Shoulder and neck pain is one of the most common complaints I come across in clinic. Often, there is no acute “injury”, as such, rather it is reported as a long, gradual onset to the point where people will feel as though their shoulders are creeping further and further upwards, towards their ears, often at times of stress or tiredness. I often hear them explaining how they can feel or see – or that they have been told previously – that these muscles are knotted or tight, and they will explain how it needs to be released, loosened or stretched.
But the structures test very differently to these descriptions. Most painful upper traps/shoulders I see are weak and long, not tight and short. The sensation of tightness or stiffness felt is because they are constantly being overloaded in a position of stress, and the muscles simply do not have the capability to endure. As we looked at in my blog about posture, muscles are designed to move, and being placed in this position of length for prolonged periods of time can, and often will, lead to a level of discomfort. How long do you sit at a desk, arms in front of you, lengthening these structures? How long do you sit in a car in the same position? And this is where I see a lot of treatment falling down, focussing too much on lengthening a muscle that is already long.
Anatomically, the Trapezius muscle is a large diamond-shaped muscle, described as lower-, mid-, and upper- portions, 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 tips of your shoulders, and down to the middle of your back, as seen in the image below. So far so good.
The complication comes from the commonly held belief of the actions of the 3 parts of the trapezius muscles. It was commonly though that the lower-, mid- and upper-traps all had isolated functions, but we now know that to not be the case. For example, we know that the actions of the trapezius muscle is insufficient to rotate or elevate the Scapula (shoulder blade) alone, instead it is its combined action with the Serratus Anterior that does this job. The action of the Serratus Anterior pulling the shoulder blade outward around the back, at about 30° of arm elevation, is ultimately when the upper trapezius muscle assist in its upward rotation and elevation.
So what does this mean? First and foremost it means that anyone in the gym doing “shrugs”, are not really hitting the upper traps, if you are not incorporating that 30° of arm elevation. There is a muscle underneath the upper-traps called the Levator Scapula, which – brilliantly – does exactly what is says on the tin; elevates the scapula (shoulder blade) – the shrug movement. So what are we strengthening exactly?
The majority of the Upper Trapezius muscle fibres attach to the end of the collarbone; when they contract they rotate the collarbone inward. This causes compression of the sternoclavicular (collarbone-sternum) joint, and allows forces and loads from the arm and shoulder to be transferred away from the neck – a pretty amazing system to protect the neck, and a system we would like to be strong and robust.
As mentioned, most painful upper traps/shoulders I see are weak and long, not tight and short. Soft tissue therapy, massage, joint mobilisation, and taping can be a hugely effective, if somewhat transient, component of treatment for your recurring shoulder issues – hence the monthly visit to your massage therapist. But the key word in all of this is “recurrent”. Why is it coming back? Why isn’t it being “fixed”? What can you do??
There is a way to build a sustainable treatment plan, achieving long term benefit, whilst empowering you to self manage. To find out how, contact Dan@DC-InjuryClinic.co.uk
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.