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Head, Neck and Shoulder Pain: How Trapezius Plays a Roll

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By: David Kent, LMT, NCTMB

When clients enter complaining of headaches, neck and shoulder pain it is easy to show them that their pain is a “symptom” of a bigger problem. Educating clients about the muscular components of their pain, often determines if they reschedule and refer their family, friends and coworkers. This article will review a few of the trigger point (TrP) patterns of the trapezius muscle and its involvement in various postural patterns.

Trigger Points:

Trigger points form in muscles for a reason and are often a result of trauma or stress. Poor posture can place a great deal of structural stress on the trapezius muscle. The human head is heavy and designed to be support by the bones of the cervical spine. Remember, muscles determine where bones are held in space. So a client with a forward head and rounded shoulder posture, has shortened muscles on the front of the body with over lengthened muscles on the back. The pains or “symptoms” are their headaches, neck and shoulder pain and we want to educate our clients on how we can address the cause.

When clients report that they have a headache that starts in their temple, deep in the head or behind the eye that continues behind their ear and into the back and side of their neck, they are describing TrP # 1 pattern of the trapezius muscle, which is one of the most common TrPs in the body (See Photo 1). Showing clients this pattern on a trigger point chart lets them know you understand the pain they are reporting and have a plan to help. This TrP forms from acute trauma from a whiplash, sustained shoulder elevation from holding a telephone to the ear, working on a keyboard that is too high, compression on the muscle from the shoulder strap of a heavy back pack or the pressure of a bra strap. Skeletal anomalies like a short lower limb or a hemipelvis should also be ruled out.

Commonly overlooked, is TrP 3 in the lower trapezius that refers a deep aching tenderness above the scapula that causes clients to report a “soreness” in the region of the upper trapezius. The pattern typically runs from the base of the occiput out laterally to the acromial process (See Photo 2). TrP1 and TrP 2 in the upper trapezius often develop as satellites within this zone of pain and tenderness that is usually referred from the lower trapezius TrP 3”1

Trigger points in middle and lower trapezius are often a result of tight pectoral muscles that should be released.

Posture:

The human body is designed with a great deal of symmetry or balance and has the same bones and muscles on both sides. Muscles on the front and back of the body counter balance each other. Addressing the cause of your client’s pain requires a whole body approach. Postural analysis is a great tool to document and educate your clients.

Muscles are like guide wires and determine where the bones are moved or held in space. When the bones and joints are properly aligned on the coronal, midsaggital and transverse horizontal planes the muscles are under minimal stress. To demonstrate this to your clients, first use muscular and skeletal charts to show the proper postural alignment of the body. Then review photos taken of your client in front of a postural analysis chart to show them which muscles are shortened, which are over lengthened and the unnecessary stresses being placed on their body causing pain. (see Photo 3)

Let your client’s know you will design a treatment plan to address their pain. Educate them on postural distortions like: forward head, high shoulder, forward rounded shoulders, collapsed abdominal posture, the position of the pelvis, anatomical deviations and more are not an isolated phenomena and cause the formation of trigger points and pain throughout the body.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic, Muscular Pain Relief Center, is in Deltona, Florida, where he receives referrals from various healthcare providers. David is President and Founder of Kent Health Systems which teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealth.com or call (888) 574-5600 for more information.

1 Simons DG, Travell JG, et al. Myofascial Pain and Dysfunction: The Trigger Point Manual, volume 1, 2nd ed. Williams and Wilkins: 1999.

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