Muscular Strain – Upper Fibers of Trapezius

Written by Trishia Baharani

A blog post discussing the ins and outs of an upper trapezius strain. Included in this post is an explanation of the role of the upper trapezius, diagnosis, signs and symptoms, treatment and exercise.

The trapezius muscle is one of the largest muscles in the body located at the neck and attaches to the middle of the back and shoulder blades. The trapezius muscle plays an important role in stabilizing the shoulder blades (scapulas). Muscular contraction is recruited during day-to-day tasks, such as lifting items, rotating the neck, and movement of arms- such as pushing, throwing and lifting. Moreover, the trapezius muscle is an accessory breathing muscle to aid with taking deep breaths.

A muscle strain occurs when the muscle can not cope with the demand for contraction or stretch placed on it, leading to stretching or tearing of muscle fibers. Most of the time, muscle strains happen for one of two reasons:

1. The muscle has been over-stretched beyond its normal range
2. The muscle has been forced to contract beyond its capability and range.

An upper trapezius strain can occur from an acute or chronic injury to the muscle fibers. An acute injury from a road traffic accident, fall or traumatic injury can cause strain to the upper trapezius. Lifting and loading heavy weight can also put your upper fibers of the trapezius under excessive stress and cause strain. Moreover, chronic presentations of this type of injury can be seen in avid weightlifters. Poor weight training form and technique can cause repetitive stress to the upper trapezius.

Muscle strains are split into three grades depending on the severity of muscle fiber damage in order to simplify diagnosis and treatment.

• Grade 1 strain: A mild strain – few muscle fibers are overstretched or sustained a tear. The injured muscle can be tender and painful- however, strength is normal.
• Grade 2 strain: A moderate strain – a greater number of injured fibers and increased sensation of pain and tenderness. There might be mild swelling, loss of strength and bruising.
• Grade 3 strain: A severe strain – full tear of the muscle all the way through. Oftentimes, individuals with a grade 3 strain describe a “pop” sensation when the injury occurred as the muscle rips into separate segments, A grade 3 strain leads to loss of muscle function, considerable pain, swelling, discolouration and tenderness at the muscle origin and the surrounding area.

The length of time it takes for a full upper trapezius muscle strain recovery depends on the grade of strain, the severity, personal health history, previous activity levels and lifestyle.

For most grade 1 muscle strains, healing time ranges between 2 to 4 weeks. Grade 2 muscle strains can expect a recovery in about 2 months. Grade 3 strains healing time varies depending on if there is a need for surgery but could take anywhere from 6 to 12 months.

• Reduced mobility, decreased range of motion or muscle weakness
• Difficulty struggling with shoulders or raising arms
• Pain between the shoulder blades.
• Neck and shoulder pain and stiffness.
• Swelling, bruising or tenderness in your shoulders, neck or back.
• Headaches
• Sharp and shooting pain in the arms and upper back
• Tingling in the arms

Non-surgical treatment follows the NICE (National Institute for Health and Care Excellence) guidelines. Moreover, the initial inflammatory period of strain involves rest, pain relief and exercise intervention to restore strength and motion to the trapezius muscles.

1. The use of analgesia for symptom relief:
   1. Anti-inflammatory drugs to reduce swelling and pain in the muscle
2. ‘PRICE’ self-management strategies for the first 48–72 hours after injury.
   1. Protection — protect from further injury
   2. Rest — avoid activity for the first 48–72 hours following injury.
   3. Ice — apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day for the first 48–72 hours following the injury. This should not be left on whilst the person is asleep.
   4. Compression — with a simple elastic bandage or elasticated tubular bandage, which should be snug but not tight, to help control swelling and support the injury. This should be removed before going to sleep.
   5. Elevation — keep the injured area elevated and supported on a pillow until the swelling is controlled. If the leg is injured, prolonged periods with the leg not elevated should be avoided. For severe sprains and strains, a short period of immobilization for a few days after injury may be needed.
3. Rehabilitation intervention with a medical professional
   1. Goals to regain mobility, and strength and to prevent future injury through strength training.
   2. Gradual return to sport/exercise, starting with the intention to gain full mobility and range of motion.
   3. Working to load the muscle in full range and strength bilaterally.
   4. Strength training upper trapezius muscle and musculature of the upper body as well.

Exercises are to be completed after the initial inflammatory period following injury (48-72 hours after).

1. The shoulder shrug and isometric hold
   1. Seated in a chair, lift your shoulders to your ears and hold for 5-10 seconds. Slowly descend back to the neutral position.
2. Seated shoulder flexion and hold
   1. Seated in a chair, arm straight in front of you, lift up to 90 degrees and hold for 5 seconds. Then proceed to lift all the way up above your head, and hold for 5 seconds.
   2. Slowly descend back to a neutral position – control your arm on the way down.
3. Shoulder blade squeezes
   1. Seated in a chair, squeeze your shoulder blades together and hold for 5 seconds. Slowly return to the starting position and repeat.

Ultimately, the goal will be to regain full range of motion and improve upon upper body strength on both sides to prevent further injury and gain strength. Exercises can be progressed to challenge ability.

Within the clinical evidence, the risk of a repetitive injury to the same muscle/ligament increases either on the same side or contralateral. Thus, it is vital to consider how to progress your rehab and to continue loading musculature to increase strength. For example, the initial phase of rehab for an upper trapezius strain may involve the exercises listed above with the aim to implement movement again and build off isometric (holding a contraction) exercises. As the exercises get easier, progression can occur to prevent a plateau.

*Please make sure you consult a professional in order to prevent injury. Also, every individual is different. There is no one size fits all approach for an injury as people prevent it differently biologically and psychologically. Individuality is key to understanding tailored rehabilitation.

1. Wall push-ups
   1. Slowly descend bringing your chest towards the wall and hovering. Squeeze shoulder blades together, and hold and push up with your arms with power.
2. Plank with scapula movement
   1. In the plank position, the core and glutes are engaged with hips levels and not lifted up. Focus on shoulder blade movement whilst loading the shoulders and upper body.
3. Shoulder press with dumbbells
   1. A seated dumbbell press can help isolate and focus on shoulder movement. Hold dumbbells in your hands at a slight angle forward – should align with your periphery and not too far back. Push the weights up and then control them on the way down in a count of 5.
4. Upright row
   1. Dumbbells your legs, nice and relaxed. Recruiting your shoulder muscles and upper trapezius to pull the weight upwards. Engage the core and slow the descent down to a neutral position which keeps tension on the contracting muscles.

*It is recommended to get the OK from a medical professional before trying out any of these exercises.

If you hear a pop or snap sound when you hurt yourself, you may have torn a ligament or broken a bone. You’ll need to go to your local hospital’s accident and emergency (A&E) for treatment. Seek medical help immediately if you have symptoms of a grade three strain, such as full loss of muscle function, considerable pain, swelling, discolouration and tenderness at the muscle origin and the surrounding area as you may need surgical intervention.

If you are experiencing any of these could be symptoms, you may be at risk of a more serious back problem. In order to seek further medical advice on how to treat your symptoms, visit your local GP or call 111.

1. Depending on the severity of the injury, the lifestyle of the individual, mental health and social factors, prognostic time can differ. Therefore, the guidance regarding how long a strain of the upper trapezius will take to heal should be interpreted with a pinch of salt. There is no one size fits all approach.
2. The risk of injury increases to the same muscle or contralateral side is proven in clinical literature due to altered biomechanics, compensatory mechanisms and non-progressive and loading rehabilitation. Thus, it is vital to keep working to regain your mobility, strength and function and to maintain this through exercise.
3. Seeing a medical professional will lead to peace of mind regarding diagnosis and allow for a tailored rehabilitation and treatment protocol for you.