Trapezius Muscle Strain: Causes, Symptoms, and Treatment

A flat rectangular band of tissue is known as the trapezius muscle. The paired muscles form a diamond shape, hence it resembles a trapezoid (diamond shaped quadrilateral). It makes up for the majority of superficial cervical as well as thoracic musculature. It has the look of a kite. It runs from the back of our neck to the middle back.

It is innervated by the spinal accessory nerve and helps us with functions like shrugging our shoulders. It is also responsible for scapular movements and horizontal shoulder abduction. Since the trapezius muscle is large, it has many attachment sites. Due to its size and attachments, it has many functions. Depending on which region of the muscle contracts, many functions are performed. It has been known to act as a scapula stabilizer.

The middle region pulls back the scapula, while lower portion performs the function of suppressing as well as rotating the scapula. In some head and neck movements, the upper trapezius works together with the sernocleidomastoid muscle. Trapezius muscle moves the shoulder blade and also rotates it outward.

The unilateral contraction causes the head to bend, whereas the bilateral contraction causes the head and the cervical vertebra to be raised. It is also known to help in the breathing process by slightly enlarging the upper chest region in order to increase the lung capacity. However, the main function is movement of the scapula and to give support to the arm.

Anatomy of Trapezius muscle

There are three anatomic regions in the Trapezius muscle known as superior, middle and inferior regions:

• The superior fibers start medially in between the occiput and C7 spinous processes. It extends laterally towards the posterior portion of the distal clavicle, the acrominon and the distal portion of the spine of scapula.
• Middle fibers originate between C7 and T3 spinous processes and it extends laterally to insert along the scapular spine.
• Inferior fibers originate between T4 and T12 spinous processes and extend superolaterally to insert on the medial confluence of the spine of scapula.

Immunohistochemical analysis was perfumed by Lindman on human trapezius muscles and he found that the mitochondrial ATPase activity was significantly different in various portions of the muscle. Low concentration of mitochondrial ATPase activity was found in lower third portion of superior region, the middle and the inferior regions too.

On the other hand, high concentrations were found in the uppermost aspect of the superior region, hence it was suggested that for high demand, short duration functionality, superior region was best suited and for low demand, long duration functionality, the rest of the muscle was best suited.

Strain in the Trapezius muscle

The trapezius muscle is located between the neck and shoulder and goes right up to the midback. Increased and repetitive amount of stress on this area causes strain. In this condition, it becomes very difficult to move the shoulders or perform any overhead activity. This muscle strain also leads to discomfort and pain with stiffness along the shoulder area due to which the person finds it difficult to move the neck. This strain limits or decreases the motion of shoulders and neck.

Causes of Trapezius muscle strain

• Stress - Trapezius muscle strain occurs when muscles are stretched beyond normal functioning. When one carries out repetitive task without taking adequate rest in between, then it results in the muscles getting irritated and inflamed, thereby causing a strain. Few of the repetitive tasks would involve, continuous pushing, pulling or performing overhead tasks. Continuously carrying out tasks which would require the use of arms, shoulder and the back and carrying heavy objects especially on the shoulders may cause strain. At times, people do push themselves while carrying out menial tasks which shouldn’t require too much pressure such as lifting, typing, pulling. There is lot of pressure exerted on the shoulder region wherein the tissues get overworked, thus causing inflammation which then leads to strain.
• Trauma - This usually happens to people who do lot of physical activity like construction workers whose job is to constantly lift heavy items on the head, push across heavy materials etc. Also, athletes who are mostly involved in swimming or tennis need to constantly use their arms. These are the people who are at higher risk of developing trapezius muscle strain. This strain is also caused due to trauma experienced during sports or auto accidents.
• Other reasons - Strains can also take place due to poor posture, whiplash injury, prolonged sitting, and arthritis. Sleeping in wrong positions, sudden twist to the neck or a jerk, a motor accident or a fall may strain the trapezius muscle.

Symptoms of Trapezius muscle strain

• Due to muscle spasm and stiffness in the neck muscles, there is neck and shoulder pain. The person may find difficulty in neck and shoulder movement and the pain may get worse with movement.

• One may experience pain in the shoulder blades and the thoracic regions. Constant pain is caused due to increased tension on the trapezius muscle.

• The person experiences difficulty in sleeping, as the person finds it tough to find a comfortable position because of the constant pain.

• Numbness or tingling sensation in the arms.

• Person experiences neck pain or a headache that goes to the side of the neck and center in the temporal area. Fatigue and inability to concentrate are also some symptoms.

• Also, the person may feel weakness in one or both arms, swelling in the affected region, pain and warmth radiating from the muscles and uncomfortable in heavy clothing since the weight of the clothes lies on the trapezius muscle and causes irritation.

• Due to repeated trapezius strain, one may experience chronic pain in the neck. This is called as trapezius myalgia. The upper portion of the neck becomes tight causing small areas of intense pain known as knots.

• If trapezius muscle gets strained due to injury, then the nearby blood vessels and the capillaries which supply blood get damaged which might lead to a sudden burst of the blood vessel. This blood collects under the skin layer and hence, a bruise can be easily observed.

Diagnosis of Trapezius muscle strain

• History - The doctor would chalk out a detailed history about work habits to find out whether the person has been involved in any intensive work which would need repetitive movement of arms or carrying any heavy objects or any sports which needs too much of hand movement.

• Physical Examination - The doctor would physically examine the affected area to look for any areas of warmth, tenderness or any swelling.

• Radiology - The doctor would conduct an X-ray to have a more detailed inspection of the inside of the trapezius muscle. By doing so, the doctor can rule out the possibility of any other potential conditions.

• Other Evaluations - The doctor may ask you to undergo a neurologic and musculoskeletal examination other than physical examination.

• New techniques - Musculoskeletal imaging techniques, magnetic resonance elastography (a research tool to measure stiffness of tissues) and musculoskeletal ultrasound are some techniques that can be used as diagnostic tools.

• CT or MRI scan – If all of the above options fail, then the doctor would go in for a MRI or CT scan to rule out the possibility of any other medical condition. Also, it would help to look at the trapezius muscle internal structure. This is done to observe conditions like pinched nerve or disc herniation. They mimic symptoms of trapezius muscle strain.

Treatment for Trapezius muscle strain

Depending on the extent of strain; whether its mild or severe, the doctor would then carry out different treatment approaches. The main aim of the treatment would be to get back free movement of the affected area along with flexibility as well as improve the motion of arms, shoulder, back and neck so that the pain is relived.

• Anti-inflammatory medications - They act as pain relieving therapy and also reduce inflammation. They increase the function of the arms and reduce discomfort. Over–the–counter medications help to ease pain. They also reduce spasms. One such medication is ibuprofen which has anti-inflammatory properties. Other medications are also there which act as muscle relaxers and pain killers.
• Procedures – If the pain tends to get severe and does not reduce with the help of anti-inflammatory medicines, then the doctor would prescribe stronger pain medications which would also involve use of narcotic pain medications. This is prescribed in limited amount. In some cases, steroid shots may be given which will relieve pain and increase mobility of shoulders.
• Therapy- Next step is physical therapy for faster healing. Some exercises will be formulated by the therapist. This would be done to increase flexibility and bring back the strength of the shoulders. One should take it gradually rather than jumping to the advanced level of therapy. Care should be taken to not further injure the already affected area. Therapy sessions encourage complete healing and also prevent future injury. Strength and flexibility should be improved by stretching and weight training, although this should be done under a professional’s supervision. Physiotherapists resolve injury and bring the person back in desired physical condition. Combination of specialized stretches and electrode administration can be carried out on the affected area as they seem to work well, when combined.

Home Remedies for Trapezius muscle strain

• Rice - The best treatment is this therapy which is a combination of Rest, Ice, Compression and Elevation. This therapy aims at treating the pain and injuries.

  First, icing is done for two days. Ice is taken on a towel and it is applied for 20 minutes on the affected area at least 2-3 times a day. This calms down inflammation, swelling and controls pain. One should avoid lying flat. After couple of days, try heat treatment which should be done in the form of a heating pad or warmed towel applied to the affected area. This should be kept for at least 20 minutes and should be done twice to thrice in a day. This will increase the blood circulation in the affected area and calm down swelling and inflammation.

  Although RICE can help treat the trapezius muscle strain, care should be taken that the ice and freezer gel packs do not reach very low temperatures as they can cause ice burns on the skin. 

• Massage – One can apply firm pressure with the index and middle finger to the affected spot. This massaging should be done in a circular motion for around one to two minutes. This helps to alleviate stiffness. Ensure to give maximum protection and rest to the affected area for the first few days so as to prevent any tearing of the fibers. After which, short movements can be done slowly.

Herbal Remedies for Trapezius muscle strain

• Ginger - Ginger is known to heal inflammation. Its volatile oil contains beta-bisabolene and zingiberene which are anti-inflammatory agents. A dosage of 250 mg to 1 gram of ginger root powder. is recommended that should be taken in three to four times on a daily basis so as to prevent any pain and swelling.
• Pineapple - Bromelain, a proteolytic enzyme found in pineapple, is also another remedy. 40 mg is recommended to be taken three to four times in a day. It may reduce inflammation.
• Cabbage slice - Cabbage slice is a natural home remedy. Wrap cabbage around ginger and then bake it in an oven for over half an hour. Once done, remove it from the oven and cut it into slices. The hot slice should be placed on the affected area and left for 20 minutes. This helps to relieve muscle spasm.

How long does the pain last?

There is no exact duration that can be given as it depends on a number of factors like the cause of the pain, its source, the change in the lifestyle after the strain and body’s response to the treatment. It is important for the body to get rest after the strain or else the symptoms may get worse. It can take one to six weeks for the affected area to heal by itself. Also, it depends on the severity of the strain. During the healing period, it is necessary to give enough rest to the body, follow a well balanced diet and to stay hydrated.

Prevention of Trapezius muscle strain

• Exercise- Trauma caused to the trapezius muscle during exercise may also cause the strain. So, it is necessary to check the technique of exercise since bad technique may lead to injury. Warm up should be done properly, especially before lifting heavy weights. Limit the exertion by not overworking which can lead to strain or injury. Discontinue the exercise if it causes discomfort.
• Stretch daily- Stretching exercises should be carried out daily once in the morning and afternoon to prevent any further injury. There are many exercises tailored to stretching, which can be found out with little bit of research and these exercises are very easy to do and do not require any equipment. These exercises also prevent re-injury.