OKAY, now that I've got your attention haha. Raise your hand if your guilty of this - your upper trap is all fired up from a tough workout, from a few miles pounding the pavement, or after a long day sitting behind a desk at work - so for treatment you end up smashing it, stretching it, and/or massaging it until the cows come home. You smash it from different angles with a lacrosse ball, get your significant other to massage it out into a nice cookie dough complexity (if this is you, you picked a good one), or stretch it by bringing the chin to opposite armpit and pulling your head in that direction…. and it feels a little better, perhaps even resolves the pain. But then…. IT COMES BACK, time and time again, and it you can’t seem to shake it. PS - if you actually raised your hand, mad props. Why does it come back? Why is the muscle such a pain to deal with? Well, its because were attacking it all wrong! I regularly hear physical therapists telling patients that this muscle is 'too tight' or ‘over active’ and so it's the cause of their chronic pain. I hear massage therapists 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 practitioners (chiros, PTs, trainers) choosing exercises to help reduce upper trap activity, by focusing on the lower traps to restore the balance between them. Well I argue the exact opposite approach is needed. The upper trap is rarely actually short and tight, even if it feels that way. All the mashing and smashing won’t do anything. Sure, the soft tissue work will trigger a neuromuscular response causing momentary improvement, but its not doing anything in the long run. Simply because that's not the root of the problem. The root of the problem is typically one of two things:
Let's talk deeper about each of these. The primary role of the upper trap muscle is to elevate and upwardly rotate the scapula (shoulder blade) to produce healthy overhead arm movements. I can’t tell you how many times I look at someone's shoulder girdle and see downward sloping clavicles (collar bones), and depressed/ downward sloping scapulas -- both indicative of lengthened, overstretched traps. To put things into perspective, the number one most common impairment associated with shoulder impingement (the most common shoulder issue) is scapular related. What attaches to the scapula? The traps! SO if the scapula is not positioned appropriately or moving efficiently around your rib cage as you raise your arm overhead, the upper traps won’t be able to function as they want to, resulting in that tense, overworked feeling you get. The “tightness” feeling that athletes complain of is actually protective tension - it's their body doing anything it possibly can to avoid dropping lower into scapular depression/ downward rotation. The tight and tense ‘feel” is because they are overloaded due to being weak. The upper traps are working to elevate the scapula against gravity all the time, and if they’re weak, they won’t be able to keep up. If you give him a bunch of massage and stretching, it's like picking a scab; he'll feel better for 15 minutes, and then in rougher shape over the long haul. You never want to stretch out protective tension. So what do we do? Stop smashing, poking, rubbing, and stretching and start strengthening. We need to get them stronger, more resilient, more robust. Now, when I say strengthening I don’t mean shoulder shrugs, that can actually make things worse. As I previously mentioned, the role of the traps is to raise the arm overhead, so that means we need to train them overhead. If we strengthen them below shoulder height, i.e. dumbell shrugs, power cleans, we are training the traps to perform an action they aren't designed to do. So you want to choose drills that drive upward rotation - such as wall slides, straight arm sled work, inchworm, overhead walking lunges, overhead squat, or landmine presses. It would also benefit you to slow down on anything that tugs the shoulders down such as deadlifts, dumbbell lunges (weights at sides), or farmer’s walks. Lasty, forget the shoulder blade to back pocket “down and back” cue. This might be one of the most overrated and overused cues of all time, often getting athletes in trouble and leading to pain. In fact, I may circle back in the near future and write an entire blog post on this cue. If you’re using it with everything you do, stop it. Especially if you have shoulder pain. Sorry to go off on a tangent but the amount of mis-information out there is absurd, and this cue is up there with the most over-rated cues out there. Anyways, train the upper traps as I outlined above and they will thank you for it. The second most common cause of the upper trap tension feeling is actually not from the upper trap at all, but what lies just beneath it - the 1st rib. 1st rib dysfunction is very common, and can closely mimic upper trap issues. To improve this, first we need to get to the root of the issue, which relates to your neck. Here’s what happens: Forward head posture → fires up your scalene muscles → pulls on 1st rib → pain Excessive amounts of forward head posture, whether from sitting behind a computer all day or poor lifting technique (for most of you athletes it might be the later - think forward head with deadlifts, double unders, squatting, rowing, pull-ups, etc, etc,), can fire up the scalenes, which are muscles that run down the sides of the neck. Over time, the scalenes become tight and hypertonic and start to excessively pull and tug on their attachment point - you guessed it, the 1st rib. The 1st rib then gets pulled into an elevated and dysfunctional position, causing that deep dull “upper trap” tension feeling. This common joint restriction is another reason why smashing and stretching the upper trap doesn’t help. So how do we treat the 1st rib? Easy. First, we need to improve the underlying cause which is essentially how we hold our head (head positioning) throughout the day and when we work out. See my previous blog post “Neck Pain in Crossfit: Why it happens, and what to do about it!” for an in depth review on this topic. However, the main thing to think about is to try to reel your head in from that nasty forward head position, and try to keep the neck neutral. Essentially, you want to try and keep the chin close to the neck. This will take the scalenes off tension and reduce its menacing pull on the 1st rib. Secondly, you want to work on self mobilizing the 1st rib into a better position. Here is an example of a great exercise to achieve this: While this is a great exercise to improve 1st rib dysfunction, you must improve your neutral cervical spine positioning for lasting results. These simple concepts can make a huge difference for long term relief.
In summary, I hope I have given you some food for thought about the poor old upper trap muscles and what to do about it. Hopefully you won’t be so quick to blame this poorly misunderstood muscle as being tight and short, and think twice before you dive in so quickly with massage, stretches, or lacrosse ball smashing. And I hope that you can see that strengthening actually improves the function of the upper traps. If you have any questions, please comment below, or reach out to us! Thanks for reading, Dr. Andrew
28 Comments
Katrina
5/19/2020 03:27:39 am
Thank you for this! I don’t believe stretching is a lasting solution either. What do you recommend if the scapula really does sit too high, when resting or even when trying to stand upright?
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Dr. Andrew
5/19/2020 05:59:56 am
Hey Katrina! Thanks for your comment! This would depend on a few things. First, is the scapula high because of levator scapulae dominance? This would be the case if the scapula was also downwardly rotated, in addition to being elevated. If this is the case, we would need to address that muscle including its relationship to the neck. Second, does the superior border of the scapula sit above the T2 vertebrae? This would determine if its actually elevated or if the entire shoulder girdle is high, creating an illusion. Hope that helps!
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Marcinex
12/14/2020 11:25:49 pm
Any good exercise to fix forward head posture?
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Dr. Andrew
1/12/2022 07:40:24 am
Hey Marcinex, sorry for the delay in response, I would start with these 3 exercises:
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Manolis
1/10/2022 01:39:44 am
Your article was very useful! Congratulations!
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Dr. Andrew
1/12/2022 07:36:49 am
Appreciate the feedback Manolis - I hope it was informative and helpful!
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Peter
1/11/2022 09:40:34 pm
Any chance you could share a link to these exercises …
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Dr. Andrew
1/12/2022 07:36:19 am
Hey Peter - Take a look at these links!
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Lewis
2/7/2022 10:01:10 am
Hey just wondering I've had pain in base of my skull right side only for over a year now when I touch my right side need the occipital it's so tender also my shoulder clicks when rotating I've tried everything nothing seems to work spoke to a physio and he said my trapezius is too weak and is causing this jusy wondering if this is the case
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Dr. Andrew
2/10/2022 08:20:45 am
Hey Lewis - a weak trapezius is a very common imbalance involved with this presentation, however that is only 1 small piece to the overall puzzle here. Strengthening it should help, just make sure you have a neutral chin tuck position. good luck!
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Marek
2/13/2022 07:05:30 am
Hey, first of all, good article!
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Carole McClean
2/13/2022 01:19:01 pm
Hi, this is SO interesting for me. Am being treated for TOS (vein got a clot and tremendous arm nerve pain). As you point out, all my chiro and physio focus on is releasing neck and traps and have me focussing on using the lower traps "back and down". My scalenes and really all my neck muscles go right back to being fired up and I still have horrible headaches and neck tension. Admittedly, my affected shoulder was totally rolled forward and is now much better. I'm a distance runner, swimmer, and I was doing more weights up until I was told not to - particularly overhead weights. So you recommend the opposite...doing the weights, and overhead stuff! I am now at almost 3 months past blood clot and would really like to not be in pain. I am going to try to strengthen my traps rather than relax them (and keep focussing on my neck position). Any other hints? Thank you so much for this different perspective...I had been wondering. Carole
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Sonny Blackwell
4/18/2022 07:00:47 am
Did strenghening the traps end up helping I’m in the same position
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Carole McClean
4/18/2022 03:57:14 pm
Well I have been doing the suggested trap strengthening - BUT it turns out the reason I have this problem is a long ago broken clavicle (along with a broken arm ...50 years ago) which has many muscles shortened, tight, with lots of scarring. I've seen A LOT of specialists and the best thing I've done is get Botox in my neck/scalp area which has allowed the rest of my trap/pectoral muscles to relax and be used functionally. I've also had a lot of fascial work done to reduce the scarring. All the chiro/physio I had didn't help until I got the botox which allows my neck/head to sit in the proper position. It's like night and day - no more pain/headaches and I'm way more symmetrical. Of course this is just my finding after many months of frustration, but I'm really glad I kept seeing different specialists until someone figured things out. Good luck!
Frank
2/27/2022 05:58:47 pm
this article is livesaver to me.
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Dr. Andrew
2/28/2022 12:02:14 pm
Hey Frank!
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Tom
3/9/2022 11:33:25 am
I have suffered from a tight right trap the past 4 years. As soon as I lift anything remotely heavy or sit in an awkward position my traps and neck hurt and get stiff. I wake up every morning with a stiff neck and lack of movement in my neck. I have seen countless physios and specialists and still have not improved.
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frank
3/13/2022 06:10:10 am
Did you try isometric neck exercises? check google images. push 6 seconds about 40-50% of your strenght. it helps me immensly, but also have MRI done to rule out other ailments.
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Dr. Andrew
3/15/2022 04:53:50 am
Thanks for taking the time provide your experiences Frank! Isometrics can be useful to decrease pain for sure, but it rarely solves an issue like this long term. In addition to identifying and solving the root cause, strengthening is certainly key!
Dr. Andrew
3/15/2022 04:51:52 am
Hey Tom - sounds like this has been frustrating you quite a bit. To solve a problem like yours long term, we need to identify and address the root cause of the issue. We work with athletes through virtual visits from around the country and would be happy to help you solve this if you're interested. Just shoot me an email at info@theharlotteathlete.com! Chronic neck pain is super common, but typically very easy to solve, event virtually!. Looking forward to hearing from you.
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Priscilla
4/5/2022 10:42:44 am
Hi Dr Andrew…
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Dr. Andrew
4/18/2022 07:09:06 am
Hey Priscilla, thanks for commenting. Your deformity may make solving your upper trap pain more complex, however there is a tremendous amount of variability in individuals so its tough to say. Strengthening and correcting cervical posture won't be successful unless the root cause is addressed appropriately.
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Priscilla
5/2/2022 05:35:43 pm
Thanks Dr Andrew. If I am not an athlete, would this still be helpful? Thank you.
Mike M
4/15/2022 04:57:26 pm
Hi Dr Andrew. I think this was a great article. And I’m looking for some help. For the past five months I’ve been having tremendous left neck pain and left upper trap pain. It really flares up when I’m walking around but nowadays it just feels like it’s constantly there. Working out however it really helps alleviate that pain for some time. My current physical therapist thinks that it’s my breathing that is causing these issues. I was in a motor vehicle accident back in July however, and it never had these issues prior. I also was working throw a torn rotator cuff which we have completely restrengthened. The left neck runs from my ear to my neck. And the upper trap pain feels like this massive not right above the scapula. Would it make sense for us to have a conversation and see if there’s anything else I should be doing? I also do have a weird irritations when doing any overhead movement right above my collarbone. There are some veins or tendons are more pronounced when I rub my fingers around that spot as compared to the left.
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Dr. Andrew
4/18/2022 07:13:36 am
Hey Mike - thanks for the feedback, I hope this article was helpful! We absolutely can help in this instance. Pain that has been present for this amount of time usually means something in missing in the overall treatment plan. I'd recommend that we first link our schedules for a brief phone call so I can learn more about your injury backstory and current situation. Fill out the short form in the link below and I will follow up with you. Looking forward to speaking!
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Travis Hayward
4/29/2022 07:45:15 am
I would defiantly like to work with someone I cannot get my upper traps to release, I’ve done massages for the last two years deep tissue dry needling and so on. The scm stays tight, scalene and upper traps can you help me please
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Dr. Andrew
5/3/2022 04:45:03 am
Hey Travis - sounds like this has been frustrating you quite a bit. To solve this problem long term, we need to identify and address the root cause of the issue. We work with athletes through virtual visits from around the country and would be happy to help you solve this if you're interested. Chronic neck pain is super common, but typically easy to solve, even virtually! Looking forward to hearing from you.
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Callum Bailey
5/7/2022 05:16:23 am
Hoping someone can help me with this it's ruining my life.
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