I have talked about the upper traps a couple of years ago here and how I think they are arguably one of the most misunderstood, mistreated and mismanaged areas in our profession. How they are surrounded by so many misconceptions and misunderstandings about them being not involved or an issue in shoulder or neck pains, or if they are, that they’re tight, knotted or over active, and how they need to be stretched, massaged or reduced in activity.
I disagree with all of this!
Yet I see and hear many therapists discussing and doing all of the above. So I thought I would have another go at defending the poor old upper traps from all of you who are still adamant in pulling, poking and pummelling them to death, and why I think this is totally the wrong way to manage them!
In my experience, all the painful, sore, tight and tense upper traps I encounter are lengthened and weakened. They may be painful to poke and press. They may respond to a bit of a stretch or a rub for a while. But that doesn't mean this is what they need.
Therapists love poking around in upper traps. They seem to think it will tell them something useful. When they find a sore spot, they think they have found the problem, they believe they have found a muscle knot, commonly referred to as a trigger point, they think they are caused by over activity or poor posture, and they have just the thing to 'fix' that, normally a thumb, an elbow, or a needle!
There is no muscle knot!
I have discussed the flaws and pitfalls that therapists face when poking around in soft tissues before here. I have demonstrated the lack of reliability of any therapist to be able to locate these so called muscle knots or taut bands no matter their skill or experience here, and in my recent article in the British Journal of Sports Medicine I discuss how these soft tissue sore spots are not muscle knots but possibly something else here.
There is also this rather interesting study here that further questions the belief that soft tissue sore spots in the upper traps are hard lumpy knots of muscle. It actually demonstrates that the most painful areas to palpate in the upper traps are in fact the softest when measured with pressure algometry, and this does NOT change after 20 mins of fatiguing exercise. Yes, ok it was conducted on healthy volunteers so we cannot say the same is seen in those with pain. But it does, blow some more holes in the trigger points are muscle knots theory. Which by the way, as theories goes, looks like a slice of Emmental cheese it has that many holes in it.
Poor posture is also often, and all too easily, blamed for upper trap pain. Upper crossed syndrome, anteriorly translanted and protracted shoulder girdles, downward rotated scapulas. All these are commonly associated with upper trap pains as well as other neck and shoulder issues. Yet there is no robust evidence that shows those with these common postures, suffer more pains or problems than others.
For example this recent paper here looks at the effect of upper back and shoulder posture on the incidence of rotator cuff tears. They checked the shoulders of 525 residents of a small mountain village in Japan with ultrasound scanning and compared what they saw with the subjects posture. They concluded that poor posture IS a predictor for both symptomatic and asymptomatic rotator cuff tears, defining ideal and poor posture as shown in the picture below.
However, this study did not compare the occupations, the sporting and recreational activities, or any past history of trauma. Nor was comorbid conditions such as diabetes mellitus and hypothyroidism looked at in the subjects. Also the rotator cuff tears in 146 subjects whom the examiners were unable to determine their spinal postures were excluded from the study. So due to these flaws and without knowing the relative contributions of the other risk factors for rotator cuff pathology, it is simply impossible to blame upper back or shoulder posture alone, basically posture can NOT be blamed!
I don't blame posture for cuff tears, or upper trap pains, or anything else for that matter!
I only blame a lack of strength and endurance of the upper traps. I blame its lack of comprehensive capacity to withstand the positions and postures we put them into. There is NO such a thing as an ideal posture. The only thing I care about with any posture is if it feels comfortable and how long you are going to be in it for.
Finally many upper traps are thought to be 'over active' when you stick some EMG units on them, and many suggest that we should be giving exercises that reduce their activity such as recommended here and here
But before we all start get carried away and think about ways to reduce upper traps over activity, which seems to be an all too common treatment and management strategy, perhaps we should be asking why are they over active? Are upper traps over active simply because they are weak, are they simply struggling under the loads and the forces they encounter. Are the upper traps over active because something else is not working as it should be, such as the rotator cuff.
I'd argue thats exactly why they are over active. I'd argue most painful upper traps need strengthening not a reduction in their activity. I'd argue that we should be look at the why rather than looking at the how to correct.
So in summary please STOP rubbing and stretching upper traps, and perhaps start strengthening them more! There are a number of great ways you can do this, but this paper here demonstrates how a modified shrug is really effective.
As always thanks for reading.