Self-massage of the trapezius muscle will relieve pain in the shoulders, back, head and arms. Trapezius muscle (upper portion) Trapezius muscle - location, functions, causes of pain

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Middle portion of trapezius muscle

Muscle function: takes part in holding the shoulder blades back, like the rhomboid muscle.

Signs of weakness: displacement of the scapula not only forward, but also upward, as the upper portion of the trapezius contracts and shortens.

Usually accompanied by weakness of the rhomboid muscle, but, in contrast, there are often cases of weakness on one side.

Muscle antagonist: pectoralis minor muscle, upper trapezius muscle.

Exercises to strengthen the middle portion of TM

1. Reduction of the shoulder blades, as for the rhomboid muscle. But the difference is that the arms are bent at the shoulder joints and are at 90 degrees (see Fig. 29).

2. The same movement in a sitting position. Three sets of 10 repetitions 2-3 times a day.

During these exercises, you can initially breathe arbitrarily. They can then be synchronized with the breath. At the moment of bringing the shoulder blades together, exhale, at the moment of relaxation, inhale. But not vice versa, because the rhomboid muscle and the middle trapezius are exhalatory muscles; when the shoulder blades are brought together, they flatten the chest.

The middle and lower portions of the trapezius muscle are very often weak, in contrast to the upper portion of the trapezius, which can be shortened, usually on one side.

But there are also frequent cases of weakness in the upper portion of the TM, which can develop due to instability of the acromioclavicular joint or compression of the accessory nerve.

Rhomboid muscle

Muscle function: stabilizes the shoulder blades, bringing them together at the back. Consists of the rhomboid major and rhomboid minor muscles. One of its edges is attached to the spinous processes of the first cervical and upper five thoracic vertebrae. The other edge is attached to the inner edge of the scapula (see Fig. 30).

With simultaneous muscle tension, the shoulder blades move closer together.

The muscle is prone to weakness, usually on both sides. At the same time, the shoulders shift forward, and a stooped posture is formed. Almost always weakens along with the middle portion of the trapezius muscle. In the area of ​​the weak rhomboid muscle, massage reveals a huge number of trigger points, which must be eliminated before starting the exercises.

Muscle antagonist: The pectoralis minor muscle, with weakness of the rhomboid muscle, will shorten, which will further increase the forward displacement of the shoulders. The second sign of its shortening: turning the hand with the back side forward.

Exercises to strengthen the rhomboid muscle

1. Lying on your stomach, arms along your torso, head touching the floor with your forehead, do not come off during the exercise. Reduction of the shoulder blades. Hold in this position for 1-2 seconds and relax. Three sets of 10 repetitions 2 times a day (morning, evening).

2. Sitting or standing, arms along the body. Reduction of the shoulder blades and relaxation. The movement is done in full, at a slow pace. Three sets of 10 times. Twice during the day (see Fig. 31 and Fig. 32).

The rhomboid muscle plays a big role in maintaining posture; it is with this muscle that you need to start exercises to form correct posture. It is also an auxiliary respiratory muscle, contracts during exhalation, therefore, when it is weak, fixation of the upper 5–6 ribs is always observed.

As a rule, weakness of the rhomboid muscles is accompanied by weakness of the long extensor muscles of the neck on one or both sides, which also need to be trained.

Pectoralis minor muscle

Case from practice

One summer, a patient came to me with very unusual complaints. He was bothered by swelling that appeared under his right eye, and then on the entire right side of his face. And the most interesting thing is that this happened in the afternoon. During questioning, I found out that this swelling only appeared on weekdays and did not occur on weekends.

Then I decided to check the position in which he spent most of his time at work.

Of course, he was sitting at the computer in such a way that his right shoulder was strongly shifted forward, and this greatly surprised him when he saw himself in the mirror. And as a result of this position, compression of the lymphatic duct under the right pectoralis minor muscle occurred, which caused swelling.

As you already know, the posture in which you are accustomed and comfortable to sit or stand is the result of the work of your muscles, and if it is not symmetrical, then you have weak, shortened and excessively tense muscles.

The most problems, of course, are created by shortened muscles, which begin to compress nerves and blood vessels, causing pain and disruption of innervation and blood supply.

One of the striking examples is the pectoralis minor muscle (see Fig. 33), which, as you remember, is shortened due to the weakness of its antagonists - the rhomboid muscle and the middle portion of the trapezius muscle. Due to their weakness, they are not able to hold the scapula at a certain distance from the spine, so it moves forward. And the attachment points of the pectoralis minor muscle come closer.

One of the main functions of the pectoralis minor muscle is to expand the chest during inhalation. When tense, it raises the third, fourth, fifth ribs during inhalation, and during exhalation it relaxes and the ribs descend. When this muscle is shortened, it turns out that the chest, namely its upper part, is already inhaling.

A person with this problem will feel like they can't take a deep enough breath. But the problem is that there is nowhere to inhale; first he needs to exhale. To do this, you need to relax the pectoralis minor muscle, which cannot do this due to a muscle imbalance between it and the rhomboid muscle.

So, let's return to our patient. In addition to swelling on the right side of his face, he was also bothered by numbness in the fingers of his right hand, especially at night.

Many people think that numbness is the result of compression of blood vessels, but in fact it is due to compression of nerves. A nerve is a kind of conductor.

You want to move your big toe, and the impulse originating in the brain runs first along the spinal cord located inside the spine, then along the nerve roots emerging from the intervertebral foramen, then along the sciatic nerve, then along smaller nerves, and finally this impulse reaches the muscle that will make the movement you wanted.

And at the same time, another electrical impulse will move, but in the opposite direction from the receptors that respond to movement and are located in the muscles and joints. This is why you can wiggle your big toe with your eyes closed and still realize that it is moving.

The treatment I began was aimed at reversing the shortening of the pectoralis minor muscle to free up the lymphatic duct, the group of nerves that run underneath the muscle, and to increase the range of motion of the chest when breathing.

I first addressed the underlying weakness in the rhomboids, middle trapezius, and lower trapezius to tone those muscles, and then began stretching the pectoralis minor. Then, to restore innervation, the cervical spine was stabilized, and all muscles were gradually included.

And, of course, the patient was trained to sit, breathe, stand and walk correctly. Because one of the main tasks is to create the correct motor pattern of movement, which is easiest and fastest to do while walking, because this is one of our most frequent movements.

The patient was also shown exercises for all muscle groups that were imbalanced - shortening and strengthening.

As a result of all this work, not a trace remained of the swelling that had half closed the eye for five years.

But such success can only be achieved when the doctor and patient work together to fight the disease. As Hippocrates' favorite proverb says: "The doctor fights a disease, and whether he can defeat it depends on which side the patient takes."

Will he fight shoulder to shoulder with the doctor, obeying and trusting him in everything, will he stand aside, fold his arms on his chest, and look at what is happening, wincing with displeasure that he still cannot be cured, without thinking about what He has the only body, unfortunately, there won’t be another, and all his illnesses are the result of many years of hard work on the way to them. Or the worst thing is when the patient goes over to the side of the disease, nurturing and cherishing it, enthusiastically telling his friends and attending physicians more and more new details of his illness-life history.

So you must always have the right attitude, you must understand what state you are in now and what your goal is - what exactly you want and what you need to do in order to be healthy and happy.

The pectoralis minor muscle is one of the muscles where shortening most often occurs. There is not a single stooped person who does not have this muscle shortened.

As you already know very well, shortening of any muscle occurs due to the weakness of its antagonist.

The antagonists of the pectoralis minor muscle are a group of muscles that fix the scapula from behind. This group includes:

Rhomboid muscle. Consists of two parts - small diamond-shaped and large diamond-shaped;

Middle and lower trapezius muscles;

Latissimus muscle.

These muscles belong to the back extensor group and are very often prone to weakness.

The pectoralis minor muscle originates from the coracoid process of the scapula. And ends at the third, fourth and fifth ribs.

When the pectoralis minor muscle shortens, its attachment points move closer together. This affects the position of the scapula most of all. The shoulder blade can perform a fairly large range of movements; unlike the ribs, it has a much larger range of movements. Therefore, the shortening of the pectoralis minor muscle primarily affects the change in the position of the scapula. Although, due to its shortening, it raises the ribs to which it is attached.

The pectoralis minor muscle is involved in inhalation: it lifts the third, fourth, fifth ribs up, and its antagonists (primarily the rhomboid muscle) relax at this time.

During exhalation, the opposite happens: the rhomboid muscle tenses, slightly moving the shoulder blades and flattening the chest at the back. But with weakness of the rhomboid and shortening of the pectoralis minor, the chest is constantly inhaled due to the fixation of ribs from the third to the fifth. This causes restriction of the movement of the chest and thereby reduces the ability to fully inhale and exhale. And this reduces the level of oxygen in the blood.

We will talk in detail about the breathing process, which muscles are involved in inhalation and exhalation, and how to restore the breathing mechanism, how to breathe correctly in one of the following chapters.

The scapula, when the pectoralis minor muscle shortens, changes its position and moves forward. This is due to the fact that the attachment point of the pectoralis minor muscle is the coracoid process of the scapula.

This makes it even more difficult for the back extensors to work, since they are forced to constantly be in a stretched state. And in this position they are very easy to injure even with slight physical activity. This is why there are so many and so common trigger points in the rhomboid, middle and lower trapezius muscles.

To eliminate shortening of the pectoralis minor muscle you need to do exercises to stretch it.

But this must be done while simultaneously strengthening the rhomboid, middle, lower trapezius and latissimus muscles. Because if they do not work, shortening of the pectoralis minor muscle will occur again.

It makes no sense to stretch the pectoralis minor muscle without training its antagonists (this also applies to other shortened muscles). No muscle will become shortened on its own. There is always a reason that caused its shortening.

And before stretching a muscle, you first need to eliminate this cause. No muscle will begin to be in constant tension on its own initiative. Something forces her to do this. And this “something” is weakened antagonists. The shoulder blade moves and the pectoralis minor muscle shortens.

The role of the pectoralis minor muscle in breathing

The pectoralis minor muscle (PMM) plays an important role in breathing. The normal state is when the shoulder blade is fixed at the back and the muscle performs the function of inhalation. As you inhale, the ribs rise, and as you exhale, they fall. If the pectoralis minor muscle is shortened, these ribs are “switched off” from movement and breathing.

During each inhalation and exhalation, there is also movement in the joint between the rib and the vertebra - this is the costotransverse joint.

But when the ribs stop moving during breathing, these joints also stop moving. With each inhalation and exhalation, this joint should move. When shortening of the pectoralis minor muscle occurs, they cannot do this.

As a result of the lack of movement, joint blocks appear in this place, which provoke even greater weakness of the antagonists of the pectoralis minor muscle, since these are all attachment points for the rhomboid muscle and trapezius. It can also cause weakness in the long extensor muscles of the neck.

Often a lot of questions arise specifically about vertebral artery syndrome and pinched occipital nerve. All this is precisely connected with the weakness of this muscle group and with the fixation of the costotransverse joints, since articular blocks have already formed at the location of these three joints during the time that there was a muscle imbalance. And now movement in the costotransverse joints is limited. Before you start doing exercises, it is necessary to eliminate fixations in the joints and make them mobile again. Remember that your rhomboid muscle attaches to your vertebrae. And if there is a fixation between the vertebra and the rib in one of the joints that has stopped moving, then the part of the rhomboid muscle that is attached to this vertebra will also lose tone.

You begin to train a muscle, which in the process begins to restore its volume and grow, but only in the part where it is attached to a fixed vertebra. This will lead to the fact that some of the fibers of the rhomboid muscle will not be included in the work and will remain hypotonic, and some, although it will restore volume, will become excessively tense and will quickly tire with a small load.

In the same muscle there will be both weak and overly tense, hypertrophied fibers (see Fig. 34). This is the whole danger of exercising without first eliminating the causes that caused them.

So, let's summarize.

Very often this muscle prone to shortening due to weakness of antagonist muscles: rhomboid, middle and lower trapezius, latissimus, less often with weakness of the pectoralis major muscle.

Signs of weakness

1. Shifting the shoulders forward, stooping.

2. Turn your arms inward, and your hands face forward.

3. Change in the color of the skin of the hand: it becomes purple and sometimes bluish due to a violation of the venous outflow. A shortened MG compresses the veins passing under it, disrupting the venous outflow of blood from the arm.

4. Numbness of the fingers or the entire hand, in some cases - the forearm or the entire arm.

5. Weakness in the arm.

6. Pain in the arm; numbness, weakness and pain are associated with compression of the nerve plexus that runs under the pectoralis minor muscle. Numbness first appears at night, in positions where the pectoralis minor muscle increases pressure on the group of nerves passing under it, then it can occur constantly if the shortening becomes stronger. Weakness in the arm may not be noticeable at first, because it appears only with increased loads, the muscles will tire faster, and then it appears during normal movements.

7. Restriction of chest movement during breathing. The MGM is attached to the third, fourth and fifth ribs and, when shortened, fixes them, preventing them from moving during breathing.

8. Obstruction of lymphatic drainage from the head and neck - swelling of the supraclavicular fossa.

MGM relaxation exercise

Standing in the doorway, rest your forearms or hands on the door frames on both sides. The elbow must be higher than the shoulder joint, otherwise the pectoralis major muscle will be pulled.

There should be a feeling of stretching in the area of ​​the pectoralis minor muscle. Hold this position for 15–30 seconds. Repeat 3 times a day for 2-3 approaches.

This complex must be combined with exercises to strengthen the rhomboid, middle and lower trapezius muscles.

1. Exercise in the corner. Place your emphasis on both arms so that your elbows are at eye level or maybe a little higher, and shift your center of gravity forward. You will begin to feel a stretch in the pectoralis minor muscle.

2. Exercise against the wall. Stand perpendicular to the wall, place one hand on the wall so that the elbow is at eye level or slightly higher, and begin to turn your body in the opposite direction, turning away from the wall, without lifting your hand. If performed correctly, tension will also occur in the pectoralis minor muscle (see Fig. 35).

Exercise in the doorway. In the doorway, place your hands in the elbow position at eye level or slightly higher. Shift the center of gravity forward (see Fig. 36).

The main mistakes made when stretching the pectoralis minor muscle

When the weight of the body shifts forward, the lower back bends. This causes tension in the back. If you feel tension in your lower back during or after exercise, pay attention to whether your lower back arches.

Incorrect hand position. The elbow is too low. In this position, it is not the pectoralis minor, but the pectoralis major, that will stretch more.

During the exercise, make sure that your head does not tilt as you shift your center of gravity forward. Look straight as you stretch the pectoralis minor muscle.

Scalene muscles

The scalene muscle group (LM) consists of three muscles: front, middle, rear stairs muscles.

Their condition is very important because it is between them that the neurovascular bundle passes, which then forms the nerves and vessels of the arm.

Shortening of these muscles causes pain, numbness in the arm, pain in the neck; often glenohumeral periarthrosis begins with shortening of the scalene muscles (see Fig. 37).

Are being shortened they are very common, there are two reasons for this.

1. Weakness of the sternocleidomastoid muscle due to instability of the clavicle. (The anterior scalene muscle takes over the function when turned off.)

2. Weakness of the long extensors of the neck (shortening of the scalene muscles occurs according to the antagonist principle).

Signs of shortening of the scalene muscles

1. Shifting the head forward.

2. Restriction of movement of the chest, since the first and second ribs to which this muscle is attached are fixed.

Manifestations of LM shortening

1. Pain in the neck and shoulder, especially when bending to the side and turning.

2. Numbness in the fingers, hands, and entire arm.

3. Weakness in the arm.

Exercises to stretch the scalene muscles

Starting position, as in Fig. 38. Press the muscle with your fingers and tilt your head. During the exercise, you should feel the tension of the muscle from the ear down to the fingers. Perform 10 repetitions in each direction 2 times a day.

Quadratus lumborum muscle

One of the main stabilizers of the lumbar spine. As you understand from the name, it has a square shape (see Fig. 39).

A distinctive feature of the muscle is that it has three groups of multidirectional fibers. And thus, it participates in several movements at once: turns (in this case, one relaxes, the other tenses), bending to the side (with tension on only one side), participates in bending forward and straightening the torso.

The quadratus lumborum (QL) muscle has several attachment points.

1. Twelfth rib from top.

2. The upper edge of the ilium is below.

3. Transverse processes of all lumbar vertebrae.

Three groups of fibers of the quadratus lumborum muscle

First group fibers of the quadratus muscle - vertical, goes from top to bottom, from the twelfth rib to the ilium. These fibers work at the moment when you bend forward, extend back, and bend to the sides. When bending to the sides, on one side the quadratus muscle tenses together with the oblique abdominal muscles, and on the other side the muscle relaxes at this time.

Second group fibers of the quadratus muscle go from the transverse processes of all five lumbar vertebrae to the twelfth rib. These fibers work when you turn. Any muscle, contracting, brings its attachment points closer together. For example, when the right quadratus lumborum muscle contracts, it rotates to the right. The oblique abdominal muscle, together with the quadratus muscle, is involved in turns.

Third group fibers of the quadratus muscle go from the transverse processes of all five lumbar vertebrae to the ilium. When they contract, a tilt to the side and a turn occurs (see Fig. 40).

So, two groups of fibers of the quadratus muscle will simultaneously participate in rotation - rotation of the pelvis relative to the chest.

Such rotations (movements) of the body are very important, as they occur when walking. Turns with this movement are symmetrical.

But this cannot be done when there is shortening and weakness in at least one of the fiber groups.

Most often, weakness of the quadratus lumborum muscle is accompanied by a change in the position of the twelfth rib, and sometimes a change in the position of the ilium.

It often happens that on the opposite side the same quadratus muscle begins to shorten. We often see that the quadratus lumborum muscle is weak on one side and shortened on the other. Due to the difference in muscle tone, a small scoliotic arch can form, but not as large as with an imbalance of the vertebral muscle.

What happens when quadratus lumborum imbalance occurs?

Firstly, restrictions arise in the movement of the body. It will be asymmetrical while walking.

Secondly, an incorrect angle of movement between the lumbar vertebrae begins to form. The mechanics of movement of the vertebral joints will change.

All this leads to hernias, disc destruction, and the formation of arthrosis. So when we work on lumbar rehabilitation and pelvic stabilization, one of the first muscles to be restored is the quadratus lumborum muscle.

It is necessary to simultaneously restore the tone of the weak quadratus lumborum muscle and remove shortening on the opposite side. This must be done in all three fiber directions. If you leave the problem unresolved in at least one of the groups, after some time everything will repeat itself, because there will be no optimal movement mechanics.

2.13.1. Functional anatomy (Fig. 18A-B)

Characteristics Beginning of muscle End of muscle

Anatomy of insertions Vertical fibers - medial All fibers converge with each other and

one third of the superior nuchal line is attached to the acromion

occipital bone, outer end of the clavicle. Wherein

occipital protuberance. vertical fibers

Medial fibers - the nuchal ligament attaches more medially
from the spinous processes of Ci-V. relative to the medial fibers,

crossing each other in
frontal plane.

2.13.2. Violation of statics when shortening the upper portion of the trapezoid
muscles (Fig. 54)

Changing position

ipsilateral side Beginning of muscle End of muscle

Direction of displacement of places Dorso-lateral parts of the head - Acromial process of the clavicle -

attachments are predominantly caudo-ventral and cranio-dorso-medial.

concentric contraction slightly laterally. The muscle seems to curl up

muscles Nuchal ligament and spinous processes towards the acromion

upper cervical Ci-v - process.

predominantly ipsilateral and

slightly caudoventral.

Change in position of places Lateral displacement of the spinous clavicle The clavicle is displaced medially,
attachment of processes Ci-v leads to compression of the intraarticular disc

lateroflexion of the upper cervical sternoclavicular joint,

department relative to the cervicothoracic At the same time acromial
transition, but the process of the clavicle is slightly displaced

volume. This is due to the fact that cranial and dorsal

lateroflexion of the cervical spine relative to the acromion
occurs in combination with the process of the scapula,

synkinetic rotation in the same
side, and caudolateral
the direction of muscle pull causes them
counterrotation, violating this
synkinesis.

Ventral displacement of the cervical
vertebrae leads to straightening
cervical lordosis. In the same time
Caudal-ventral displacement of the occiput
leads to extension of the head
relative to the cervical region with
formation of local
hyperlordosis in the upper cervical
level.

Direction of center shift Head and upper cervical region - Acromyl end of the clavicle -
severity of the region ventro-ipsilaterally. dorsocranial.

Cervicothoracic junction and upper
thoracic region - dorso-contra-
laterally.

Changing position
neighboring regions

Associated dysfunctions
joints and ligaments

On the lower cervical and upper thoracic
department is formed “C”-shaped
scoliosis with convexity of the arch at the level
cervicothoracic junction in
contralateral side and
hyperkyphosis of the upper thoracic region.

Functional blocks of spinous

processes C|-v.

Hypermobility - cervical
cranial and cervicothoracic
transitions.

Shoulder girdle with the same name
the sides rise up and
moves back.

Functional block acromio-
clavicular joint.
Hypermobility - sterno-
clavicular joint.

Body position when
examination of the ipsilateral
sides

Origin of muscle

End of muscle

Front view

Side view

Back view

The head is displaced ipsilaterally.
The ipsilateral ear is displaced
forward, lowered and clearly visible, and
contralateral - shifted back,
raised and often its outlines are not visible.
The nose is displaced contralaterally.
The lateral contour of the neck is straightened.

The head is shifted forward.
The ipsilateral ear is displaced
ventro-caudal.

Cervical spine is displaced
ipsilateral relative
shoulder girdle, and the head is tilted in
ipsilateral side
relative to the neck. Wherein
the contralateral ear is displaced upward
and back. At the cranial level
cervical junction visible
transverse fold (sign
extension), on the cervical and upper
the thoracic level shows a “C”-shaped
scoliosis with convexity at the level
cervicothoracic junction in
contralateral side.

The shoulder girdle is rotated so that
ipsilateral shoulder girdle displaced
dorsally, reduced transversely
size and raised up.
The acromion process is displaced
dorsocranial. Side contour
bodies at its level forms
step-like deformation
sternoclavicular level
articulations. The relief is smoothed.

Acromial end of clavicle together
with ipsilateral shoulder girdle
displaced dorso-cranially. Cervical
lordosis is smoothed.

Increased convexity at the level
cervicothoracic junction and upper
thoracic spine.

Ipsilateral shoulder girdle
displaced dorsocranially and
reduced in transverse size.
Lateral contour of the neck and shoulder girdle
straightened. At the level of the acromion-
clavicular joint - local
bulging of the lateral contour.

2.13.4. Violation of the dynamics of the shortened upper portion of the trapezoid
muscle during its advanced contraction (Fig. 56)

Atypical motor pattern "Shoulder abduction"

Subsequence
muscle activation

Direction of movement
in the joints

Visual criteria

1. Upper portion
trapezius muscle.

Sternoclavicular joint -
contralateralflexion, external
rotation of the clavicle relative
shoulder blades.

Head - extension,
Cervical spine - anterior displacement,
ipsilateroflexion, counterrotation.
Shoulder joint - flexion,
adduction.

The patient lifts and rotates
outward to the scapula and collarbone along with
humerus.
At the same time it produces
ipsilateroflexion and counterrotation
head, moving it forward.
Next comes inflection
shoulder joint. On the cervical and
"C"-shaped scoliosis.

1. Deltoid
   (clavicular portion).
2. Supraspinatus muscle.

Atypical motor pattern "Extension of the head and neck"

Sequence Direction of movement
activation of muscles in joints

Visual criteria

1. Shortened top portion
trapezius muscle

Head - extension,
ipsilateroflexion, counterrotation.
Cervical spine -
anterior displacement,
ipsilateroflexion, counterrotation.
Sternoclavicular joint -
counterlateroflexion. Outdoor
rotation of the clavicle relative
shoulder blades.

The patient performs head extension
at the same time as her
ipsilateroflexia and
counter-rotation. Next is the cervical region
moves forward at the same time
performing ipsilateroflexion and
counterrotation.

The shoulder girdle rises up
along with the hand and shoulder blade and
rotates outward: On the cervical and
the upper thoracic region intensifies
"C"-shaped scoliosis.

1. Contralateral upper
   portion trapezoidal
   muscles
2. Back extensor

Characteristic

Origin of muscle

Dimon

Hello. I work out in the gym (but my work is sedentary). There have been cases when, after doing exercises on the muscles of the shoulder girdle, it was as if the left side of the trapezius was “shot”. Afterwards it hurt slightly, so I attributed it to a sprain and quickly relieved the symptoms with Diclofenac or Dolobene ointments. However, after the new year, discomfort in the area of ​​the left side of the trapezius began to persist for a long time: it could not bother during the day, but appeared in a certain position of the body, for example, when the left hand was pulled forward or down, expressed in the form of nagging pain. I tried to “feel” for the source of pain in the area of ​​the left side of the trapezius and near the spine, but to no avail. Therefore, I applied ointments over a fairly large area. Then the pain began to “radiate” behind the triceps of the left arm, and then in the forearm. I tried to use the ointment there too, tried to drink diclofenac and other painkillers - it practically did not help in those very “uncomfortable” positions of the body or hands. Afterwards, the nagging pain became somewhat weaker, but with the same positions of the body or arms, a slight numbness (tingling) began, and then cramps of the triceps of the left arm, the left pectoral muscle and the left side of the latissimus, and the force of the contractions was quite strong. The left side has become weaker. At that moment, they pointed out to me a possible pinched nerve in the cervical spine (the symptoms are similar, but the pain in the neck and arm was not constant). I don’t have the opportunity or time to go for a massage, but I try to massage the trapezius area near the spine on my own, I do head tilt exercises (I don’t experience any pain while doing it). The cramps have become smaller, the numbness is less frequent, and there is almost no pain. But I can’t tense my left pectoral muscle, as if partial atrophy has occurred. The essence of the question: how (ointment, medications, B vitamins, specific exercises) can I help recovery (final relief from pain, cramps, restoration of muscle tone)?

Hello! You need to see a neurologist to find out the cause of muscle atrophy, which occurs more often against the background of a lack of functional activity of the root (disc entrapment). Muscle atrophy is an indication for surgery for a disc herniation, but first you need to perform an MRI of the cervical spine and try to find a combined conservative treatment for you using modern medications and techniques. - Anti-inflammatory therapy (50 mg 3 times a day (suppositories - 2 times a day) Movalis 1t 2 times a day Nise 0.1 2 times a day) - Local applications (50% pp + novocaine 0.5% -10.0 + hydrocortisone 75 mg) - drugs that relieve muscle spasms: (Sirdalud 2 mg - 3 rubles per day Miolastan 100 mg - 3 rubles per day Botox 25-75 units intramuscularly, Baclofen 10 mg - 3 rubles per day) - Stimulation of microcirculation (Trental 0.4 - 3 rubles per day Teonicol 0.3 g - 3 times a day 1.0-6.0 i/m Actovegin 2.0 - i/m) - Antioxidant therapy (Tocopherol (Vit E) - 0.3 g per day Vitamin C 0.5 g per day (Tioctacid, Espalipon, Berlition) 0, 6g per day - 3-4 months Mexidol 0.125g - 3 rubles per day - 1 month or more).

Attachment places:

Initial: spinous processes from the 6th to 12th thoracic vertebrae

Final: medial third of the spine of the scapula

Function: rotation of the scapula, provides inferior stabilization of the scapula; helps maintain the spine in extension, retracts the humeral process

Synergists:

Stabilizers: upper trapezius muscle

Innervation: axillary nerve, anterior roots C 2,3,4

Neurolymphatic reflex:Front: 7th intercostal space on the left.

Behind: Between T7-8 near the plate on the left

Neurovascular reflex: 1 inch above lambda

Nutrients: spleen concentrate or nucleoprotein extract, vitamin C, calcium

Meridian: spleen, pancreas

Time of maximum activity: 9-11 o'clock

Organ: spleen

Emotion: care

Subluxation: Th XII-LI

Neurological tooth:

Option

I.P.P. Standing or sitting. Shoulder joint in position F/E - 0°, Abd - 130°, and maximum external rotation. The elbow is fully extended, the hand is in a neutral position. The shoulder blade is completely pressed against the chest.

I.P.V. – behind the patient's back. The stabilizing hand controls the movement of the scapula.

Contact point: lower third of the forearm.

Direction of influence: along an arc, caudo-ventro-medially.

Option

I.P.P. – lying down. The hand position is the same.

I.P.V. – on the side of the patient, on the side of the muscle being tested.

Contact point: there

Direction of influence: Same

Errors I.P.P.

1. shoulder in flexion – activation of the posterior portion of the deltoid, infraspinatus, and serratus anterior muscles; shoulder in extension – activation of other portions of the trapezius and rhomboid muscles

2. abduction less than 130° – activation of the middle portion of the trapezius, rhomboid muscles

3. External rotation is not performed or it is not complete – activation of the posterior portion of the deltoid, infraspinatus muscles

4. elbow in flexion position – activation of the MFC of the arm

5. the hand is bent or straightened - activation of the MFC of the hand

I.P.V errors

1. the doctor is in front of the patient - distortion of the direction of influence

2. no control of scapula movement (complete lack of stabilization or stabilization elsewhere) – distortion of test interpretation, activation of trunk muscles

Place of contact

1. contact of the hand or wrist joint – activation of the MFC of the hand (see figure)

Direction of influence

1. medial pressure – additional stabilization of the joint

2. pressure with a lateral component, cranially – additional stretching of muscle fibers

3. ventral pressure – additional stretching of the muscle, activation of other portions of the trapezius, rhomboids and levator scapulae muscles

4. caudal pressure – activation of the upper trapezius, supraspinatus, levator scapulae, and serratus anterior muscles

Rhomboid muscle.

Insertion: Rhomboid major muscle

Initial: spinous processes from the 2nd to 5th thoracic vertebrae.

Final: medial border of the scapula from the spine to the inferior angle.

Function: adduction of the scapula and slight elevation of its medial border. The lower fibers of the muscle contribute to the downward rotation of the shoulder joint cavity. As the arm abducts, the rhomboids relax and allow scapular abduction, then they contract and stabilize the scapula as it rotates and continues to abduct.

Insertion: Rhomboid minor

Initial: nuchal ligament, spinous processes of C7 and T1.

Final: medial border of the scapula at the root of the spine of the scapula.

Function: adduction and slight elevation of the scapula.

Synergists: all portions of the trapezius muscle, the latissimus muscle and the levator scapulae muscle.

Stabilizers: upper and lower portions of the trapezius muscle, levator scapulae muscle, back extensors, abdominal muscles

Innervation: dorsal scapular nerve, C4-5

Neurolymphatic reflex: anterior – 6th intercostal space, from the midclavicular line to the sternum on the left; posterior – between T6, 7, at the plate on the left.

Nutrients: vitamin A

Meridian: liver

Time of maximum activity: 1-3 hours

Organ: liver (sometimes stomach)

Emotion: anger, discontent, aggression

Subluxation:

Neurological tooth:

MFC – deep dorsal chain of the arm, spiral chain of the torso

Option

I.P.P. – Sitting. Shoulder in position E - 0°, Abd - 0°, Rint/ext - 0°). Elbow bent 140°, hand in neutral position. The patient pulls the scapula towards the spine and lifts it.

I.P.V. - standing at the patient's side, on the opposite side of the muscle being tested. The stabilizing hand stabilizes the shoulder and controls the movement of the medial edge of the scapula with the thumb.

Contact point:

Direction of influence: along an arc ventro-lateral.

Option

I.P.P. – lying on your stomach. The hand is in the same position.

I.P.V. – standing on the side of the couch, on the opposite side of the muscle being tested. The stabilizing hand stabilizes the shoulder and controls the movement of the medial edge of the scapula with the thumb.

Contact point: back of the forearm, just above the elbow joint

Direction of influence: along an arc ventro-lateral.

API errors

1. Shoulder in flexion – activation of the pectoralis major muscle, the anterior portion of the deltoid muscle

2. shoulder in internal rotation – activation of the pectoral muscles; in external rotation – activation of the latissimus and teres muscles

3. elbow flexed less than 140° - activation of the pectoralis major and latissimus muscles

4. holding your breath – activation of the deep MFC

5. the hand is bent – ​​activation of the anterior MFC of the hand; the hand is extended – activation of the posterior MFC of the hand; the hand is pronated – activation of the pectoralis major muscle; the hand is supinated – activation of the anterior superficial MFC of the hand.

6. shoulder raised – activation of the upper trapezius and levator scapula muscles

7. head in lateroflexion to the test side - activation of the scalene muscles and lateral MFC

IPV mistakes

1. The stabilizing arm does not control the medial angle of the scapula - distortion of test interpretation

2. the stabilizing arm does not fix the shoulder - activation of the upper trapezius and levator scapula muscles.

3. doctor on the side of the muscle being tested - changing the direction of influence

Contact location errors

1. Contact for olecranon - activation of the posterior MFC of the hand

2. contact for the middle part of the humerus - activation of the posterior MFC of the arm, a painful reaction is possible due to irritation of the neurovascular bundle

The trapezius muscle is a triangular, flat muscle that, with its wide base, faces the posterior midline and occupies the back of the neck and upper back. Its base faces the spine, its apex faces the acromion of the scapula. Together, both trapezius muscles on both sides of the back are shaped like a trapezoid. The upper bundles of muscles are shaped like a coat hanger.

Anatomy

Where is the trapezoid? The trapezius muscle is located on the surface.

It consists of 3 parts:

• the upper part is located in the neck area;
• middle - on top of the shoulder blades;
• the lower one is located between the shoulder blades and under the shoulder blades.

The anatomy is clearly visible in the photo and you can see where the attachment of the tendon bundles is located.

The tendon bundles of the trapezius muscle are short and run:

• from the external occipital protrusion;
• from the medial third of the superior nuchal line of the occipital bone;
• nuchal ligament;
• from the spinous processes of the seventh cervical of all thoracic vertebrae;
• from the supraspinous ligament.

From these places, the bundles are directed laterally, converging towards the center, forming a place of attachment on the bones of the shoulder girdle. The upper bundles go down laterally, the place of attachment is the posterior surface of the outer third of the clavicle.

The middle bundles run horizontally from the spinous processes of the vertebrae outward, the place of attachment is the acromion and scapular spine.

The lower bundles go upward laterally, transforming along the way into a tendon plate, forming a place of attachment on the scapular spine. At the level of the lower border of the neck, the muscle is widest.

At the level of the process of the 7th cervical vertebra, the muscles form a pronounced tendon area.

The upper trapezius muscle is exactly what people think of under the trapezius muscle itself. The upper part rotates and leads to the spine and also elevates/depresses the scapula (shrug) and assists with most movements of the neck and head. The top layer shapes and controls shoulder movements.

Slouching causes tension in the upper trapezius muscle in its stretched state. This leads to pain in the neck and headaches.

The middle and lower parts bring the scapula to the spine - the so-called. retraction of the shoulder blades.

Motor innervation of the trapezius is provided by the spinal portion of the accessory nerve. Innervation: accessory nerve and cervical plexus (C III - C IV).

Functions of the trapezius muscle

The trapezius muscle is responsible for several functions:

1. simultaneous contraction of parts of the trapezius brings the scapula closer to the spine;
2. contraction of the upper fascicles raises the scapula;
3. contraction of the lower muscle bundles lowers the scapula;
4. the upper and lower bundles, simultaneously contracting, rotate the scapula;
5. when contracted on both sides, the muscle extends the cervical spine and helps tilt the head back;
6. with unilateral contraction, the face turns slightly.

Pain in the trapezius muscle

Pain in the trapezius muscle is very common, because it is in this segment that stress points often arise.

The trapezius is called one of the most painful muscles: myalgia here, according to statistics, takes 2nd place, giving way to 1st pathologies manifested in the lumbosacral region.

The trapezoid consists of layers and fibers of different structures. Overstrain, spasm and weakness in these segments provoke painful sensations.

Causes of pain:

• muscle overstretching during training or sudden movement in a cold room;
• bruise or concussion;
• tendonitis, inflammation, myositis or the appearance of painful seals resulting from degenerative processes at the site of attachment to the cervical vertebrae;
• permanent trauma is associated with some monotonous professional movements of gymnasts, dancers or frequent wearing of heavy backpacks, it can cause swelling;
• static overvoltage typical for working positions of drivers and office workers. Scoliosis and other postural abnormalities can lead to this pathology;
• hypothermia can provoke myositis;
• stress and depression cause muscle strain, myositis;
• any muscle neuralgia may be accompanied by a headache.

In addition, pain and swelling can be caused by protrusions, herniated intervertebral discs, facet syndrome, neuralgia, and spinal contusion. The neuralgic nature of pain in fibromyalgia may be accompanied by sleep disturbances, morning stiffness in the neck, and the patient wakes up more tired than when he goes to bed.

Features of pain:

• aching character;
• subside only after a course of treatment;
• may be reflected upward, into the neck, into the back of the head, and a tension headache may be present;
• may limit neck and head movements;
• increase with pressure.

Symptoms of pain:

If the pain is localized in the upper layer, the person develops the following posture: shoulders raised up with the neck tilted towards the pain.

The patient turns his head, rubs the location of the pain. In these places, neuralgia of the facial nerve manifests itself in a similar way;

Pain in the middle layer is felt between the shoulder blades and intensifies when it is necessary to hold the item with outstretched arms;

The pain of the lower layer is manifested by pressing sensations in the lower neck.

Diagnostics

Diagnosis should exclude dangerous pathologies, radicular compression syndromes, and other symptoms. It is necessary to separate pain in the trapezius from similar symptoms of migraine and vascular diseases. Pathology is diagnosed by palpation, which helps to identify trigger points, hypertonicity and spasmodic areas. The spasmodic tissue feels like a dense cord along which pain points are located.

Near the spasmodic areas, swelling begins to develop, which compresses the closest nerve (usually the intercostal nerve) and muscle neuralgia develops, characterized by sharp pain. The muscle ceases to be innervated and ceases to produce the necessary movements. In this case, neuralgia goes away on its own as soon as the effect on the nerve of the spasmed muscle stops.

The doctor also collects anamnesis and finds out from the patient the relationship between pain and overexertion, hypothermia or a static posture.

To clarify pain symptoms more clearly, a muscle test is used:

1. The patient raises his shoulders up, and the doctor presses down on them while simultaneously palpating the muscles.
2. The patient pulls his shoulders back, and the doctor provides resistance while palpating the muscle.
3. The patient raises his hand and points it back, the doctor resists the movement and palpates the muscle.

All the information and symptoms obtained in combination make it possible to accurately diagnose the pathology.

Treatment

Treatment of pain in the trapezius muscle is, first of all, the use of manual techniques, including massage of the trapezius muscle. However, according to recent research, manual techniques only affect shortened muscles, which reduces pain, but does not eliminate the root cause of the disease. Over time, the pain appears again.

The mechanism responsible for the development of pronounced clinical manifestations of the disease is complex and multifactorial, therefore it is necessary to influence the disease from all sides.

When treating pain in the trapezius muscle, psycho-emotional correction should be carried out simultaneously, since in 85% of diseases myalgia is accompanied by a depressive state.

This could be aromatherapy, autogenic training, breathing techniques. Correction of vascular pathologies of the brain is carried out with nootropics and amino acids. Then manual therapy, acupuncture and massage for the trapezius muscle are prescribed. The patient should perform relaxation exercises himself in his free time.

To treat myofascial syndrome, it must destroy the pathological overtension in the trigger. The patient should avoid postures that provoke overload; the use of corsets to correct posture is recommended. If the pain is severe, lidocaine or other injectable painkillers are prescribed. According to indications, drug treatment with myelorelaxants is prescribed.

The effectiveness of the therapy depends on the earliest possible contact with a doctor and how responsibly the person treats the treatment.