Talofa Samoa and welcome back to your weekly Physiotherapy column! Today's column is about the trapezius muscle and comes to you from Pro Health Clinic in the UK. Enjoy!

Trapezius pain is often characterised by acute pain and stiffness in the upper trapezius muscle, which makes the movement extremely difficult. It is also referred to as “Trapezius Myalgia (TM),” where the term “Myalgia” means “muscle ache or muscle pain.” Trapezius pain is typically not considered a disorder itself but is seen as a manifestation of some underlying condition.

What is the trapezius muscle?

Before we understand what “trapezius pain” is, let’s briefly understand the trapezius muscle. The trapezius is a flat and broad superficial muscle of the body which gets its name from its trapezoidal shape. It has multiple origin and insertion points around the shoulder joint. The trapezius muscle is a part of the superficial muscles of the back which include rhomboids, latissimus dorsi, serratus anterior, and levator scapula. These assist in the extension and side flexion of the axial skeleton.

The points of origin include the occipital bone of the skull, the nuchal ligament (ligamentum nuchae), and the spinous processes of cervical and thoracic vertebrae.

The points of insertion include: the lateral third of the clavicle bone, the acromion process, and the spine of the scapula (shoulder blade)

This dynamic muscle is involved in various movements: shoulder elevation, scapula abduction, head and neck extension, scapulohumeral rhythm etc. The trapezius has three parts; each part has its functions:

• Superior/ Descending fibres are involved in elevating the pectoral girdle (shoulder girdle)
• Middle fibres of the trapezius muscle are mainly responsible for scapular retraction (middle trapezius)
• Inferior/ Ascending fibres perform the task of depressing the scapula (lower trapezius)

“Trapezius pain” is generally associated with the superior part of the trapezius. It can often be confused with neck pain. 

How does Trapezius pain feel?

Trapezius Myalgia may manifest as a pain radiating from the shoulders through the upper back and neck. Moreover, the trapezius muscle also holds some trigger points for “referred pain” i.e. pain perceived at a position other than its location of origin. The persistent type of trapezius pain is more common in women, as they are involved in a more static workload and are prone to more muscular stress. 

Most Common Symptoms:

• Sudden and persistent pain in the neck or shoulders
• Muscle strain, stiffness, tightness, or spasms
• Restricted arm movements (limited range of motion)
• Poor posture
• Soreness in the upper trapezius area
• Chronic pain in the inter-scapular region (upper back pain)
• Difficulty while performing tasks that require arm or shoulder movement.
• Headaches in the posterior (occipital) region
• Concentration problems
• Lower Back Pain
• Shoulder muscle spasms
• Tingling sensation (Paresthesia) or numbness
• Swelling, warmth, or tenderness of the affected area

Note:

Diseases like cervical or shoulder osteoarthritis or spondylosis, Thoracic Outlet Syndrome, rotator cuff tear, polymyalgia rheumatic, etc, may also cause similar symptoms; therefore, a precise diagnosis is required to rule out these conditions.

Most Common Causes of Trapezius Dysfunction:

• Excessive stress or tension can make muscles stiff and sore. This can be due to excessive muscle contraction (muscle overuse), mental stress, or anxiety.
• Trapezius pain can be due to any trauma, injury, or damage to the trapezium or due to a condition called “muscle pull.”
• Sudden movements like whiplash, acute injuries like head or neck injuries, car crashes, and forceful exertions can also cause trapezius myalgia.
• Overuse of the trapezius muscle, lifting bulky objects, or maintaining bad body postures (also referred to as repetitive stress injury) can also lead to TM.
• People who are engaged in strenuous, monotonous work (repetitive tasks) are at high risk of trapezius pain (especially lifting heavy objects).

Diagnosis And Examination of Trapezius Pain:

Your healthcare professional cannot diagnose trapezius myalgia based on any specific diagnostic criteria because there is none. However, the following measures can be used to diagnose if someone has TM or not:

Subjective assessment 

• Medical history of the patient

Objective assessment

• Physical assessment for cervical and shoulder range movement, muscle strength, and palpation (palpable trigger points)
• Neurological tests
• Medical reports, Imaging studies, etc

Note: If these conservative measures do not offer satisfactory results, the patient is referred to an orthopaedic for detailed analysis.

• Trapezius muscle function can be assessed with the help of surface electromyography (sEMG) which is a non-invasive method to detect and analyse the electrical activity of a muscle at rest, and during activity, it checks static as well as dynamic muscle activity.
• It is important to rule out all other diseases with similar symptoms as that of trapezius pain before making any diagnosis.

How Can Trapezius Pain Be Treated?

Different strategies can be used to treat trapezius pain. The most effective ones are Physical therapy and exercise. Physical therapy relieves acute and persistent pain, while exercise enhances blood flow to the muscle, boosting its oxygen supply.

Exercise: 

The foremost step is to maintain a good posture, as this can play a major role in improving trapezius functionality. Various exercises are found beneficial in alleviating trapezius pain. The most helpful include high-intensity strength training exercises. These are neck-strengthening exercises that involve progressive overload for 20 minutes. Such exercises for a year can be useful in the long-term mitigation of neck and shoulder pain and can prevent the onset of such pain in the future. These involve:

• Upright row
• Shoulder shrugs
• Reverse flies
• One-arm row
• Lateral raise
• 
  

Acupuncture for trapezius pain

Also called dry needling can be used as a short-term remedy for trapezius pain. Acupuncture is a traditional Chinese method that involves the insertion of fine needles at a specific point in the soft tissues of the musculoskeletal system to provide pain relief.

Transcutaneous Electro Nerve Stimulation (TENS) therapy

This therapy uses low-voltage current to counter pain and hence can also help in trapezius myalgia. Moreover, magnet or laser therapies are also available.

Biofeedback therapy

Biofeedback treatment uses sensors or electrodes to improve trapezius inactivity during computer work and hence shows positive results in the case of work-related trapezius pain.

Hot and cold therapy for trapezius pain

Applying heat or ice can relieve pain and inflammation of the trapezius muscle.

Medications

Certain OTC (over-the-counter drugs) can be used to lower pain and swelling. These include:

• Analgesics (pain-relieving medications)
• NSAIDs (Non-Steroidal Anti-Inflammatory drugs)
• Local trapezius trigger injections

But it is advised to take these drugs only on a doctor’s prescription.

The Bottom Line:

Trapezius pain is a common medical condition from which both genders are equally suffering. Various physical, psychosocial and environmental factors contribute to such pain. Treating trapezius myalgia requires identifying the cause of pain and seeking medical advice. It is very important to consult your healthcare provider to get professional advice. There is a need to educate the public about work-related and stress-related factors contributing to neck and shoulder pain.

• Eliana Viali is a physiotherapist and can be contacted via email at [email protected]