Trapezius Trigger Points

Introduction

The trapezius is a large upper back and neck muscle responsible for shoulder movement, head support, and postural stability. When trigger points develop in this muscle, they can cause neck pain, shoulder tightness, and headaches, often mimicking tension headaches, cervical spine dysfunction, or rotator cuff issues.

Name and Area

  • Name: Trapezius

  • Area: Located in the upper back and neck, running from the occipital bone and cervical spine to the scapula and clavicle.

Indications

Trapezius trigger points may contribute to:

  • Pain in the Neck, Shoulders, and Upper Back (Mistaken for Tension Headaches or Cervical Radiculopathy)

  • Pain That Radiates to the Side of the Head and Behind the Eyes (Can Mimic Migraines or Sinus Headaches)

  • Tightness in the Shoulders That Restricts Arm and Neck Movement

  • Pain That Worsens with Stress, Poor Posture, or Prolonged Sitting at a Desk

  • Pain or Tenderness at the Base of the Skull That Feels Like a “Heavy Head” Sensation

  • Burning or Aching Pain Between the Shoulder Blades (Common in Those with Forward Head Posture)

Pain from this muscle is often mistaken for cervical spine issues, rotator cuff dysfunction, or myofascial pain syndrome.

Muscle Action

  • Elevates the Scapula: Lifts the shoulders upward, essential for shrugging and carrying loads.

  • Retracts the Scapula: Moves the shoulder blades toward the spine, assisting in postural alignment.

  • Supports Head and Neck Movements: Works with other neck muscles to maintain stability and control movement.

The trapezius is crucial for upper body posture, neck function, and shoulder mechanics.

Signs and Symptoms

Individuals with trapezius trigger points often report:

  • Pain in the Upper Neck That Spreads to the Temples or Behind the Eyes

  • A "Heavy" Feeling in the Head That Worsens After Long Periods of Sitting or Driving

  • Burning or Tightness Between the Shoulder Blades That Feels Like a “Knot”

  • Pain or Weakness When Lifting the Arms Overhead or Holding Objects at Shoulder Level

  • Neck Stiffness and Reduced Rotation (Difficulty Looking Over the Shoulder or Tilting the Head Back)

  • Pain or Tenderness in the Upper Shoulders That Worsens with Emotional Stress or Anxiety

Pain worsens with forward head posture, prolonged screen use, or repetitive arm movements.

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Perpetuating Factors

Common causes of trapezius trigger points include:

  • Forward Head Posture (Common in Desk Workers, Gamers, and Smartphone Users)

  • Chronic Stress or Anxiety (Can Cause Muscle Guarding and Shoulder Tightness)

  • Carrying Heavy Bags on One Shoulder (Can Cause Asymmetrical Muscle Strain)

  • Frequent Overhead Reaching (Common in Painters, Climbers, and Weightlifters)

  • Sleeping in an Awkward Position (Can Cause Morning Stiffness and Neck Pain)

Trigger Point Referral Pattern

Trigger points in the trapezius refer pain to:

  • The side of the head and behind the eyes (Can Mimic Migraines or Sinus Pressure Headaches)

  • The neck and shoulder blades (Mistaken for Rotator Cuff Dysfunction or Upper Back Tightness)

  • The upper back and scapular region (Can Resemble Thoracic Spine Dysfunction or Postural Strain)

Pain from this muscle is often confused with cervical radiculopathy, shoulder impingement, or tension headaches.

Differential Diagnosis

Trapezius trigger points may be mistaken for:

  • Tension Headaches (Dull, Aching Pain That Wraps Around the Head, Worsens with Stress or Poor Posture)

  • Migraines (Severe, Pulsating Headaches That May Include Light Sensitivity and Nausea)

  • Cervical Radiculopathy (Neck Pain That Radiates to the Shoulder and Arm, Due to Nerve Compression)

  • Rotator Cuff Dysfunction (Shoulder Pain and Weakness, Common in Overhead Movements and Lifting Tasks)

  • Thoracic Outlet Syndrome (Pain, Numbness, or Weakness in the Arm Due to Nerve or Vascular Compression in the Shoulder)

A thorough cervical spine, shoulder, and postural assessment is necessary to rule out these conditions.

Associated Trigger Points

Trapezius trigger points often co-exist with:

  • Levator Scapulae (Neck and Shoulder Blade Stiffness, Common in Forward Head Posture and Chronic Tension)

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Migraines or Sinus Issues)

  • Rhomboids (Scapular and Upper Back Pain, Common in Those with Poor Shoulder Posture and Weak Back Muscles)

  • Suboccipital Muscles (Base of the Skull Pain, Contributes to Tension Headaches and Upper Neck Stiffness)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Trapezius (Upper Fibers) Occipital bone, spinous processes of C1–C7 Clavicle, acromion of scapula Accessory nerve (CN XI), cervical spinal nerves (C3–C4)
Trapezius (Middle Fibers) Spinous processes of T1–T4 Spine of the scapula Accessory nerve (CN XI), cervical spinal nerves (C3–C4)
Trapezius (Lower Fibers) Spinous processes of T5–T12 Medial spine of the scapula Accessory nerve (CN XI), cervical spinal nerves (C3–C4)

The trapezius is innervated by the accessory nerve (cranial nerve XI) and cervical spinal nerves (C3–C4), which also control shoulder movement, head stabilization, and posture.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the upper shoulders, neck, and scapular region.

  • Resisted Shoulder Elevation and Retraction Testing: Assess pain and weakness when lifting the shoulders upward or pulling them backward against resistance.

  • Postural Analysis: Look for forward head posture, rounded shoulders, or excessive thoracic kyphosis.

  • Cervical and Shoulder Mobility Testing: Rule out nerve compression, rotator cuff dysfunction, or muscular imbalances.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the trapezius, reducing neck tightness and improving shoulder mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure along the upper shoulders, neck, and scapula.

  • Myofascial Release: Helps improve circulation and reduce muscle tension in the upper back.

Stretching

  • Upper Trapezius Stretch: Tilt the head to the side while keeping the shoulders relaxed to stretch the trapezius.

  • Scapular Mobility Stretch: Move the shoulder blades in circular motions to improve flexibility and reduce tightness.

Strengthening Exercises

  • Scapular Retraction Drills: Strengthens the upper back to counteract excessive trapezius strain.

  • Chin Tucks (Neck Postural Training): Helps reduce forward head posture and improve cervical alignment.

Postural and Behavioral Adjustments

  • Avoid Prolonged Forward Head Posture (Keep Screens at Eye Level to Reduce Neck Strain)

  • Use Proper Ergonomics While Sitting (Ensure Good Posture and Shoulder Alignment)

  • Practice Deep Diaphragmatic Breathing (Reduces Chronic Neck and Upper Back Tension)

Conclusion

The trapezius plays a vital role in shoulder movement, head stabilization, and postural alignment, but trigger points in this muscle can lead to significant neck pain, shoulder tightness, and headaches, often mimicking other conditions like tension headaches or cervical spine dysfunction. By incorporating dry needling, manual therapy, targeted stretching, strengthening exercises, and postural adjustments, individuals can alleviate pain, enhance mobility, and prevent chronic upper back and neck dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.

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