(Upper Trapezius = Orange; Middle Trapezius = Red; Lower Trapezius = Purple)
Sometimes I find it difficult to remember to look further than the patient’s area of pain. When assessing the neck, I may assess the posture of the head and upper back, range of motion of the neck and back, joint mobility, palpations, etc. I may notice that the upper trapeziuses are overactive and strong but not consider the strength of the lower trapeziuses. I started to wonder if the strength of the lower trapezius could be a factor for people suffering from certain types of neck pain.
I came across an article that assessed the strength of the lower trapezius muscle in individuals with single sided neck pain. The article by Petersen and Wyatt found that the lower trapezius muscle on the affected side was significantly weaker than the lower trapezius muscle on the unaffected side. They also did not want to assume that strengthening of the lower trapezius will help with neck pain even though they found a significant muscle strength difference.
(Click the link below for assess to the article)
Purpose: To examine lower trapezius muscle strength in individuals with unilateral neck pain, as an initial step in determining if impairments need to be assessed and addressed in this population.
Methods: This is a descriptive and within-subject comparative study. The researchers examined 25 individuals with unilateral neck pain for greater than 3 months and did not have radicular symptoms. The examiners tested the strength of the lower trapezius by using a handheld dynamometer at the distal forearm with the subjects in prone and the upper extremity in line with the lower trapezius fibers (~130 degrees in shoulder abduction). The examiners stabilized the contralateral scapula. They completed 2 measurements and averaged the values. Each subject was tested bilaterally and the examiners were blinded.
Results: The lower trapezius strength on the affected side was significantly (p<0.001) less than the lower trapezius strength on the unaffected side with a mean difference of 3.9N. They did not find a correlation between duration of neck pain and lower trapezius weakness.
Limitations: The researchers did not include an asymptomatic group for comparison. Also, there is conflicting evidence of which manual muscle test position for the lower trapezius and placement of the dynamometer are optimal.