating symptoms along the angle of the neck and the vertebral border of the scapula (8).

Levator Scapulae is the second most common trigger point location after the upper 

 in those with mechanical neck pain (22). In a study by Lluch et al., the occurrence was up to 65% in those with spinal pain and levator scapulae trigger points were the most common trigger point found in whiplash patients (23).

Comparison of upper trapezius, levator scapulae and rhomboid trigger points 

Comparison of Upper Trapezius, Levator Scapulae and Rhomboid trigger points (listed from superior to inferior) with posterior deltoid trigger point marked on male subject:

Postural Dysfunction and the Levator Scapulae

Techniques and Ending Info

Levator Scapulae (Self-Administered) Static Release

Levator Scapulae (Self-administered) Dynamic Release

Levator Scapulae Static Stretch

Levator Scapulae, Trapezius and Splenii Vibration Release

Static Manual Release Technique

Exercises and Techniques for Levator Scapulae

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. 

Oladipo GS, Aigbogun Jr EO, Akani GL. (2015). Angle at the medial border: the spinovertebral angle and its significance. 

Nasu H, Yamaguchi K, Nimura A, Akita K. (2012). An anatomic study of structure and innervation of the serratus anterior muscle. 

Choi W, Cynn H, Lee C, et al. (2014). 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

Munoz-Munoz S, Munoz-Garcia MT, Alburquerque-Sendin, et al. (2012). Myofascial trigger points, pain, disability, and sleep quality in individuals with mechanical neck pain. 

Journal of Manipulative and Physiological Therapeutics. 35(8): 608-613.

Lluch E, Nijs J, De Kooking M, et al. (2015). Prevalence, incidence, localization, and pathophysiology of myofascial trigger points in patients with spinal pain: a systematic literature review. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Levator Scapulae

Related Courses:

Course Description: Levator Scapulae

Introduction to the Levator Scapulae
3 Sub Sections

Levator Scapulae Actions
1 Sub Section

Fascial Integration

Postural Dysfunction and the Levator Scapulae

Exercises and Techniques for Levator Scapulae
5 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Levator Scapulae

Related Courses:

Course Description: Levator Scapulae

Introduction to the Levator Scapulae3 Sub Sections

Levator Scapulae Actions1 Sub Section

Fascial Integration

Postural Dysfunction and the Levator Scapulae

Exercises and Techniques for Levator Scapulae5 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Levator Scapulae
3 Sub Sections

Levator Scapulae Actions
1 Sub Section

Exercises and Techniques for Levator Scapulae
5 Sub Sections