TRIGGER POINT OF THE WEEK – TRAPEZIUS
Those who use trigger point therapy will be familiar with the trapezius and its trigger point pain maps. These are present in almost every head and neck issue that presents clinically. The Trapezius is the most superficial of the shoulder and neck muscles, it is broad and large. It has two separate nerve innervations with the sensory part from the ventral ramus of C2,3,4 and the motor component via the accessory or XI cranial nerve. This is fundamental because some suggest it is a repository for holding tension and that the cranial nerve connection allows the brain to literally “dump” tension into the neck and shoulders. Many people hold emotional tension in the upper trapezius. There are several pain maps depending on where the trigger points manifest. Trigger points in the lower and middle fibers of the trapezius tend to manifest locally whereas, the upper fibers have a more extensive referred pain pattern into the neck and face.
Upper fibers: pain and tenderness, posterior and lateral aspect of upper neck. Temporal region and angle of jaw.
Middle fibers: local pain, radiating medially to spine.
Lower fibers: posterior cervical spine, mastoid area, area above spine of scapula.
It is interesting to note how the Trapezius Pain Map incorporates several others such as SCM and Levator Scapulae. The upper portion decelerates the head, the middle portion decelerates protraction, and the lower portion decelerates shoulder elevation. Myofascial trigger points here lead to tension headaches, with sharp pain felt in the neck. As the Trapezius is an important neck muscle, any spastic activity in the Sternocleidomastoid, Sub-occipitals, Scalenes, Longus Colli, Levator Scapulae, or many other muscles will have an effect on its efficiency.
How do you treat trigger these trigger points? We’d be delighted if you want to share your own best practice.