The trapezius is a large superficial diamond shaped muscle that spans the neck, shoulders, and mid back region. This muscle has three divisions of muscle fibres – the upper fibres, the middle fibres, and the lower fibres. The respective attachment sites and fibre direction of these three divisions are clinically significant in that each division of muscle fibres performs its own distinct function or “Action”. The upper trapezius muscle fibres run in an inferolateral direction, and they elevate the scapula (causing a shrugging motion of the shoulders). The middle fibres run laterally from the vertebrae to the scapula, and they retract the scapula, drawing it towards the body’s midline. The lower trapezius muscle fibres run superolaterally and, when activated, they work to depress the scapula, drawing it inferiorly.
figure 1- the Trapezius Muscle (right side)
– The Inion of the Occipital Bone
– The Medial 1/3 of Superior Nuchal line on the Occipital Bone
– The Ligamentum Nuchae
– The Spinous Processes of C7-T12
– The Spine of the Scapula
– The Acromion Process of the Scapula
– The Lateral 1/3 of the Clavicle
– Upper Fibres – Scapular Elevation
– Middle Fibres – Scapular Retraction
– Lower Fibres – Scapular Depression
Caution: make sure to carefully assess the structures prior to performing the following techniques. Also, ensure that the tissue has been adequately warmed up before performing any deep techniques or stretches.
1. MYOTONIC RELEASE TO LOWER TRAPEZIUS FIBRES
– Objective: To reduce and potentially eliminate contractures and adhesions commonly found in the trapezius muscle. Contractures and adhesions in the trapezius can result with chronic repetitive strain injuries and overuse injuries (such as from working excessively at a desk or computer with poor ergonomics), the chronic stage of healing after traumatic muscle strains (eg. athletic neck or shoulder injuries), and other traumatic injuries that cause damage to the muscle or other structures in the posterior and lateral neck region (such as front or side impact Motor Vehicle Accidents).
– Positioning: Have your client lying prone with his torso towards the edge of the table (so that the G/H joint on the side of the muscle you are treating is over the edge of the table).
– To perform this technique, stand at the side of the table, at about the level of your client’s shoulder.
– Technique: First, ask your client to maximally shorten the lower trapezius muscle fibres by retracting and depressing the scapula, and then ask him to bring his arm into a position of maximal lateral extension.
– Place your superior hand (the hand that is towards the head of the massage table) on your client’s back, just inferior to the scapular attachment of the lower trapezius muscle fibres, and apply a reinforced thenar eminence pressure in an inferomedial direction (i.e. in the direction of the lower trapezius fibres).
– Ask your client to slowly move his arm into lateral flexion and flexion, (as though he is reaching superiorly and across his face). By doing this motion, the client’s scapula will be drawn laterally and superiorly, thereby lengthening the lower trapezius fibres.
– While your client is doing this motion, perform a deep muscle strip in an inferomedial direction along the length of the muscle from the scapula all the way down to the attachment at the lower thoracic spinous processes. Once your client is at the end range, ask him to hold the muscle in that lengthened position for an additional two or three seconds.
Figure 2 –A client actively brings her arm across her face, while therapist applies an inferomedial reinforced thenar strip.
– At the end of the motion, ask your client to bring the shoulder and arm back to the starting position, and then repeat the movement. Repeat this stroke for a total of 3-5 passes.
This myotonic technique is a very effective technique in that the deep strip addresses contractures, adhesions, and trigger points in your client’s lower trapezius muscle fibres. In addition, this technique simultaneously adds a mobilization element to the Scapulo-thoracic joint, as well as a stretch element to the lower trapezius muscle itself.
2. ISCHEMIC COMPRESSION TO UPPER TRAPEZIUS
– Objective: To release trigger points (hyperirritable bands within the muscle belly) in the upper trapezius muscle fibres. Trigger points can occur in muscles due to injury (to the muscle itself or to other structures in the region), or due to overuse. They are a source of local as well as referred pain, and they reduce the flexibility, strength, and overall functionality of the muscle.
– Positioning: Ask your client to lie supine on the table, with his head fully on the surface of the massage table. (You can remove the headrest so that you can more easily gain access to the upper trapezius muscle).
– To perform this ischemic compression to the upper trapezius, stand (or sit) at the head of the table.
– Technique: First, palpate along the muscle to find the trigger point in the upper trapezius. To locate a trigger point, palpate the muscle to feel for a taut band or a twitch response in the muscle belly. A common location of upper trapezius trigger points is in the middle of the muscle belly, approximately 1 to 2 inches medial to the acromion process of the scapula.
– Once you have located the trigger point, apply an ischemic compression by gradually applying pressure to the trigger point with your thumb. (see figure 3). The client will likely feel referred pain in a question mark pattern (along the back of the neck, around the side of the head, and a then a focused pain right behind the eye). Keep in communication with your client, checking to ensure that you are staying within the limits of his pain tolerance. Hold this technique for approximately 20 seconds to 1 minute, until your client tells you the pain has diminished, or until you feel the muscle fibres begin to relax under your pressure.
– Once you feel this release, gradually release your pressure. Then apply a few effleurage strokes to flush out the area, and follow up with a passive stretch to the muscle.
Figure 3 – Ischemic compression to an upper trapezius trigger point causes a “question mark” pattern of referred pain.
3. PASSIVE STRETCH TO UPPER TRAPEZIUS:
– To lengthen the upper trapezius muscle fibres. This stretch will work to reduce pain in the muscle caused by trigger points as well as muscle tension. A properly applied muscle stretch will also improve the flexibility, strength, and overall functionality of the trapezius muscle by reducing contractures and adhesions. (NB – If scar tissue in the muscle has been treated with friction techniques, a passive stretch following the friction techniques can also help to functionally realign the scar tissue so that the muscle can function in a more efficient manner).
– **Stretches are most effectively performed after the muscle has been adequately warmed up with massage and/or properly administered hydrotherapy.
– Have your client lying Supine with the head fully on the massage table. As this is a passive technique, your client’s muscles should be fully relaxed.
– Begin your technique standing at the head of the table, with one hand underneath your clients occiput.
– (As with any technique, please remember to perform this passive stretch with great care, particularly since you are dealing with complex neurovascular structures in the neck region).
– To stretch the upper trapezius muscle fibres, slowly and carefully bring your client’s head and neck into pain free forward flexion, contrilateral side flexion, and ipsilateral rotation (the ipsilateral rotation draws the inion away from the shoulder, thereby additionally lengthening the muscle). With your other hand, apply an inferior pressure to the shoulder, drawing the scapula inferiorly. (see figure 4) .
– Make sure to perform this stretch in a gentle, sustained manner, always staying within your client’s pain tolerance. If your client feels pain, then you have gone too far with the stretch. Also check in with your client during the stretch to ensure that he is breathing properly. Hold this stretch for approximately 30 seconds, and then gradually release the stretch by returning your client’s head, neck, and shoulder back into the neutral position. Repeat this stretch a total of 3 times.
figure 4 – The therapist performs a stretch to the upper trapezius muscle fibres.
The techniques highlighted in this article are courtesy of…
The Massage Students Video Guide – Video 1: The Torso
(From: www.RMTstudents.com… The #1 Online Study Centre for Massage Students).
Dwayne Gray, RMT, is president of RMTstudents.com Inc. He is a 2003 Graduate of the 2,200-hour Massage Therapy program at ICT Kikkawa College in Toronto. Dwayne has certified in Active Release Techniques, Hot Stone Massage, Ultrasound Therapy, TENS, and IFC Therapy. He has owned a successful sports injury clinic in Burlington, Ontario, managed the world’s largest team of Registered Massage Therapists under one roof (50) with the Brydson Group, in Toronto, and now independently performs injury rehab treatments in Pickering, ON, while continuing to work to build RMTstudents.com for massage students. He can be contacted through www.RMTstudents.com.