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Trigger Point Therapy - Treating the Trapezius

Posted by Judith Winer on

Trapezius Trigger Points

Trapezius - Common Trigger Point Sites

The left and right trapezius viewed as a whole create a trapezium in shape, thus giving this muscle its name.

As the trapezius is an important neck muscle, any spastic activity in the sternocleidomastoid, suboccipitals, scalenes, longus colli, levator scapulae, or many other muscles will have an effect on its status. Many people hold emotional tension in the upper trapezius.

The upper portion decelerates the head, the middle portion decelerates protraction, and the lower portion decelerates shoulder elevation.

Myofascial trigger points here lead to tension headaches, with sharp pain felt in the temporal bone and into the masseter, behind the eye and ear (on the same side), and along the side of the neck.

Occasionally, pain will travel to the back of the head, and a burning pain will be experienced down into the vertebral side of the scapula and middle back. Trapezius myofascial trigger points can cause loss of balance and dizziness.

Myofascial trigger points in this muscle are often mistaken for disc pathologies, neuralgia, spinal stenosis, shoulder bursitis, or arthritis.


Medial third of superior nuchal line of occipital bone. External occipital protuberance. Ligamentum nuchae. Spinous processes and supraspinous ligaments of seventh cervical vertebra (C7) and all thoracic vertebrae (T1–12).


Posterior border of lateral third of clavicle. Medial border of acromion. Upper border of crest of spine of scapula, and tubercle on this crest.


Upper fibers: pull shoulder girdle up (elevation). Help prevent depression of shoulder girdle when a weight is carried on the shoulder or in the hand.

Middle fibers: retract (adduct) scapula.

Lower fibers: depress scapula, particularly against resistance, as when using hands to get up from a chair.

Upper and lower fibers together: rotate scapula, as in elevating the arm above the head.


Motor supply: accessory XI nerve. Sensory supply (proprioception): ventral ramus of cervical nerves C2, 3, 4.

Basic functional movement

Example (upper and lower fibers working together): painting a ceiling.

Sports that heavily utilize this muscle

Examples: shot put, boxing, seated rowing.

Common problems when muscle is chronically tight/ shortened (spastic)

Upper fibers: neck pain or stiffness, headaches.

Trigger Point Referred Pain Patterns

Upper fibers: pain and tenderness, posterior and lateral aspect of upper neck. Temporal region and angle of jaw.

Middle fibers: local pain, radiating medially to spine.

Lower fibers: posterior cervical spine, mastoid area, area above spine of scapula.


Chronic tension and neck ache, stress headache, cervical spine pain, whiplash, tension/cluster headache, facial/jaw pain, neck pain and stiffness, upper shoulder pain, mid-back pain, dizziness, eye pain, emotional stress, depression.


Habitual postures, work, stress, neck problems, shoulder muscle weakness, use of mobiles phones / tablets, scoliosis, sports related (e.g. tennis, golf), playing musical instruments.

Differential Diagnosis

Capsular-ligamentous apparatus. Articular dysfunction (facet).


SCM, masseter, temporalis, occipitalis, levator scapulae, semispinalis, iliocostalis, clavicular part of SCM, neck/jaw/shoulder joint muscles.

Trigger Point Therapy Treatment Techniques

Spray and Stretch  YES
Deep Stroking Massage YES
Compression YES
Muscle Energy Techniques YES
Positional Release YES
Dry Needling YES
Wet Needling YES


Self help

Self massage can be very effective. Pressure tools recommended. Stretching!

General advice to patients

Posture (standing and at work). Stress management. Bra straps. Pectoralis minor tension (round shoulders). Stretch!


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NAT 5-Step Shoulder Technique


This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 









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