Upper Traps: Over assessed, over blamed, and very misunderstood!
There’s a culture within physiotherapy to blame a specific muscle when things are painful or problematic for people. Muscles such as the psoas, glutes, transverse abdominus have all been blamed, criticised and demonised over the years for being either over-active, under-active, too weak, too tight, or just dysfunctional. One such muscle I see getting blamed for a lot of neck and shoulder problems is the Upper Trapezius, however, I think the poor old upper traps doesn’t deserve this criticism and so I want to take a look at this muscle a little more.
Many physios try to tell me that their patient’s upper trap muscles are both the cause and reason for their neck, shoulder, and upper back problems. I hear them saying how this muscle is too tight, too tense, or over-active and how it needs to be reduced, released, and loosened and how tasks or exercises that encourage upper trap activity are bad and to be avoided.
Well, I think this is a load of crap and I think most people with upper trap symptoms first don’t only have pain due to the upper traps muscle itself, but I also think they often need to do the exact opposite of what they are often advised to do for it. I believe most with painful upper trap sensations need to load, strengthen, and exercise them more, not less, and I dont think that they need to stretch or rub, poke, or prod them to make them feel better.
I believe painful upper traps that feel tight, tense, or over-active are due to many reasons and causes such as referred pain from other areas, stress, anxiety, but also due to them lacking capacity, tolerance, and endurance to the day to day forces and demands placed upon them. I believe that many upper trap muscles hurt not because they are working too much, but because they can’t keep up with the work they have to do and that avoiding loading the upper traps is a big mistake in those with upper trap pain.
Anatomy and Biomechanics
However, that let’s first take a look at the Trapezius muscle and its role in a bit more detail. The Trapezius is a large, broad, flat muscle located on the back of your neck, shoulders, upper back. It is the most superficial muscle of the upper back and is attached to the base of your skull, the lateral end of your collar bone, the top and spine of the scapula, as well as attaching to all the vertebrea of your neck and thoracic spine.
The Trapezius muscle is commonly described as having three functional portions, labelled the upper, middle, and lower fibres. These sections are often described as having different separate functions on the action of the scapula or shoulder blade, with the lower fibres said to depress it back and down, the middle fibres retracting it, and the upper fibres elevating and upwardly rotating it.
However, this is a very simplistic way to look at a muscles actions as no muscle works in isolation, and no one part of a muscle works in isolation from its other parts. This is especially true for the different parts of the trapezius muscle when we consider that they all have a common nerve supply from the Spinal Accessory Nerve.
How a muscle affects movement is due to its nerve supply, its origins and insertional attachments, but also the orientation and angle of its muscle fibres, and this is what a study by Johnson and Bogduk looked at for the Trapezius back in 1994 (ref). In this paper, they described the angle and orientation of the upper trap muscle fibres and showed how they are anatomically disadvantaged to create upward rotation of the scapula when the arm is in a neutral position.
They described how the upper fibres of the trapezius need the assistance of both the lower and middle fibres to upwardly rotate the scapula, demonstrating how these different parts of the same muscle do not work in isolation. They also describe how the Trapezius muscle can not rotate or elevate the Scapula on its own, and how it needs the coupled action of many other muscles such as the Serratus Anterior to create Scapula movement.
The Trapezius muscle actually moves the scapula by counteracting the muscle forces of other muscles acting on it. For example, when we elevate our arm the Serratus Anterior attempts to pull the Scapula laterally around the chest wall. At about 30° of arm elevation, the lower trap fibres resist this Scapula movement causing it to start to tilt upwards, once this upward rotation of the scapula starts then the upper fibres assist in its continued upward rotation and elevation.
So it could be stated that upward rotation of the shoulder blade in the early stages of arm movement occurs more due to the action of serratus anterior and counteraction of the lower fibres of the trapezius rather than the contribution of its upper fibres. It’s only once the shoulder blade has started to upwardly rotate that the upper fibres of the trapezius really come into play.
This I think has some implications for some of the commonly prescribed exercises often given by physios and trainers which are thought to influence different parts of the traps. For example, does shrugging the shoulders with the arms by the side really work the upper traps that well? And do Scapula ‘setting’ exercises that ask people to pull their shoulder blades back and down really work the lower traps that well?
I’d argue no, and believe shrugging your shoulders with the arm by your side is NOT the most efficient way to load the upper traps, and some research by Tania Pizzari supports this when they looked at subjects shrugging in neutral or with the arms at 30º of abduction and found more upper traps activity in the abucted position than the neutral position (ref). I also don’t think telling people to pull their shoulder blades back and down before they move their arms is a good way to exercise the lower trapezius or anything else for that matter.
But what about all those EMG studies showing adverse trapezius muscle activity in people with shoulder and neck pain showing “over activity” in their upper traps when compared to those that don’t pain I hear you say? (ref, ref, ref, ref)
Well, as much as I appreciate the work done here by some well known, prominent, and prolific researchers in the shoulder and neck pain and rehab world, I think they and many others have misinterpreted what EMG can and can not tell us about a muscles strength, function, and ability. I also feel this research has over the years lead to a culture within physiotherapy to rely on EMG studies way to much, blaming muscles such as the upper traps unfairly and inaccurately.
The first thing to consider with EMG studies is that pain will affect them for many reasons. A painful muscle will not have a similar EMG signal as a non painful muscle. This altered EMG signal in a painful area doesnt tell you anything about cause, source or reason for the painful sensations.
Next EMG studies that look at upper trap activity often use surface EMG, which is fine for superficial muscles such as the traps but they can be prone to picking up electrical signals from deeper muscles underneath. Often the location for the upper trap surface EMG pad is around the superior pole of the scapula which may also pick up levator scapulae activity underneath it. Therefore could some of the increased upper trap EMG readings seen in some of these studies actually be due to increased levator scapulae muscle activity?
However, the far more important and often overlooked factor to consider with EMG research is that it can not and does not inform us reliably about a muscles strength or its ability to produce force. EMG measures a muscles electrical activity or its neural excitability, and although there is a correlation between increased neural excitability and muscle motor unit recruitment and muscle fibre activity, this does NOT mean we can determine how much force a muscle can produce based on the EMG reading alone (ref, ref).
Just because a muscle is recording a high EMG reading doesn’t imply this muscle is able to produce a high force output, and conversely just because a muscle is recording a low EMG reading doesn’t imply this muscle can only produce low levels of force. Strong muscles can record low EMG readings and weak muscles can record high EMG readings.
I think many have misunderstood and misinterpreted many EMG studies over the years to think high or over-activity in a muscle means it is strong and low activity means they are weak. From this, a culture of rehab and corrective exercises have been born from EMG research such as scapula stabilisation with over focus on lower trap strengthening and upper trap stretching which I think ineffective and needs to be changed.
Strengthen Don’t Stretch
Most I see with neck and/or upper trap painful sensations don’t have strong upper traps, rather many have load intolerant, fatigued and/or weakened upper traps. Therefore I think more with upper trap painful sensations regardless of the cause or source need upper trap strengthening exercises not stretches.
I also think those who are told they have scapula dyskinesia and need to do scapula stability exercises focusing on their lower traps are also wasting their time. In fact, the whole notion of scapula setting exercises, forcing the shoulder blades back and down before moving the arm just doesn’t make any sense to me.
I also think many therapists who see those with neck or shoulder pains have forgotten and overlooked a very important role of the upper traps and that is its ability to offload and redistribute forces away from the cervical spine. When you look at the anatomy of the upper traps you can see that the majority of its fibres attach to the distal third of the clavicle and the orientation of these fibres mean that when they contract they rotate the clavicle compressing both the AC and SC joint. This action I think can help transfer loads from the arm and shoulder through the clavicle, into the sternum and rib cage, and possible away from irritated cervical structures.
This is why I think upper trap exercises should be included in many of those with neck realted issues as well, as stronger more robust and resilient upper traps could help offload irritable cervical structures, or perhaps help improve the capacity of these structures to tolerate loads and forces better.
Shrug Like A Monkey
I often prescribe upper trap strengthening exercises to those with long-standing neck and shoulder problems with exercises such as lateral raises, upright rows, and even shrugs and overhead shrugs. However, one of my favourite exercises for loading the upper traps is an exercise I call ‘monkey shrugs’.
Monkey shrugs involve holding a load in your hands be that some dumb bells, barbell plates, or even just some shopping bags or bottles of water. The idea is to is bring this load up the side of your torso towards your armpits as if doing a monkey impression, hence its name. This action forces your elbows out to the side and upwards, and if you add a shrugging action at the end of range you will feel that really hitting the upper trap muscle beautifully as shown in the above image (note: ugly facial expressions are not necessary!)
So I hope I have given you some food for thought about the poor old demonised upper traps and that you will not be as quick to blame this poor misunderstood muscle quite so often, and maybe think twice before you dive in so quickly with massage, stretches or needles for those that feel pain here. I hope I have also shown how strengthening and improving the capacity and tolerance of the upper traps can be helpful and not harmful for many things that can cause pain to be felt in the upper traps pain and those with neck or shoulder related issues.
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