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Levator Scapula

Developing trigger points in this muscle can mimic many different conditions. Tension headaches, migraines, cerviogenic headaches, SICK scapula, and subacromial impingement syndrome. 

 

Staying in one prolonged position like sitting in bed using your laptop or tablet contributes to trigger points and excessive muscle tension. 

Did you wake up this morning with a stiff neck? Are you unable to turn your head to one side? For the most part, we tend to say "Oh, I slept wrong last night and now my neck is stiff and sore." But in reality, it can be a number of factors that lead up to this. Sleeping with your neck in a tilted position, working at a desk, and using the keyboard with your head turned to one side for extended periods of time. Holding a phone between the ear and the shoulder or speaking at length with someone while the head is turned to the person at your side like when going out to a sushi restaurant. Individuals who perform repetitive overhead activities such as throwers, swimmers, or volleyball players may tend to develop trigger points in the neck and shoulders. The first thing I would do as a neuromuscular therapist is to perform a detailed assessment of what muscles are talking to you and create a plan that includes not only the bodywork needed but the number of sessions as well as some corrective actions to remedy your pain and get you back to living the life you want to live. Today we are going to dive into the "crick in the neck" muscle. 

The levator scapula is one of my favorite muscles. I like it for its uniqueness in that it has a posterior twist from its superior to its inferior attachment. The anterior-facing fibers at the superior attachment of the cervical spine become the posterior-facing fibers on the inferior attachment of the scapula. The primary functions of the levator scapula are to elevate the scapula, downward rotation of the scapula, and ipsilateral cervical rotation. It is innervated by the C3 and C4 spinal nerves and from C5 via the dorsal scapular nerve. Bi laterally it is a major influence in stabilizing the cervical spine during neck flexion.

Holding the shoulder in an elevated and shortened position is the leading cause of activation and perpetuation of trigger points and is involved in shoulder pain and impingement, headaches, mechanical neck pain, whiplash-associated disorders, scapular dysfunction, and fibromyalgia. When treating patients with jaw pain, cervical radicular symptoms, and upper extremity dysfunctions the levator scapula should be given consideration. Postural corrections at work and home (including sleeping habits) are primary corrective actions needed to prevent activation of trigger points in the levator scapula.

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Muscles that reinforce the functions of the levator scapula in elevation are the Upper Trapezius, Rhomboid Minor, and Rhomboid Major. These are movements like; a construction worker carrying a heavy bucket. Or a Cross Fitness Athlete, rescue personnel carrying a litter.  The muscles that counter elevation of the scapula are latissimus dorsi, lower trapezius, serratus anterior (lower fibers), and the pectoralis minor. 

 

Muscles that reinforce the functions of scapular downward rotation are latissimus dorsi, rhomboid minor, and rhomboid major. These are movements like; closing the hood on a car. The muscles that counter scapula downward rotation are the upper trapezius, lower trapezius, and serratus anterior. These are moves like eccentric contraction or the negatives in lateral dumbbell raises. 

 

When resisting contralateral side-bending, ipsilaterally the levator scapula becomes active with the ipsilateral upper trapezius and cervical spinal extensor muscle in an isometric hold. So movements like carrying a suitcase or groceries can activate trigger points in the levator scapula muscle. 

When retracting and extending the head and neck the same muscles become active bilaterally when acting isometrically. 

The levator scapula assists the sternocleidomastoid, splenius capitis and services, scalenes, upper trapezius, and the erector spinae muscles with the scapula stabilized. 

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Any portion of the muscle can be found to have trigger points although they are most often found in the midportion of the muscle belly or close to the insertion of the scapula. Pain is referred to the angle of the neck with it spilling over along the vertebral border of the scapula and branching off to the acromial angle of the scapula. 

 

The upper half of the muscle is related to headaches and neck pain if trigger points are active and the lower half of the levator scapulae muscle refers pain to in the posterior scapula and can even be severe during rest.

  • 95% of patients had maximum tenderness with 2 cm of the superior angle of the scapula. 

  • 73% had small nodules or crepitations that were palpable at the tender spot. 

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Tension in the levator scapulae muscle is a common cause of neck stiffness and are unable to completely turn their head to the same side because of pain and the pain caused by contracting the levator scapulae as well as turning to the opposite side due to muscle tension. They often turn their entire body.  

Reference: Travell, Simons & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual

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Related: 

6 Reasons To Get A Massage

Athletic Performace And Cupping

Make Peace With Imperfection

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Michael Hale is a Neuromuscular Therapist, Personal Trainer, and Health Educator who graduated from National Holistic Institute (NHI) and International Sports Science Association (ISSA). He wholeheartedly believes that strengthening the body is equally as important as relaxing the body in order to reach homeostasis.

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