The upper back and shoulders are among the main areas you can find this condition to occur.
Populations most commonly at risk are those who:
- Spend hours sitting at a desk or computer, especially if positioned in less than ideal postures (eg. accountants), where unfortunately, accuracy and focus on the task at hand often trump focus on ergonomics.
- Have occupations requiring continuous movements with the arms in a forward position (eg. piano players), leading to overstretching of the muscles over time.
- Have roles requiring positions that are sustained for an extended period of time (ie. dental professionals), leading to increased risk of muscle fatigue.
- Perform heavy lifting, carrying or pulling activities, (eg. student’s heavy back pack, parents and their infants, etc.), which if done repetitively, can set you up for a combination of both overstretching and fatigue.
- Have shoulders being pulled forward by overdeveloped short anterior shoulder-girdle muscles, resulting from an imbalanced upper body strengthening program (eg. power lifters), when often extremely important regional stability exercises can be missed.
- It can even occur by simply adopting habitual postures over a period of time that promotes this type of shoulders rolled forward position (eg. Favoring a sleep posture on the same side for years).
I think it’s safe to say this condition can affect pretty much anyone at one point or another, including myself.
By way of these extensive attachments, it functions as both a postural and an active movement muscle, used to tilt and turn the head and neck, shrug, steady the shoulders, and twist the arms. More specifically, the upper trapezius elevates, the lower trapezius depresses, the upper and lower trapezius work together to rotate, and the middle trapezius retracts the scapula, or shoulder blade.
One of the most challenging issues in regards to a strain of the trapezius muscle, is that the underlying weakness which gradually progresses over time, can be present for some time without any or many complaints before it results in significant functional limitations. Initially, you may feel a local sore spot while in certain positions or while performing certain tasks. Or, perhaps you might first notice it when applying pressure to the areas where the muscle attaches to the vertebrae or shoulder blade. It may appear as an acute pain or tenderness not otherwise obvious with typical daily tasks. One reason for this development of pain is as a result of repetitive unopposed traction by the muscle on its bony attachments along the spine. This eventually leads to a point where the tissues have reached their limit, a type of warning system if you will. With all the research and development in pain science over the recent years however, we know of course that this may not be the only factor, but it is still nonetheless an important one.
The good news is that if the onset is relatively recent, simply modifying your posture to gently engage these muscles or resting in a position that supports your upper back can offer relief as it removes the element of continuous tension on the tissues. However, if adaptive tightness in the muscles through the front of the shoulders has developed, or if significant weakness throughout the trapezius is present in the case of more longstanding symptoms, a simple change in posture may not be enough.
The best course of action in this case, will require a fair bit more effort, particularly if effective long term management is the goal. However, the final results will definitely be worth it in the end.
A comprehensive management plan should include:
- Modifying the position or activity that has caused the pain
- Use of ice or anti-inflammatory medication in cases where pain is of a continuous nature, at least initially where management of the symptoms aids in rest and recovery
- In cases where marked weakness of the middle and lower trapezius is present, regardless of whether opposing tightness exists, a shoulder support may occasionally be indicated to consistently relieve tension on the muscles for a period of time
- A carefully prescribed exercise program that isolates stretching the tight muscles and specifically targets progressive strengthening of the weak muscles, again typically the middle and lower trapezius muscles are the ones in need of strengthening
- re-education of functional movement patterns that have more than likely been altered as a result of pain and muscles learning to compensate over time
Not only can this type of program assist with management of upper back pain, but it can also help aide in the recovery of several shoulder conditions that can result from the presence of underlying trapezius muscle strength imbalances. In fact, focus on optimizing trapezius mechanics can be appropriate in the rehabilitation of most rotator cuff conditions. One study has even indicated complete resolve of chronic elbow symptoms, solely by focusing on resolving underlying strength deficits of the middle and lower trapezius. Though more research is still needed, what is apparent is that the benefits of adding more focus on the trapezius muscle to your workout routine will clearly outweigh the risks of putting in the extra time. Enjoy your workout!
If you have any questions regarding this or any other blog posted, please feel free to contact the clinic. We’re here to help.
~ Elizabeth Stefanyshyn-Alonso BScPT, FCAMPT
- Kendall, F.P., Kendall McCreary, E. & Provance P.G., Muscles: Testing and Function with Posture and Pain, 5th Ed., Lippincott Williams &Wilkins, 2005.
- Bhatt, J.B., Randal, G., Chavez, A. & Yung, E., 2013, Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report, Journal of Orthopaedic & Sports Physical Therapy, Vol 43, No 11, pp 841-847.