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Upper Trapezius Mania
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Upper Trapezius Mania - October 1, 2001 9:31:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Group:
It seems that many of us have an upper trapezius fixation. I consistently see therapists doing exercises to get it to shut off during shoulder elevation and to relax during biofeedback. And why not?? The upper trap is a consistent source of pain both from shoulder and neck problems. In many people it seems to be hypertrophied and in most healthy people it can be tender to touch.
But do we know what we are doing with this muscle??? Is it tight and stiff requiring stretching???? Or could it be that it is actually overstretched and that our cervical lateral flexion streteches are making it worse? What role does it play in neck dysfucntion (via its attachments to the C-Spine). And finally........why should it be silent during shoulder elevation? Is it not a scapular rotator????
Fire away with the opinions!!!!!!!!!!!!!!
mcap
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Re: Upper Trapezius Mania - October 1, 2001 7:10:00 PM
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sarty
Posts: 65
Joined: April 22, 2001
From: Florida, USA
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Great topic!!!!
I'll weigh in with my 2 cents here. Upper trap pain, as well as Levator Scap pain, seem to present in tandom with just about every cervical or shoulder diagnosis that I see.
Now...just to stir up the hornets: When using a myofascial approach, I can identify active trigger points in the UT and quite often the Levator Scap as well. Now, I can go the myofascial route (which I personally really enjoy) and do the ischemic pressure, myo. stretches, posture correction, etc....and get results
OR more often than not, even if I identify active TPs, I can do a McKenzie or Strategic Orthopedic approach and that pain centralizes! The TPs, by definition, then become "latent" (referring with deep palpation only). No deep tissue pressure, no stretching.....
Hmmmmm.
So, what's causing what? Interesting!
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Re: Upper Trapezius Mania - October 2, 2001 4:50:00 AM
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gerry
Posts: 238
Joined: July 6, 1999
From: Montgomery, AL, USA
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Try placing thumb on one side of the upper trap, index finger and middle finger on the other side and apply a slight pressure between the fingers and thumb. Wonderful correction can be acheived in behavior of children who were previously not paying attention to the parent. [IMG]http://www.rehabedge.com/forums/eek.gif[/IMG]
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Re: Upper Trapezius Mania - October 2, 2001 10:39:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Sarty:
My guess, is that if you can centralize the pain, then it is probably referred from the cervical spine.
This brings us to the central issue. Is the pain generator local to the upper trap or not. I tend to think in most cases, it isn't but I have little to go on.
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Re: Upper Trapezius Mania - October 3, 2001 4:04:00 AM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
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To all:
I always thought that the upper trapezius worked with levator scapulae and lower trapezius to control scapular motion. I believe the upper trapezius is often over stretched, resulting in depressed shoulders which may lead to brachial plexus and cervical facet joint problems. Just keep in mind that lateral flexion of the cervical spine does not strech just the upper trapezius... there are other muscles, namely the scalenes and SCM that may be tight.
The Upper trapezius muscle is important and at time may need to be trained... YES, in patient who have difficulty elevating the arm due to poor scapular control, the upper trapezius needs to be activated and strengthened (most of these patient I have found to be post surgical patient, who have been reluctant to move the arm). It is really up to your clinical reasoning and objective findings to determine whether to leave this muscle, stretch it or strengthen it.
Henry***
PS - and yes, the upper trapezius trigger point can give a Physiotherapy devastating authority and power [IMG]http://www.rehabedge.com/forums/mad.gif[/IMG]
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Re: Upper Trapezius Mania - October 3, 2001 4:48:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Henry:
Great post. I will ask one question......how do you know whether to strengthen, stretch, relax, massage or leave it alone. This is the dilemna. You could rely on observation and evaluation, but there are no research oriented methods that I am aware of.
mcap
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Re: Upper Trapezius Mania - October 3, 2001 2:32:00 PM
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henryryry
Posts: 100
Joined: September 6, 2000
From: Brisbane, Australia.
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mcap,
I find the levator scapulae in most cases are dominant, and tend to pull the scapula early, and upon releasing this muscle, if their scapula upward rotation is still early, then I would look at upper trapezius strength. You need these two elevators to counter the other's rotation component. But I agree with you, it is difficult to know when to stretch, strengthen or just leave it alone... I guess that is where your clinical reasoning and observation skills come in.
Henry***
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Re: Upper Trapezius Mania - October 4, 2001 5:12:00 PM
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sarty
Posts: 65
Joined: April 22, 2001
From: Florida, USA
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Mcap,
I agree. And it brings us to the question, which came first, the chicken or the egg? The cervical dysfunction or the trigger points/tense muscles? Do we attack the first (if we can determine it?) or the most recent? Or both? And what if it's not coming from there at all? Maybe it's a shoulder dysfunction. Or an SI issue. Or a fallen arch throwing off the gait. Or poor eyesight causing abnormal neck postures. [IMG]http://www.rehabedge.com/forums/wink.gif[/IMG]
Are we treating the symptom and not the problem?
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