Best Exercises for the Trapezius Muscle
June 21, 2016
5 min. read
In this article we will discuss the following (click any to jump to that section):
To start this Evidence-Based Strength Training Series, well take a look at the often-neglected scapulothoracic muscles, their functions and the best exercises to recruit them.
Scapulothoracic Muscles and Pain
Typically, when clinicians consider how to manage upper quarter pain, they're careful about using local exercise and manual therapy. However, with a proper movement assessment or regional interdependence philosophy, clinicians recognize that impaired scapulothoracic muscles often contribute to pain in distal or proximal joints. Weakness or poor neuromuscular control of the periscapular muscles has been implicated in subacromial impingement4,18, lateral epicondylalgia2,7,12, cervicogenic headache10, and neck pain3,16.
In a prospective cohort study by Clarsen et al, scapular dyskinesis led to an 8.4 times greater risk of shoulder injury during an elite male handball season.6 Further, Lawrence and colleagues found that shoulder pain due to subacromial impingement significantly reduced scapulothoracic upward rotation at lower angles of humerothoracic elevation and sternoclavicular posterior rotation throughout humerothoracic elevation.11
Biomechanics Review: Scapulothoracic and Glenohumeral Joints
In humeral elevation, the scapula rotates up 1 for every 2 of elevation until 120 are achieved. Afterwards, the scapula rotates 1 for every 1 of elevation until the arm reaches maximal elevation.
The scapula typically tilts posteriorly between 20 and 40 in the sagittal plane.
The scapula rotates externally between 15 and 35 in the transverse plane.17
These joint movements rely on coordinated and balanced work from several muscles: the trapezius, serratus anterior, levator scapulae, rhomboid, and pectoralis minor muscles.
Anatomy of the Trapezius
The trapezius starts at the medial third of superior nuchal line, external occipital protuberance, nuchal ligament, and the spinous processes of C7-T12 vertebrae with a distal insertion at the lateral third of clavicle, acromion process, and spine of scapula.
Trapezius is divided into 3 distinct portions:
Upper trapezius (UT) providing scapular elevation
Lower trapezius (LT) providing scapular depression
Middle trapezius (MT) causing scapular retraction
The UT and LT together rotate the glenoid cavity superiorly, which is often a problem for individuals with shoulder impingement or pain.11
From Biomechanics to Exercises
Upper Trapezius
Primary function: scapular elevation
The highest Maximal Isometric Voluntary Contraction (MVIC) is achieved with elevation of scapula. During scapular abduction, UT activity progressively increases from 0 to 60 and from 120 to 180 of abduction.1
Researchers have found that the highest electromyographical (EMG) activity occurs in the following exercises:
Because UT weakness is rather rare (unless secondary to neurological involvement), it seldom deserves attention when treating the upper quarter pain. Instead, clinicians focus on strengthening middle and lower trapezius and normalizing the activation ratio of UT to the lower two trapezius (MT and LT).
| [Table] Click to see MVIC values for UT exercises |
Middle Trapezius
Primary function: scapular retraction
MT is often activated with scapular retraction. The highest MVIC for the MT has been recorded during the following exercises:
As the UT often compensates for a weak MT or LT, it may be beneficial to use exercises with a good UT:MT ratio such as:
side-lying forward flexion
side-lying external rotation
prone shoulder extension5
| [Table] Click to see MVIC values for MT exercises |
Lower Trapezius
Primary function: scapular depression
Because LT impacts scapular upward rotation, external rotation, and posterior tilt, its strengthening yields better results than that of UT and MT.17
This connection has been confirmed by many studies of the LT weakness and its association with pain.
Numerous studies also looked into maximal EMG activity of the LT during upper extremity strengthening and determined that MVIC has been significantly higher during the following exercises:
Arm raised overhead in line with the LT muscle fibers9
External rotation at 90 of abduction9,15
Horizontal abduction with external rotation5
Prone shoulder abduction5
While high MVIC is a good criterion for choosing exercises, an optimal UT:LT ratio can be even better. Being the primary actors in upward scapular rotation, UT and LT should make adequate and relatively equal contributions to maintain normal biomechanics. A study by Cools and colleagues determined that the following exercises have the best UT:LT ratios:
Side-lying forward flexion
Side-lying external rotation
Horizontal abduction with external rotation5
In a similar study by McCabe et al., the following exercises activated the LT over the UT:
Seated press-up
Unilateral scapular retraction
Bilateral shoulder external rotation13
| [Table] Click to see MVIC values for LT exercises |
Choosing the Best Exercise
Although these studies give us a glimpse into properly selecting exercise, very few exercises have been or will ever be studied. When choosing an exercise for your patient, be sure to consider:
the biomechanics of the movement
current evidence for or against the exercise
your patients presentation, and goals for treatment
The trapezius is an important piece of the puzzle, but the serratus anterior, rhomboids, and levator scapulae also contribute to upper quadrant pain.
For more information on treating shoulder dysfunction, check out Eric Hegedus's course Evidence-Based Treatment of the Shoulder: An Update.
Below, watch a video explaining shoulder impingement from the MedBridge's Patient Education Library.
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