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) !!!

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

  1. Hi,

    I’ve a internally rotated shoulder and constant trap inflammation as a result. It also causes the nerve to trap resulting in numbness in the neck, ear, arm and fingers. I’ve been a weightlifting for many years but it seems as though the muscle memory in the lower trap (right) is shot. I’ve been struggling with this injury for many years and see many physios. They all give me the same exercises, face down on the floor, then pull shoulder back and down – sadly to no avail. Can you recommend any exercises?

    Do you have a contact number/email to arrange a possible consultation?

    Regards and thanks for the great post.

    Dan

  2. A really nice article! This was mentioned in counterpoint to this article: http://breakingmuscle.com/mobility-recovery/the-dynamic-duo-of-shoulder-impingement

    The subject of shoulder impingement syndrome is near and dear to my heart, as I’ve been dealing with it for some time now in one shoulder, and went from zero to burn in very short order in 2013 in the other shoulder. I just recently had shoulder decompression surgery to address this in the latter shoulder (removed a couple of bone spurs in the process, amongst other details), and during the procedure the surgeon discovered that my supraspinatus tendon was sufficiently torn to require an immediate repair. That would explain the pain that no amount of mobility work could help to eliminate.

    Fwiw, during my search for pain relief, I did learn a bit about brachiating, as described at the following link. (Disclaimer: the site reads a bit like an infomercial, but the information is out there, and you can glean some of the info from this site directly.): http://www.kirschshoulder.com/

    Minor quibble, since this sort of thing tends to leap off the screen and punch me in the nose:

    – scapular – adjectival form of scapula, or alternatively this: http://en.wikipedia.org/wiki/Scapular
    – scapula/scapulae (noun) as described here: http://en.wikipedia.org/wiki/Scapula

    • Hi Jim thanks for your comments, first of all I never knew about the spelling of scapula/scapular meant different things, I thought it was just a US v UK thing, like skeptical v sceptical so thanks for that, every day is a school day.

      Secondly I glad to see my blog is being used to ask questions around the commonly held belief that upper traps are tight and over active, rarely do I find this is the case!

      I will look into brachiating not heard of it before, and I wish you a speedy recovery after your shoulder operation.

      Kind regards
      Adam

      • Hi Adam, no worries on the -a/-ar variation, I had a suspicion you were in the UK. I’m a Canadian expat and my wife is from New Zealand. She’s brought similar linguistic variations into conversations (both spoken and written). The best example of this is when we were discussing Cuba Gooding Jr, she spelled his name as “Coober”. 🙂

        Had my second physio appointment today. ROM on Tuesday was about 100º, today it’s at 130º. Prediction for next week is 90% of max ROM or better, assuming due diligence with my ‘homework’.

        Cheers,
        Jim

    • Thanks for the link Kevin, having only a quick scan of the abstract my initial thoughts are its a small study, and not compared against a sham Rx or any other manual therapy so we can’t rule out positive effects due to patient expectations and attention of receiving the treatment opposed to any true effects. My other issue is the reliability of what is a trigger point and finding them is extremely poor so can’t even say we are ‘treating’ them if we can’t find them!

      Thanks again for the paper will read fully soon

      Regards

      Adam

  3. Nice article. Quick question, would snatch grip barbell shrugs provide enough upward rotation due to the widened grip to be of benefit/reduced lev scap invovement in your opinion?

    Pretty much any shoulder elevation with my arms in neutral, and recently even when doing rowing exercises now, is eliciting an uncomfortable sensation in my left lev scap. Overhead shrugs I get next to no range of motion so I am guessing my upper traps are pretty dormant!

  4. Hi Adam:

    I am coming a bit late to this excellent and instructive page.
    In the same order of thinking, any chance that you might devote a full article to the LEVATOR SCAPULAE, with nice diagrams, full explanations, and your thoughts about stretching those muscles, and strengthening them as well. With descriptions of your preferred exercises, and also your usual critical comments.

    A full article on the levator scapulae would be a boon to many of us.
    Hoping that you find this subject of interest and can insert it in your writing agenda.
    ROO BOOKAROO, June 2, 2014

  5. Adam,

    Great article! It gave me a different view of looking at my pain.
    I am having right levator scapulae pain for two months now. I just don’t get why only right side of this muscle stays activated(??). My chiropractor and I don’t see my right shoulder is lower than left, but right shoulder is slightly rounded. I had been doing exercises for my lower, middle trap, rhomboids, and rotator cuff strength, but not seen any improvement on my pain. Then I read your article and most of the comments here today. I found that Zach(commented here) and I have similar problem. So I started overhead shrugs to reduce use of levator scap and strength upper trap. Actually, it feels good and relieved little bit.
    I just want to clarify some stuff with you and ask you a question..
    So your thought is that there is pain on levator scap becuase people try to put their scapular down and back position which makes it too depressed? and is that why our levator trying to hold the scapular up position?
    and are we supposed to exercise our upper trap to support our scapular up instead of using too much of levator? ( I hope I understood right….)
    And last question, do you know why my right side of upper trap is bigger than left when I am having pain on my right levator scap?

    Thanks again for this awesome article!

    • Hi Bowtie

      Thanks for your comments

      The levator scapulae is a strong downward rotator of the scapula and does often get short, tight often in those that weight train and do heavy standard shrug, it also gets problematic in those that hold their shoulder in static positions for long times

      The upper fibres of traps are the opposing muscle to the levator scap and is a strong upward rotator of the scapula, and so a balance between them must be found

      Most upper traps exercises aren’t that good at addressing that balance most target levator scapula and so the one i suggest are a simple way to address this

      As to why one shoulder is higher than the other or shoulder is more rounded, there are a million reasons but in my experience most of the time its normal, as humans we are not symmetrical, everything we do day to day is asymmetrical and so asymmetries appear quite normally quite naturally and have nothing to do with peoples pains or problems

      Of course I cant comment on you as I haven’t seen you, but i find differences in shoulder daily and 99% of the time they are not the issue

      Hope this help

      Cheers

      Adam

      • Thank you for the reply, Adam!
        May I ask you one more question?

        I have damaged my rotator cuff 3 years ago. I’ve had cortisone injection 3 times so far, pretty much once a year. Now I just want to actually fix it. I have not done any MRI or X-ray to see if I really had had injured it.
        I did some research and seem to have torn rotator cuff partially. I don’t think mine is torn too much so I have to have a surgery, because the pain is not too much. It just bothers me.
        So my question is, let’s say that my tear is not as much as that I have to consider surgical treatment, if I should do rotator cuff isometric exercises and prone Y. Or should I just not do it until it is completely fixed.
        I’m planning on getting PRP injection about two months later. I have to do push ups until then…… for my job… T T

        I really appreciate what you do here on this website.

        Gunbae!

        Bowtie

  6. I’ve had HUGE knots on my upper traps for years. NOTHING works to ‘release’ them. Chiro, massages, trigger point therapy, needling, stretching, nothing. Massaging only makes the headaches worse. I started thinking that they’re not in fact TRULY tight. They are tight because they are overstretched. My theory is that I spent a life of slouching at the computer. The traps were overstretched and in response, the muscles in the upper traps contracted and developed trigger points to prevent injury. How does that theory sound? Either way, I’m gonna try doing something I’ve never done, work out my traps.

  7. Evening Adam,

    Another very interesting and thought provoking article. You mention that activation of lev scap is possibly responsible for the higher emg readings found in UFT. I am just wondering if their are any articles which support this statement? I completely agree with your point but am unable to find any supporting literature and wondering if I am missing it. Most emg research shows figures of 0.65-0.9 ( probably part funded by emg suppliers) I would appreciate any info you have.

    Thanks a million,

    Alan

    • Hi Alan

      No I’m sorry don’t know of any papers that show what lev scap activity is like when recording upper traps, I have searched high and low and as I’m aware none have been done.

      It is just an observation and theory that I have based on seeing some upper trap EMG work being done and the location of the sensor, and the fact that no one has considered or placed a fine wire EMG into lev scap as they record upper trap.

      I have discussed this with some researchers doing EMG work on the traps and they just seem to dismiss it without even considering it as a potential confounder, if I had time and access to lab, I would do it, but alas I dont!

      Cheers

      Adam

  8. Adam:

    You could ask your question to
    Stuart McGill, Ph.D.
    Professor of Spine Biomechanics,
    Faculty of Applied Health Sciences, Department of Kinesiology,
    University of Waterloo
    mcgill@uwaterloo.ca

    He is well-known in the US for his studies of the lower back problems, but he has done kinesiology EMG studies for all kinds of top athletes, including weight lifters, etc…
    He has a great lab, is well experienced, and might welcome the opportunity to add a new study to his abundant bibliography.
    It is worth asking him.

  9. We’ve had great results with “loosening” the upper trap after mobilizing the thoracic spine and re-educating the thoracic erectors. Reducing kyphosis and anteriorly rolled shoulders could possibly be eliminating overstretching of the traps? Seems logical…probably the first train of thought that explains this phenomenon!

  10. I was pawed in the face during light mma training. 6 months have passed with constant headaches, nausea, & dizziness. With trips to the neurologist, gp, 2 physio’s. Neuro said it was my vestibula. Physio said it was my spine out of alignment. Bending over with perfect posture still results in dizziness after all the rehab & a clear MRI. Neck bridges send me to bed for days with a throbbing migraine.
    I tried your shrugging exercise recommendations and noticed my headaches were no worse – which they usually are after weight training. They may have even lessened somewhat. I’m glad I happened across your web page and that you took the time to write about weak traps. I’m hopeful that by including these shrugs in my lifts, pull ups & dips ill strengthen this muscle pair and get rid of these symptoms.

    Cheers

  11. Hey, I’ve been struggling with neck pain for four years now. It’s never been strong enough to disable me and I still lift, but all I’ve been doing is stretching, getting trigger points with a lacrosse ball, strengthening lower traps, and mid traps, and leaving the upper traps alone cause they were already “too strong and overactive” I was told, and it seemed to make sense.

    I had a somewhat similar issue with my hip flexor, and I stumbled upon this article explaining how having a weak psoas major, which is stretched out to the max basically, causes all the other muscles doing the hip flexion to become really tight and full of trigger points to compensate for the psoas major being weak. Strengthening my psoas major and doing heavy hip thrusts solved that issue pretty quickly.

    So then I stumble upon the “same” thing, just with upper traps. This is just what it feels like to me, but my levator scapulae is VERY tight, and all these little muscles pulling shoulders forward. I’m thinking that they are compensating for my weak upper trap, and that if I strengthen it back up they can kick back and relax. And also doing all that strengthening on lats, pecs, basically everything but the upper traps, will increase the pulling on them. This led me to believe I just needed to stretch more, but it was the exact opposite.

    I’ve only worked upper traps about a week now but I already feel improvements. I’ve only done regular shrugs and boy I was weaker than I thought I’d be on those. Basically when I press or whatever, my upper traps can do the work they are supposed to do, without assistance from the other muscles, causing all that pain.

    Especially I have this “string” of tight muscle at front side neck, going “under” my collar bone, shooting down my arm and all the way down my to my thumb and little finger. It never did loosen up no matter how much I massaged it or what I did to it. And it is my belief that it had to be like that to compensate, and now finally it’s loosening up.

    It’s been very relieving and exciting to finally find the solution to this, like what if I had gone for years on thinking my upper trap was tight? Kept on stretching it and strengthening all the muscles, THE HORROR… If I’m clever enough to remember I’ll write back in a few months, hopefully it will all be gone then.

    Your article really helped me understand this, thank you.

  12. Hi Adam, I’m a professional guitarist and I’ve been struggling with upper trap pain for years. It constantly spasms and aches. I’ve seen countless acupuncturists, acupressurists, massage therapists, physios, orthopedic surgeons. You name it….. And it’s always the same deal…. Pinching, poking, stretching…. I’ve recently had 4 weeks of intensive cervical traction. Nothing helped. Woke up this morning with excruciating pain and a spasm in the upper traps. Turned the computer on and stumbled across your article. Picked up a couple of light weights and did 10 reps of the two shrug exercises that you’ve shown. Pain instantly reduced by 80%. I’m in bliss right now. Thank you!

  13. I have been dealing with shoulder impingement for years now. It occurs on the frontside of my shoulder near my collarbone. My shoulder is elevated and protracted compared to my other side which doesn’t give me problems. I have tried doing everything that is recommended online including: upper trap stretches, pec stretches, lower trap work, rear delt work, and serratus anterior work. But no improvement. Do you think if I started training upper trap strength it would help me?

      • Thanks for sharing your insights Adam.
        Have had left side upper trap issues (desk worker) and tried the usual posture, stretching and manual therapy with little relief over the years.
        Following your strengthening advice, have bought some weights and started the monkey shrugs. This works on multiple levels. Thanks for offering your alternative!

  14. I really enjoyed that article! As a therapist, I’ve had my share of success by focussing on the coordination of the entire shoulder girdle instead of stretching or massaging the upper trap. Your article reminds me other protocols I have thought about, but never actually tried, involving regular famers walks with heavy weights. I have always find that those were great for upper traps along with overhead pressing or shrugging. Thanks for sharing your thoughts on that!

  15. Only just got round to seeing this article – will ensure I subscribe !

    Great piece of writing and as a Pilates instructor I often hear ‘shoulders down’ “pilates ‘v’ for the lower traps” “relax your shoulders” and indeed no one taking their shoulders up to their ears – how can you reach high and overhead if you can’t do this pain free?

    One thing I’d like to add to the post is my thought there is also an importance of seeing how the scap moves and its timing – if you can’t see the rhythm you don’t necessarily know what needs to change either muscularly or patterning wise or both…

    thanks !

    • Scapula timing or rhythm is a big unknown, again a lot of people believe they know what should be normal, but when you read the evidence as I have there is so much variety of ‘normal’ pain free scapula movements that we don’t know what normal is so we certainly can’t say what abnormal is either! For example anterior scapula tilt and downward rotation has been shown to be both a risk and protective of shoulder problems… Go figure hey!

      Let scapula just be Scapulas let them wiggle, tilt shift around as they want, the human body/nervous system isn’t stupid, it normally knows what’s best for it without our meddling or interventions!

  16. If a patient has less subacromial space (as mentioned in your article), would doing e overhead shrugs in the scapular plane be effective?

  17. Hello Adam !
    I wanted to thank you for your blog, your commitment to good science and clearing the non-sense is very refreshing. I hope to read more of your high quality content in the future !
    Came here to try to get my shoulders/upper body in good health, since I’ve been experiencing some annoying “pop” sounds at the sterno-clavicular joint after going back to the gymnastic rings… If you had any advice on these injuries, or could do an article explaining the function of the clavicle, etc, it would be awesome ! I suspect of small, pain-free subluxation, but I’m clueless as to what I can do… Only physio consulted just released the “trigger points” in my shoulder, relaxing it for two days and then back to square one.

    Thanks once again 🙂

  18. Adam, I suffer from chronic pain in my upper traps and levator after a whiplash injury, plus radiating pain into my arms. Your upward shrugs are the only things that have helped for my dominant arm. May I ask how long these exercises need to be done for long term effect? I have to thank you for your help. Its awfully nice of you to put this info out to help people.

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