The Upper Traps, over assessed, over blamed & very misunderstood!

There is a strong culture within physiotherapy to blame a specific structure, be it a muscle, ligament, nerve, fascia etc etc when things are sore and painful for our patients. The Upper Trapezius muscle is one such structure that gets an awful lot of blame, but unfairly and incorrectly in my opinion.

I regularly hear physio’s telling patients that this muscle is too tight or ‘over active’ and so the cause of their neck or shoulder pain. I hear them explaining how they can feel or see that this muscle is knotted and tense, and explain how it needs to be released, loosened and stretched. I also see and hear many therapists choosing exercises to help reduce upper traps activity, by focusing on the Lower Traps to restore the balance between them.

Well I argue the exact opposite approach is needed.

Most, if not all the painful upper traps I see are weak and long, not tight and short, and yes they can ‘feel’ tight and tense, but they ‘feel’ this way because they are over loaded due to being weak. Hence we don’t need to be stretching or massaging these muscles, we need to be giving strengthening exercises, which is completely alien and counter intuitive for some.

I argue that weak inefficient Upper Traps are often the culprit for a lot of shoulder and neck pains, and I argue that most Upper Traps need to be strengthened a lot more, a lot, lot more.

However lets first look at the anatomy and function of the Upper Traps to help us understand it better. The Trapezius muscle is a large flat muscle that is found down the side of your neck and top of your shoulders. Its the most superficial muscle of the upper back and runs from the base of your skull, along to the tip of your shoulder, all the way down to the middle of your back, see image below.

It is commonly described as having three separate portions, the upper, middle, and lower fibres. These sections are often described in the text books as having differing functions on the action of the shoulder blade (the scapula). The lower fibres are described as depressing it, the middle fibres retract it, and the upper fibres elevate and upwardly rotate it.

However, this is a very simplistic way to look at any muscle function. Firstly, no muscle works in isolation, all muscles work in synergy with others, and one muscle certainly doesn’t work in isolated parts, they tend work as a whole unit, albeit with some parts working harder than others during different movements.

How a muscle affects movement is also not just due to its insertions and origins, but also the orientation and angle of its muscle fibres. This is what Johnson and Bogduk looked at in the Trapezius muscle in their 1994 paper here.

What they found questioned the commonly held thoughts and explanations of how the Trapezius functions. But despite this paper being over 20 years old these findings are still not that well known and so many myths about the Traps still exist.

Johnson and Bogduk found that the angle and orientation of the upper fibres of Trapezius are unable to create ANY significant elevation of the scapula when the arm is in neutral. They also showed that the upper fibres need the co-ordinated assistance of the lower and middle fibres to upwardly rotate the scapula, highlighting that they do not function in isolation. They also found that the Trapezius muscle is insufficient to rotate or elevate the Scapula alone, instead it is its coupled action with the Serratus Anterior that does.

The action of the Serratus Anterior pulling the scapula laterally around the chest wall at about 30° of arm elevation is when the lower Trapezius muscles fibres first start to resist the movement, which then starts to cause the scapula to tilt into upward rotation. Once this upward rotation of the scapula has started then the upper Trapezius fibres further assist in its upward rotation and elevation.

The Upper Traps only really contribute to Scapula upward rotation and elevation once the arm is in slight abduction!

This not well known fact I think has some big implications on the exercises and movements given by physios and trainers that are thought to influence Trapezius muscle activity. For example does standard shrugging or hitching actions when the arm is in neutral target the Upper Traps as Scapula upward rotators? Not very much it seems, if at all.

Errrr, what…..!!! Shrugs don’t work the Upper Traps!!!

Well they do, anyone who has shrugged will tell you they do. But its only really when the arm is in > 30° of abduction and the scapula has already started to rotate do they really kick in!

With the arm in a neutral position, the other thing to consider is another key scapula elevator muscle that is working, the appropriately named Levator Scapulae. However, as the Levator Scapluae attaches onto the medial superior pole of the scapula, so it also creates downward scapula rotation, usually the exact opposite movement we are looking to achieve in a lot of shoulder problems.

Now what about studies showing ‘over activity’ in the Upper Traps and suggesting that we need to reduce it for shoulder problems such as research done by Ann Cools et al 2007.

Well as much as I really respect and admire the work Ann Cools and her colleagues over in Belguim have done, I think in regards to the Upper Trapezius they could be mistaken, and partly to blame for all this anti Upper Traps culture in physiotherapy.

Firstly, these studies look at upper Trapezius activity using surface electromyography or EMG, which is a useful tool, and I do like EMG research as it aids my exercise prescription and clinical reasoning by giving me an insight into a muscles level of activity. But they do have issues, and they are not infallible to error, and the information taken from such studies has to be used with caution.

For example despite normalisation procedures designed to limit the effect of cross talk between other muscles when using EMG equipment, there is always some, especially with surface EMG, and I suspect at the point often used for reading upper Trapezius activity it also picks up the Levator Scapulae. I have a suspicion that the Levator Scapulae cross talk maybe producing the so called high EMG readings from Upper Trapezius.

I also think the EMG readings of the Upper Trapezius can be ‘misinterpreted’ as high or ‘over active’ in those with shoulder pain and dysfunction due to another forgotten and overlooked action of this muscle!

A primary role of the Upper Trapezius is to distribute loads away from the neck.

The majority of the Upper Trapezius muscle fibres actually attach to the distal third of the clavicle and due to the orientation of these fibres, when they contract they rotate the clavicle medially. This rotation of the clavicle strongly compresses the sternoclavicular joint, and this is a rather useful action.

In fact it’s a bloody marvelous action and is probably the most beneficial and often overlooked action of the Upper Traps.

The compression of the sternoclavicular joint by the upper Trapezius allows forces and loads from the arm and shoulder to be transferred away from the neck, passing them down through the collar bone, into the sternum, rib cage and axial skeleton. Pretty damn useful, and maybe good to know for those with neck issues?

How many physios give Upper Traps strengthening exercises for those with neck pains or problems?

As I said, nearly all the upper Trapezius I see clinically are long and weak, struggling to upwardly rotate the Scapula efficiently. It is this struggling of a weak and fatigued muscle that I also think causes the ‘over active’ readings on EMG studies.

So instead of stretching, rubbing, poking sore and painful Upper Traps, lets get them stronger, more resilient, more robust.

It just seems daft to me to ask a muscle that wants to lift and elevate the scapula AND off loads the neck to work less! Of course get the Lower Traps and Serratus Anterior working, but why not ALSO get the Upper Traps to stronger as well! In my opinion and clinical experience when the Upper Traps become more resilient, more robust, more strong with exercise it only seems help those I see with shoulder and neck pains, not hinder them.

I regularly give out exercises and movements with an ’emphasis’ on strengthening the Upper Traps to patients with long standing neck and shoulder problems who have tried everything else, such as manual therapy, postural correction, rotator cuff work, scapula setting etc etc… With some really good results.

Some examples of the exercises I use are over head shrugs see picture below (I sometimes prefer the elbow a little more flexed so the arm isn’t too high in elevation as this can be a bit uncomfortable or un-achievable in those with sub acromial pain or stiffness).

Another exercise that I often give is one I’ve lovingly called ‘Monkey Shrugs’ these are done by holding your arms down by your sides then sliding them up the side of your body, up to about waist height so your elbows are bent slightly out to the side. I then ask the patient to shrug from this position. This really targets the Upper Trap muscle as the scapula is already in slight upward rotation and the arm is in approx 30-45° of abduction.

Here is a link to some videos I have done of the monkey shrugs and overhead shrugs

Now these are just some of the Upper Traps targeted exercises out there and they may not be suitable for all, and there are other Upper Traps targeted exercises such as Wall Slides, Face Pulls, or even the good old Y or W lifts, which have all been found on EMG studies to get high Upper Traps activity.

In summary I hope I have given you some food for thought about the poor old Upper Traps muscle and that you will not be as quick to blame this poor misunderstood muscle quite so often, and think twice before you dive in so quickly with massage, stretches or needles!

And I hope that you can see that by actually strengthening and improving the function of the Upper Traps it could help a lot of neck and shoulder problems, and that you might consider giving Upper Trap focused exercises for your patients more often.

As always thanks for reading

Happy healthy exercising

Adam

PS: NEWS FLASH, since writing this piece over a year ago there has been some research here supporting my opinions on the upper traps, hoooraaah! Obviously I’m as biased as hell and I think it’s a wonderful paper but have a read for yourselves. It shows that a modified shrugging action , with the arm in approx 30° abduction creates better scapula upward rotation but also greater upper and lower traps activity… Damn I love being right… probably… possibly… ;0) !!!

100 thoughts on “The Upper Traps, over assessed, over blamed & very misunderstood!

  1. Hi Adam, i am currently doing a study on corrective exercise into shoulder mobility, I’m with you’re thinking that the upper trapezius needs to be strengthened when tight, I’ve used shoulder shrugs to do this, however, ive been unable to back up with academic reference that supports doing retracted shoulder shrugs when the upper traps are tight. Do you have any that i can use to back this up.

    Kind regards

    James M

  2. You say that “upper traps ‘feel’ tight and tense, but they ‘feel’ this way because they are over loaded due to being weak”. In my view, upper traps are rarely weak and this is simply because they are used so much – not necessarily in scapular control but in head control. Most us spend a good part of every day with the head down peering down at what’s in our filed of vision. Oh! and included in that, into a computer. This is hard work for upper traps and any work for a muscle makes it stronger – in this instance often over-strong and shortened.

  3. How can a muscle remain weak if overloaded? surly the concept of overloading a muscle increases its strength? My understanding of trapezius pain is the balance between anterior chest muscles and posterior ones. unfortuntantly in this day and age, we can find any small study to confirm a hypothesis.

  4. THANK YOU! I have been saying this for years and all my colleagues roll my eyes at me.
    It is similar for “tight calves” that magically enough improve when you do some calf strengthening. Wait.. what???
    I often see very poor trapezius (all fibres) activation leading to poor upward rotation/ elevation which contributes to a plethora of should issues and neck pain (especially with Lev Scap compensating).
    I find shrugging (at 30+ abd) against a red or green theraband tubing that loops around the foot and the scapula can be combined with cuff strengthening, shoulder presses or even sport specific like a forehand in tennis to improve their scapular mechanics while working on other pathologies.
    Thanks again Adam for blowing minds of the stale recipe book physio’s and challenging beliefs in our profession. We need more people like you!

  5. This is not so!! The masters (travell, simons, rachlin and gunn) of MF pain and misery teaches us to Heat, knead, needle, stretch, rehab, restore the person before you attempt to strengthen a sick muscle in a stressed person. The disease is still embedded in the muscle tissues so the muscle will still act erratic. This may make a sick muscle more powerful to choke you to death and further overload the systems.

  6. Wonderful read. With all due respect, however, I treat upper trapezius because I find a painful muscle is often inhibited and hard to activate correctly. Only after the symptom is addressed I strengthen the muscle, if it is indeed weak. And assess why there are issues to begin with.

  7. I agree! Upper traps is neglected and no muscle works in isolation. Also, perhaps strengthening of the upper traps also works because contraction will stimulate the golgi tendon organs and result in relaxation and improved circulation to the muscle etc etc PNF style.

  8. Great article. I recently had a day off and spent the day playing computer games. Like all day stupidly. I noticed fatigue in the back of my neck/traps. Then I went to Wrestling practice (first one in two months due to an ijury of the foot) and I hurt my neck. Well, the tightness is in the left trap. I noticed doing handstands relieves the pain as it strengthens the trap.

    And when you do these excercises, you are increasing blood flow to those particular muscles, which always helps with healing. I find sometimes when I have an injury a light bodybuilding high rep slow controlled tempo workout will “enrich” the muscles with bloodflow and light inflammation which starts the healing process

    For me, long story short is, in my body STRETCHING NEVER WORKS. I ALWAYS HAVE TO STRENGTHEN FIRST! THE BODY WON’T ALLOW A CHANGE IN MUSCLE LENGTH IF IT’S TRYING TO PROTECT THAT MUSCLE IN THE FIRST PLACE BECAUSE IT@S TOO WEAK TO GO INTO THAT RANGE!

    I was also a brekadancer, lots of handstands and heavy upper trap work. NEVER HAD A NECK INJURY OR SHOULDER PROBLEM UNTIL I STOPPED !

  9. First of all thank you Adam for posting such a wonderful article. 2 years ago i was tasked with lifting heavy objects and after that i had constant tension headaches like something is pulling my head muscles down. After months of therapy(traditional heat therapy and stretching of upper traps) the condition only worsened. Thank god i came to your article and what i did right away was grab two dumbells and started monkey shrugging. I was really afraid to do this because i was hammered by many doctors that dont ever shrug them again. After i shrugged 8 reps, i felt like a new man. All the tension was gone away. However some tension is still left but its going away as the time passes by and i continue shrugging. I couldnt find a reason why lifting heavy objects caused tension headache and why strengthening traps caused my headaches to go away. Keep in mind that i had depressed shoulders from lifting too heavy objects.
    Once again, thank you.

  10. Adam – while I enjoyed reading through your perspective, I have to greatly disagree and here is why. I did my Master’s research in scapular positioning associated with scapular dyskinesis. There are many, many more articles than you cite that prove Ann Cool’s theory about over (and early) activation of the upper trap. I think you bring up a fair discussion point with possible signal from the levator scapulae, however, unlike the upper trap, the levator is a downward rotator of the scapula, though not a very strong one. I think your argument would be valid if the patient you were evaluating had correctly positioned scapulas, but my symptomatic patients often present with Type I or Type II scapular dyskinesis, indicative of a resting upwardly rotated and/or protracted (or internally rotated) scapula. This positioning would lengthen the levator which would make the argument that it is actually underactivating.

    We can all appreciate that the trapezius is a very complex muscle. I am of the belief that even though it has three different directional fibers, all fibers should have equal strength to maintain equilibrium. And yet, probably over 90% of my patients with shoulder pain are significantly weaker with middle and lower trap manual muscle testing than upper trap. Our society has become lax on promoting good posture. Overactivation of the upper trap would encourage that somewhat hunched position and shoulders closer to ears (like we naturally do when we are cold). Obviously there are other factors in poor posture as well (i.e. spinal mechanics, pec minor length, etc), but without equal pull from all three fibers of the trapezius, an imbalance creates havoc for the scapular positioning – thereby increasing potential for bad posture, decreased neck and shoulder mobility, and (possibly) injury.

    In a previous comment, you also asked about assessing for tightness in the upper trap. Muscle energy research has created a test that assesses the firing pattern of shoulder musculature (check out Greenman and Chaitow). It actually somewhat falls in line with your argument about upper trap activating above 30 degrees of abduction. The appropriate firing pattern for abduction should be 1. supraspinatus 2. deltoid 3. infraspinatus 4. middle and lower trap 5. contralateral quadratus lumborum. This test has the patient abduct to 90 degrees with the clinician keeping their hands on same side shoulder and opposite side QL. Dyfunctional testing would reveal activation of upper trap and early firing of opposite QL. Test it and you will see how many people fire upper trap when they aren’t supposed to. It is because the middle and lower fibers are not maintaining equal pull and control. I treat this dysfunction with a number of techniques, then reassess using this test. I often find an almost immediate change in the firing pattern. Point here being, the upper trap actually should not be activating with abduction – at least until above 90 when the scapula really begins to upwardly rotate. And yet, it often is because either it is trying to make up for the weakness in the other fibers of the trap, or it overpowers the supra and deltoid.

    I think the point that your article should be making is that maybe upper trap is blamed too often without assessing other potential factors. Upper trap hyperactivity may be present, but it may not be the CAUSE of pain or dysfunction. Care should also be given to anterior 1st rib elevations, cervical and upper thoracic spine compensatory rotations, and posterior rib dysfunctions. However, upper trap overactivation is absolutely an issue. Care and focus should be directed at balancing all structures (particularly addressing equal pull in all fibers of the trap). The article you link at the end of your post by Pizzari confuses me because they conclude that “upward rotation shrug might be useful to address scapular dyskinesis involving drooping shoulders and reduced scapula upward rotation”, yet they don’t seem to do a good job defining what “reduced scapula upward rotation” means. To me, I would interpret that as the scapula already starts in an upwardly rotated position – which would prove the point that the upper trap would be ‘tight’. If the scapular starting position is correct and upward rotation is still decreased, I would argue there are confounding factors, like injury or dysfunction to the glenohumeral joint, as the strength of the musculature does not determine the available range of motion.

    Thanks for your insight and discussion!

    • Hi Andrew, thanks for your in depth comments and thoughts. I’m afraid to say that I dont agree with anything you say. For the sake of brevity I dont want to go through all the points you made but I will comment on the belief that you can palpate the correct firing sequence of muscles during movement. First there is simply no way anyone without complex EMG equipment will be able to detect the sequence and timing due to the very short latent times between these muscles firing. This approach smacks of the outdated beliefs with had with Trans Abs, Multifidus and even VMO in the quads, all these have now been abandoned due to lack of reliability and validity, and unless you can direct me otherwise I have not seen any data to support the clinical reliability to assess the firing sequence of the muscles you mention during scapula movement.

      In my opinion, this thinking is outdated and lacking plausibily but more importantly any scientific support

      Kind regards

      Adam

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