Neck Pain and the Role of the Trapezius Muscle

By Dan Streubel, MPT

Poor postural habits and neck pain are increasingly common among individuals who work predominately at a computer.  Common poor postures include a forward head position, protracted shoulders, and scapular winging and tipping. 

Studies place estimates of the prevalence of some of negative postural habits at frequencies that are shocking (at least to our mothers):[1]

• Forward head = 66%
• Increase in kyphosis = 38%
• Right rounded shoulder = 73%
• Left rounded shoulder = 66%).

These postural deficits are associated with imbalances in several of the muscles around the neck and shoulders.  Common patterns of imbalance in these muscles include:

• Muscles that are often tight (and shortened):
  • Upper Trapezius
  • Levator Scapulae
  • Pectoralis Major and Minor
  • Sternocleidomastoid
• Muscles that are often inactive (and lengthened):
  • Lower Trapezius
  • Rhomboids
  • Middle Trapezius
  • Deep Neck Flexors
  • Serratus Anterior

Studies have shown that excessive muscle tone and tightness in the upper trapezius tightness have been associated with increased stress on the cervical spine and can cause increased cervical lordosis.[2]

A recent study on this issue highlighted the effectiveness of retraining the postural muscles and specifically the upper and lower trapezius on decreasing neck pain.[3]  The study compared the activity of the three portions of the trapezius muscle in healthy controls to a group of individuals with neck pain and poor scapular posture while typing. 

The individuals in the group with neck pain were observed to generate less activity in the lower trapezius compared to the control group.  This decrease in lower trapezius muscle activity has been postulated to be associated with neck and shoulder pain issues. [4]

Following exercises for posture correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions of the trapezius.  The authors concluded that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals. [5]

Considering the broader implications of this study, it makes sense that scapular posture correction exercises can lead to less upper trapezius overload and neck pain, especially when these exercises are performed routinely throughout the day with individuals who are working predominately at the computer.

A related study published in Arthritis & Rheumatism 2008 looked at specific strength training of the upper trapezius versus general fitness training in individuals with chronic neck and muscle pain.[6]  The general fitness exercise group rode a stationary bike 20 mins 3 times per week.  The more specific strength training group used hand weights and performed 20 minutes of shoulder and neck strengthening exercises (3 sets of 8-12 reps) 3 times per week.

The strength training group demonstrated a marked reduction in pain of 79% with the more neck-specific exercises.  This positive effect was observed to persist even after cessation of the intervention. 

Based on these and related studies, the following recommendations for exercise programs aimed at targeting neck pain would include:

1. Strength training at a high intensity (8-12 rep max) for 20 minutes 3 times per week
2. Scapular posture correction exercises
3. General posture awareness and modification

---

[1] Phys Ther. 1992 Jun;72(6):425-31.

[2] Relationship Between the Shoulder and Cervicothoracic Spine. 2006 APTA Orthopedic Section

[3] Man Ther. 2010 Jul 19. [Epub ahead of print]

[4] Man Ther. 2010 Jul 19. [Epub ahead of print]

[5] Man Ther. 2010 Jul 19. [Epub ahead of print]

[6] Arthritis & Rheumatism 2008; 59(1) 84–91