Understanding the Trigger Point Story: Treating the Upper Trapezius

Person touching shoulder where pain is

Trigger points (TrP) are defined as palpable nodules located in the myofascia, primarily at the entrance point of the motor endplate in a muscle belly. They are typically 2 to 10 mm in length and occur in muscles that are in a chronically short position.1

Sherrington’s Law of Reciprocal Inhibition states, “When one set of muscles is stimulated, muscles opposing the action of the first are simultaneously inhibited.” Trigger points tell a story that can be invaluable for solving complex orthopedic biomechanical problems and which may lead us to more successfully treating musculoskeletal injuries and pain.2

Why Do Trigger Points Become Tight?

Trigger points occur because of prolonged abnormal posturing and/or lack of proper movement. They also tell us which muscles may be the functional antagonists—in this case, long/weak—and how a joint may be functioning in all three planes of motion. Let’s explore a common example from the upper extremity.

Upper trapezius trigger points are commonly associated with rotator cuff tendonitis and impingement, cervical compression syndromes, and tension headaches. The upper trapezius elevates and upwardly rotates the scapula. It becomes hyperactive in forward head posturing as it actively supports the cranium. The antagonist to the upper trapezius, the lower trapezius, is placed in a long/weak position with an increase in thoracic kyphosis and may be further inhibited with an upper trapezius trigger point.

It is common for clinicians to address upper trapezius tightness with direct techniques such as trigger point massage and stretching, which often yields temporary results. How can we support the manual technique with a movement-based program based on the properties of trigger points and the principle of reciprocal inhibition?

We must first listen to the story the trigger points are telling us.

Activating the Lower Trapezius

The lower trapezius is the functional antagonist to the upper trapezius. If it is long/weak, the upper trapezius will be short/tight. The lower trapezius becomes long and weak in the presence of a thoracic kyphosis. This muscle is best activated with arm elevation past 90 degrees.

Shoulder Flexion Wall Slide with Towel (see below) and Shoulder Overhead Press in Abduction with Dumbbells exercises are excellent ways to activate the lower trapezius with arm elevation. Sitting thoracic extension movements (STEMs) are effective in decreasing thoracic kyphosis. Thoracic Foam Roll Mobilization Backstroke helps stretch out the latissimus dorsi, a common cause of thoracic kyphosis.


Correcting an Elevated Shoulder Girdle

An elevated shoulder girdle is often caused by an elevated pelvis on the same side. This is confirmed by a TrP in the quadratus lumborum (QL). The Shoulder Flexion Wall Slide with Towel and Triangle Pose (see below) exercises are excellent solutions to lengthening a QL and leveling the pelvis and shoulders.

Decreased thoracic rotation can also cause an elevated shoulder girdle. The Sidelying Open Book Thoracic Rotation with Knee on Foam Roll stretch or Shoulder External Rotation in Abduction with Anchored Resistance (see below) will help restore normal thoracic rotation.

Try these exercises with your patients to address upper trapezius tightness and consider treating trigger points in your future patients’ programs.

  1. Trigger Points. (2023, March 11). Physiopedia, . Retrieved 20:15, May 31, 2023 from http:///index.php?title=Trigger_Points&oldid=328301.
  2. Kohler M, Stratmann P, Röhrbein F, Knoll A, Albu-Schäffer A, Jörntell H. Biological data questions the support of the self inhibition required for pattern generation in the half center model. PLoS One. 2020 Sep 11;15(9):e0238586. doi: 10.1371/journal.pone.0238586. PMID: 32915814; PMCID: PMC7485810.