Static Manual Release: Upper Trapezius, Levator Scapulae, Rhomboids and Pectoralis Minor (for Upper-Body Dysfunction)

This course describes static manual release techniques for the muscles of the scapula that are commonly assessed as over-active and prone to trigger point development. Unfortunately, it is easy to be confused by a large number of synonyms for the terms used for these techniques. For example, the techniques described in this course may be considered refinements of massage, massage therapy, therapeutic massage, deep tissue massage, medical massage, sports massage, trigger point massage, static compression techniques, soft tissue mobilization, muscle inhibitory techniques, and manual therapy techniques. Even the term trigger point is referred to by a variety of synonyms including muscle knots, nodules, adhesions, over-active muscle fibers, hypertonic fascicles, spasms, and acute points of hyper-contractility, and the trigger point phenomenon is likely part of every reference to short muscles, muscle tightness, muscle tension, muscle spasm, upper back stiffness, and neck stiffness, etc. Part of the reason so many synonyms exist is the rich history of scientific inquiry, from multiple disciplines and cultures, that have contributed to our understanding of the techniques described in this course.

This course includes techniques for the upper trapezius, levator scapulae, rhomboids, and pectoralis minor muscles. Release techniques for these muscles are commonly included in an integrated program designed to address neck pain, neck stiffness, upper back pain, scapular (shoulder blade) muscle pain, and shoulder pain. These techniques may also aid in addressing posture correlated with cervical, upper thoracic, scapula, and shoulder dysfunction including forward head posture, thoracic kyphosis, scapula dyskinesis, and rounded shoulder posture. Last. these techniques may be beneficial when included in an integrated program designed to address elbow dysfunction (e.g. lateral epicondylitis a.k.a. tennis elbow), upper back pain (e.g. thoracic spine dysfunction), and/or lower back pain (lumbar spine dysfunction).

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Upper Trapezius Manual Static Release
• Levator Scapulae Manual Static Release
• Rhomboids Manual Static Release
• Pectoralis Minor Manual Static Release

Additional Static Manual Release Courses

• Static Manual Release: Upper Trapezius, Levator Scapulae and Splenii
• Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors
• Static Manual Release: Scapular Muscles
• Static Manual Release: Shoulder Muscles
• Static Manual Release: Trunk Muscles
• Static Manual Release: Hip Flexors
• Static Manual Release: Hip Internal Rotators
• Static Manual Release: Hip External Rotators
• Static Manual Release: Tibia External Rotators
• Static Manual Release: Lower Leg Muscles

For a review of muscle fiber dysfunction and trigger point etiology:

• Muscle Fiber Dysfunction and Trigger Points
• Trigger Point Assessment and Palpation

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Massage Therapists
• Occupational Therapists - Advanced
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

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   • Deep Cervical Flexors
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    • Serratus Anterior
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    • Upper Trapezius
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33. Kwon JW, Son SM, Lee NK. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 27: 1739-1742.
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    • Upper Trapezius Dysfunction Etiology
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    • Palpation (Upper Trapezius Continued)
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    • Treatment (Upper Trapezius Continued)
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64. Abbaszadeh-Amirdehi, M., Ansari, N. N., Naghdi, S., Olyaei, G., & Nourbakhsh, M. R. (2017). Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points . Journal of bodywork and movement therapies, 21(1), 48-52.
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    • Combination of Techniques
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77. Fernández‐de‐las‐Peñas, C., Cleland, J. A., Palomeque‐del‐Cerro, L., Caminero, A. B., Guillem‐Mesado, A., & Jiménez‐García, R. (2011). Development of a Clinical Prediction Rule for Identifying Women With Tension‐Type Headache Who Are Likely to Achieve Short‐Term Success With Joint Mobilization and Muscle Trigger Point Therapy. Headache: The Journal of Head and Face Pain, 51(2), 246-261.
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    • Levator Scapulae (18, 20, 24, 67-68, 71-72, 78 - 81)
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86. Fernández-de-las-Penas, C., Ge, H. Y., Alonso-Blanco, C., González-Iglesias, J., & Arendt-Nielsen, L. (2010). Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. Journal of bodywork and movement therapies, 14(4), 391-396.
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88. Thigpen CA, Padua DA, Michener LA, Guskiewicz K, Giuliani C, Keener JD, Stergiou N. (2010). Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks. Journal of Electromyography and Kinesiology. 20: 701-709 .
    • Additional Levator Scapulae and Trapezius Studies
89. Martin-Herrero, C., de Souza Rodrigues, D. P., Alburquerque-Sendin, F., Ortega-Santiago, R., & Fernández-de-Las-Peñas, C. (2012). Myofascial trigger points, pain, disability and quality of sleep in patients with chronic tension-type headache: a pilot study. Revista de neurologia, 55(4), 193-199.
90. Palacios-Ceña, M., Castaldo, M., Wang, K., Catena, A., Torelli, P., Arendt-Nielsen, L., & Fernández-de-Las-Peñas, C. (2017). Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine, 96(13).
91. Palacios-Ceña, M., Wang, K., Castaldo, M., Guillem-Mesado, A., Ordás-Bandera, C., Arendt-Nielsen, L., & Fernández-de-las-Peñas, C. (2018). Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia, 38(2), 237-245.
92. Alonso-Blanco, C., Fernández-de-Las-Peñas, C., Fernández-Mayoralas, D. M., de-la-Llave-Rincón, A. I., Pareja, J. A., & Svensson, P. (2011). Prevalence and anatomical localization of muscle referred pain from active trigger points in head and neck musculature in adults and children with chronic tension-type headache. Pain Medicine, 12(10), 1453-1463.
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94. Ferracini, G. N., Florencio, L. L., Dach, F., Chaves, T. C., Palacios-Ceña, M., Fernández-de-las-Peñas, C., … & Speciali, J. G. (2017). Myofascial trigger points and migraine-related disability in women with episodic and chronic migraine. The Clinical journal of pain, 33(2), 109-115.
95. Ferracini, G. N., Chaves, T. C., Dach, F., Bevilaqua-Grossi, D., Fernández-de-las-Peñas, C., & Speciali, J. G. (2016). Relationship between active trigger points and head/neck posture in patients with migraine. American journal of physical medicine & rehabilitation, 95(11), 831-839.
96. Fernández-Pérez, A. M., Villaverde-Gutiérrez, C., Mora-Sánchez, A., Alonso-Blanco, C., Sterling, M., & Fernández-de-las-Peñas, C. (2012). Muscle trigger points, pressure pain threshold, and cervical range of motion in patients with high level of disability related to acute whiplash injury. journal of orthopaedic & sports physical therapy, 42(7), 634-641.
97. Castaldo, M., Ge, H. Y., Chiarotto, A., Villafane, J. H., & Arendt-Nielsen, L. (2014). Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Medicine, 15(5), 842-849.
98. Fernández-de-Las-Peñas, C., Alonso-Blanco, C., & Miangolarra, J. C. (2007). Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Manual therapy, 12(1), 29-33.
99. Fernández-de-las-Peñas, C., Galán-del-Río, F., Alonso-Blanco, C., Jiménez-García, R., Arendt-Nielsen, L., & Svensson, P. (2010). Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disoders. The Journal of Pain, 11(12), 1295-1304.
100. Doraisamy, M. A., Kumar, C. P., & Gnanamuthu, C. (2010). Chronic tension type headache and the impact of myofascial trigger point release in the short term relief of headache. Global Journal of Health Science, 2(2), 238. (compression)
101. Moraska, A. F., Schmiege, S. J., Mann, J. D., Butryn, N., & Krutsch, J. P. (2017). Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. American journal of physical medicine & rehabilitation, 96(9), 639-645.
102. Quinn, C., Chandler, C., & Moraska, A. (2002). Massage therapy and frequency of chronic tension headaches. American journal of public health, 92(10), 1657-1661.
103. Sedighi, A., Ansari, N. N., & Naghdi, S. (2017). Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache. Journal of bodywork and movement therapies, 21(4), 810-814.
104. Fernández‐de‐las‐Peñas, C., Ge, H. Y., Arendt‐Nielsen, L., Cuadrado, M. L., & Pareja, J. A. (2007). Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. European Journal of Pain, 11(4), 475-482.
105. Hidalgo‐Lozano, A., Fernández‐de‐las‐Peñas, C., Calderón‐Soto, C., Domingo‐Camara, A., Madeleine, P., & Arroyo‐Morales, M. (2013). Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck–shoulder muscles. Scandinavian journal of medicine & science in sports, 23(1), 66-73.
106. Bablis, P., Pollard, H., & Bonello, R. (2008). Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial. Chiropractic & Osteopathy, 16(1), 4. (Levator Scapulae)
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107. Ludewig, P. M., & Cook, T. M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical therapy, 80(3), 276-291 .
108. Ballantyne, B. T., O'Hare, S. J., Paschall, J. L., Pavia-Smith, M. M., Pitz, A. M., Gillon, J. F., & Soderberg, G. L. (1993). Electromyographic activity of selected shoulder muscles in commonly used therapeutic exercises. Physical Therapy, 73(10), 668-677.
109. Kwon, J. W., Son, S. M., & Lee, N. K. (2015). Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. Journal of physical therapy science, 27(6), 1739-1742.
110. Weon, J. H., Oh, J. S., Cynn, H. S., Kim, Y. W., Kwon, O. Y., & Yi, C. H. (2010). Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork and movement therapies, 14(4), 367-374.
111. Wegner, S., Jull, G., O’Leary, S., & Johnston, V. (2010). The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. Manual therapy, 15(6), 562-566.
112. Smith, M., Sparkes, V., Busse, M., & Enright, S. (2009). Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: is there imbalance and can taping change it?. Physical Therapy in Sport, 10(2), 45-50.
113. Cools, A. M., Declercq, G. A., Cambier, D. C., Mahieu, N. N., & Witvrouw, E. E. (2007). Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian Journal of Medicine and Science in Sports, 17, 25–33.
114. Lin, J. J., Wu, Y. T., Wang, S. F., & Chen, S. Y. (2005). Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clinical rheumatology, 24(6), 569-575.
115. Cools, A. M., Witvrouw, E. E., Declercq, G. A., Danneels, L. A., & Cambier, D. C. (2003). Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. The American journal of sports medicine, 31(4), 542-549.
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118. Cools, A. M., Witvrouw, E. E., Declercq, G. A., Vanderstraeten, G. G., & Cambier, D. C. (2004). Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. British journal of sports medicine, 38(1), 64-68.
119. Petersen, S. M., & Wyatt, S. N. (2011). Lower trapezius muscle strength in individuals with unilateral neck pain. journal of orthopaedic & sports physical therapy, 41(4), 260-265.
120. Day, J. M., Bush, H., Nitz, A. J., & Uhl, T. L. (2015). Scapular muscle performance in individuals with lateral epicondylalgia. journal of orthopaedic & sports physical therapy, 45(5), 414-424.
121. Falla, D., Farina, D., & Graven-Nielsen, T. (2007). Experimental muscle pain results in reorganization of coordination among trapezius muscle subdivisions during repetitive shoulder flexion. Experimental brain research, 178(3), 385-393.
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123. Lucas, K. R., Rich, P. A., & Polus, B. I. (2008). How common are latent myofascial trigger points in the scapular positioning muscles?. Journal of Musculoskeletal Pain, 16(4), 279-286.
124. Chen, C. K., & Nizar, A. J. (2011). Myofascial pain syndrome in chronic back pain patients. The Korean journal of pain, 24(2), 100.
125. Chiarotto, A., Clijsen, R., Fernandez-de-las-Penas, C., & Barbero, M. (2016). Prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 97(2), 316-337.
126. Ge, H. Y., Wang, Y., Fernandez-de-Las-Penas, C., Graven-Nielsen, T., Danneskiold-Samsøe, B., & Arendt-Nielsen, L. (2011). Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients. Arthritis research & therapy, 13(2), R48.
127. Bastos, J. L. N., Pires, E. D., Silva, M. L., de Araújo, F. L. B., & Silva, J. R. T. (2013). Effect of acupuncture at tender points for the management of fibromyalgia syndrome: a case series. Journal of acupuncture and meridian studies, 6(3), 163-168.
128. Tewari, S., Madabushi, R., Agarwal, A., Gautam, S. K., & Khuba, S. (2017). Chronic pain in a patient with Ehlers-Danlos syndrome (hypermobility type): The role of myofascial trigger point injections. Journal of bodywork and movement therapies, 21(1), 194-196.
129. Yoo, W. G. (2013). Changes in pressure pain threshold of the upper trapezius, levator scapular and rhomboid muscles during continuous computer work. Journal of physical therapy science, 25(8), 1021-1022.
130. Palmerud, G., Sporrong, H., Herberts, P., & Kadefors, R. (1998). Consequences of trapezius relaxation on the distribution of shoulder muscle forces: an electromyographic study. Journal of Electromyography and Kinesiology, 8(3), 185-193.
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132. Sun, A., Yeo, H. G., Kim, T. U., Hyun, J. K., & Kim, J. Y. (2014). Radiologic assessment of forward head posture and its relation to myofascial pain syndrome. Annals of rehabilitation medicine, 38(6), 821.
133. Jones, D. H., Kilgour, R. D., & Comtois, A. S. (2007). Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women. The Journal of Pain, 8(8), 650-656.
134. Fagundes, A. D. A., Reis, M. C. R., Salles, M., & Licurci, M. G. B. (2013). Immediate effects of acupuncture for managing myofascial trigger-point pain: A pilot study. Medical Acupuncture, 25(1), 55-60.
135. Hong, C. Z., Kuan, T. S., Chen, J. T., & Chen, S. M. (1997). Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison. Archives of physical medicine and rehabilitation, 78(9), 957-960.
136. Seol, S. J., Cho, H., & Do Hyun Yoon, S. H. J. (2014). Appropriate depth of needle insertion during rhomboid major trigger point block. Annals of rehabilitation medicine, 38(1), 72.
137. Lee, D. G., & Chang, M. C. (2018). Dorsal scapular nerve injury after trigger point injection into the rhomboid major muscle: A case report. Journal of back and musculoskeletal rehabilitation, 31(1), 211-214.
138. Sultan, H. E., & El-Tantawi, G. A. Y. (2013). Role of dorsal scapular nerve entrapment in unilateral interscapular pain. Archives of physical medicine and rehabilitation, 94(6), 1118-1125.
139. Bubnov, R. V., & Wang, J. (2013). Clinical comparative study for ultrasound-guided trigger-point needling for myofascial pain. Medical Acupuncture, 25(6), 437-443.
140. Metin Ökmen, B., Ökmen, K., & Altan, L. (2018). Comparison of the Efficiency of Ultrasound‐Guided Injections of the Rhomboid Major and Trapezius Muscles in Myofascial Pain Syndrome: A Prospective Randomized Controlled Double‐blind Study. Journal of Ultrasound in Medicine, 37(5), 1151-1157.
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148. Hanten, W. P., Olson, S. L., Butts, N. L., & Nowicki, A. L. (2000). Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical therapy, 80(10), 997-1003.
149. Gulick, D. T., Palombaro, K., & Lattanzi, J. B. (2011). Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points. Journal of bodywork and movement therapies, 15(3), 319-325.
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151. Borstad, J. D., & Ludewig, P. M. (2005). The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. Journal of orthopaedic & sports physical therapy, 35(4), 227-238.
152. Lucas, K. R., Rich, P. A., & Polus, B. I. (2010). Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points . Clinical Biomechanics, 25(8), 765-770.
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154. Fitzgerald, G. (2012). Thoracic outlet syndrome of pectoralis minor etiology mimicking cardiac symptoms on activity: a case report. The Journal of the Canadian Chiropractic Association, 56(4), 311.
155. Lawson, G. E., Hung, L. Y., Ko, G. D., & Laframboise, M. A. (2011). A case of pseudo–angina pectoris from a pectoralis minor trigger point caused by cross-country skiing. Journal of chiropractic medicine, 10(3), 173-178.
156. Hong, C. Z. (2000). Specific sequential myofascial trigger point therapy in the treatment of a patient with myofascial pain syndrome associated with reflex sympathetic dystrophy: Commentary. Australasian Chiropractic & Osteopathy, 9(1), 7.
157. Mutlu, E. K., Birinci, T., Dizdar, G., & Ozdincler, A. R. (2016). Latent trigger points: What are the underlying predictors?. Archives of physical medicine and rehabilitation, 97(9), 1533-1541.
158. Andrzejewski, W., Kassolik, K., Brzozowski, M., & Cymer, K. (2010). The influence of age and physical activity on the pressure sensitivity of soft tissues of the musculoskeletal system. Journal of bodywork and movement therapies, 14(4), 382-390.
159. Hong, C. Z. (1998). Algometry in evaluation of trigger points and referred pain. Journal of Musculoskeletal Pain, 6(1), 47-59.
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163. Hong, C. Z., & Hsueh, T. C. (1996). Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Archives of physical medicine and rehabilitation, 77(11), 1161-1166.
164. Shin, H. J., Shin, J. C., Kim, W. S., Chang, W. H., & Lee, S. C. (2014). Application of ultrasound-guided trigger point injection for myofascial trigger points in the subscapularis and pectoralis muscles to post-mastectomy patients: a pilot study. Yonsei medical journal, 55(3), 792-799.
165. Wong CK, Coleman D, diPersia V, Song J, Wright D. (2010). The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. Journal of Bodywork & Movement Therapies. 14: 326-333.
166. Rosa, D. P., Borstad, J. D., Pogetti, L. S., & Camargo, P. R. (2017). Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain. Journal of Hand Therapy, 30(1), 20-29.
167. Peacock, C. A., Krein, D. D., Silver, T. A., Sanders, G. J., & Von Carlowitz, K. P. A. (2014). An acute bout of self-myofascial release in the form of foam rolling improves performance testing. International journal of exercise science, 7(3), 202.
168. Page, P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254.
169. Rimbey, D. M. (2005). Diagnosis and Treatment of Pectoralis Minor Entrapment with Underlying Cervical Disc Herniation: A Case Study. Journal of the American Chiropractic Association, 42(2).
170. Bron, C., De Gast, A., Dommerholt, J., Stegenga, B., Wensing, M., & Oostendorp, R. A. (2011). Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC medicine, 9(1), 8.
171. Donnelly, J. M. (2002). Physical therapy approach to fibromyalgia with myofascial trigger points: a case report. Journal of Musculoskeletal Pain, 10(1-2), 177-190.