Presented by- MD Monsur Rahman MPT in Musculoskeletal Disorders

1. Trapezius
 The trapezius is a broad, flat, superficial muscle extending from the cervical to thoracic
region on the posterior aspect of the neck and trunk. The muscle is divided into three
parts: descending (superior), ascending (inferior), and middle.
 The muscle contributes to scapulohumeral rhythm through attachments on the clavicle
and scapula, and to head balance through muscular control of the cervical spine.

2. Origin
o The muscle attaches to the medial third of superior nuchal line;
external occipital protuberance, nuchal ligament, and spinous
processes of C7 - T12 vertebrae.
Insertion
o The muscle inserts on the lateral third of clavicle, acromion, and spine
of scapula.
Nerve Supply
o Spinal root of accessory nerve (CN XI) (motor)
o Cervical nerves (C3 and C4) (pain and proprioception)[2]
Blood Supply
o Transverse cervical artery (cervicodorsal trunk)

3.  Function
• The superficial muscles of the back (trapezius, latissimus dorsi, rhomboids, levator
scapula, serratus anterior) contribute to extension and side flexion of the axial skeleton.
The cervical extensor muscles (descending trapezius and cervical erector spinae)
counterbalance the pull of gravity on the head, as the head tends to be pulled into flexion
due to its anterior centre of gravity
 Action
• Descending part: elevates pectoral girdle
• Middle part: retracts scapula
• Ascending part: depresses shoulders
• Descending and ascending together: rotates scapula upwards
• Bilateral contraction: extends neck
• Unilateral contraction
• Ipsilateral side flexion of neck
• Middle part: assists with ipsilateral side flexion and contralateral axial rotation of upper
thoracic region

4.  Functional contribution
The trapezius muscle is a postural and active movement muscle, used to tilt and turn the head and
neck, shrug, steady the shoulders, and twist the arms. The trapezius elevates, depresses, rotates,
and retracts the scapula, or shoulder blade.
 Trigger Point Referral Pattern

5. Palpation
superficial, can palpate upper, middle and lower
Upper is frequently involved in neck injuries
Hold the sloping superior lateral portion between fingers and thumb and palpate from
origin (O) toward the clavicle/acromion and its insertion (I)
With patient (pt.) standing: abduct shoulders to 90 degrees and retract shoulder girdle.
Slightly bend the trunk forward so antigravity.
Upper can also be seen with elevation and lower with depression

6. Length tension testing
Patient: Positioned in supine lying with the arms resting by the side and the knees
flexed.
Therapist: Standing at the head of the bed.
Action: The therapist supports the posterior aspect of the head with both hands and
then passively flexes the craniovertebral joint. The right
hand stabilizes the lateral one third of the patient’s right clavicle and acromion
palpating the muscle. The therapist then gently and slowly flexes, left side flexes and
right rotates the mid and lower cervical spine with the left hand. The hand stabilizing
and the hand moving the body part senses the tension in the muscle and barrier. The
amount of range and the end feel is assessed and the reproduction of any symptoms
is noted. This test is then repeated on the contralateral side and compared.

7. Treatment
 Stretching
Sit upright in a chair and make sure that your posture is correct. These stretches can be done in
repetitions of 15-20 every hour to decrease trapezius muscle pain. Begin by rolling the shoulders back so
that the shoulder blades feel like they are being pinched together. Then raise your shoulders up towards
the ceiling and lower them down gently. You can then bend your neck from side to side by tilting your head
towards your shoulder and counting to 3, then repeating in each direction.
 Massage
Pain in the shoulder and neck can be prevented or reduced with massage.It is possible to reduce
trapezius muscle pain through self-massage. Reach back with one hand and find your trapezius muscle.
Beginning at the base of the neck, try to knead the trapezius muscles.
 Pressure
You can also apply some pressure to the area along your shoulders and between the shoulder blades. If
there is an area that is more tender, apply pressure for ten seconds and then release so that the muscle
can relax