Generality
Generalities of the trapezoid
The trapezius contracture is one of the most common muscular discomforts, both among sportsmen and sedentaries.
It is often perceived as a tension, which can generate tenuous and continuous pain, tendentially acute during certain movements. It is not difficult to treat but, in some subjects, it tends to recur with a certain frequency. If you are interested in the upper part it is commonly called "torticollis", but if it concerns the lower part it is also vaguely defined as "back pain"; however, it represents the most frequent cause of pain perceived in the cervical area. To better understand everything related to this muscular discomfort, it is necessary to "dust" what concerns the functional anatomy of the trapezius.
Did you know that ...
By contracture is meant a hardening of the muscle fibers, often of whole bundles, which "undulate" above all due to a pre-stretching due to a discontrolled movement or to a pre-existing condition compromised - inflammation, poor flexibility, coldness etc. By definition it does not foresee a serious damage to the muscle fibers, but without inflammation there would be no pain, which instead characterizes this type of injury. It is however less severe than muscle stretching and muscle tearing.
Trapezoid - also called "trapezius" or "trapezoid" or "spinotrapezio" - is the name of two large striated symmetrical muscles of the superficial loggia, respectively one on each side, which are placed in the upper portion of the back - by touching two axes, it goes from the nape at the end of the chest, and from one shoulder to the other.
The trapezoid extends:
- Longitudinally downwards, from the occipital bone of the skull to the lower thoracic vertebrae of the spine
- Laterally, from the spine to the height of the scapula.
The trapezoid has the function of moving the shoulder blades and supporting the arms .
From the biomechanical point of view, the trapezoid consists of three parts with respective functional capacity:
- Upper part (descending) supporting the weight of the arm
- Median region (transverse) that portrays the scapula
- Lower part (ascending) that rotates medially and depresses the scapula .
The trapezoid name derives from the typical quadrilateral or diamond shape of the two segments; being positioned specularly, in axis with respect to the vertebral column, these take the form of a "rhombus".
For more information on trapezius generalities, before reading the paragraphs concerning the specific muscle contracture, consult the following paragraphs on functional anatomy, function, innervation and dedicated exercises.
The trapeze is massively recruited in the execution of the throws. In the weight room he is trained above all with the clean, but as we will see it is a practice that is actually not very specific. In bodybuilding, the entire trapeze helps to structure the regions aesthetically: high back, shoulders and neck.
Curiosity
Many bodybuilders, including the eight-time "Mr. Olympia" winner Ronnie Coleman, perform a maneuver known as "trap slap" - short for "trapezius slap" - before lifting particularly high loads. This technique requires the intervention of a "spotter" - training partner - who slaps the upper back of the lift, with the effect of mentally preparing him for impending lifting. The most common variant of the trapezius slap is the "lat slap" - abbreviation of "latissimus dorsi slap" - used above all if the area of the trapezoid is inaccessible - ie during the classic back squat.
Symptoms and Causes
Symptoms and causes of trapezius contracture
That of the trapezius is one of the muscular districts most involved in contractures. Many, among professionals - especially physiotherapists - argue that the trapezium is probably the most common contracture, with greater incidence in sedentary people, overweight and, secondarily, in athletes who use explosive and / or elastic force, or the rapidity in movements in all its expressions - maximum speed of execution, resistance to speed or to fast force, etc.
In fact, the trapezius contracture seems to occur especially in subjects who have not properly developed this and / or other related muscle districts in the same movements. Contributing in a decisive manner to the maintenance of posture, especially of the upper portion of the body - neck, shoulders, high back, etc., participates not only in the kinetic chain of the walker and the runner, but also of those who "stand" at the desk to write with the computer.
The incidence of the trapezius contracture is therefore negatively correlated to the level of desirable physical activity, but more precisely to the non-competitive motor activity or however performed within the limits of reasonableness. A positive link with age is shown, ie there are more cases of trapezius contracture in adults than in growing subjects, and in the elderly compared to adults. On the contrary - in the context of the specific population - this correlation seems to be reversed in elite athletes. The severity of the trapezius contracture, on the other hand, is positively correlated with the intensity of the motor activity and with the use, as we have said, of the maximal force, of the explosiveness, of the expression of elastic force and of the various forms of speed.
Still in the sports field, but the same is true for those who carry out heavy work activities - therefore in the absence or lack of automation - those who do not warm up sufficiently, or who immediately engage in intense efforts and are more interested in the trapeze. discontrollati.
It is important to remember that, especially in the fitness field, the lack of technical knowledge very often leads instructors, coaches and therefore their students / users to make gross mistakes. In this case, just in the attempt to prevent the trapezius contracture, there are several people who try their hand at stretching - exercises to improve muscle flexibility, including the sheaths and to a small extent the tendons - and in joint mobility - exercises to improve the joint mobility - totally cold. While these protocols, carried out warmly and adequately, could contribute to reducing the incidence of trapezius contracture, on the other hand, carried out cold or recklessly, they are a certain cause of muscle injury.
Often misinterpreted or generalized with pseudonyms of torticollis or back pain, trapezius contracture can easily be caused by chronic postural and / or imbalance problems. They generate specific muscular tensions, sometimes latent and undervalued, which, exacerbated by sudden "cold" movements, tend to become more acute when they become inflamed. Many overlook the importance of sleep; today it is impossible to establish the etiopathological role of an inadequate mattress or net, but it is instead absolutely certain that an incorrect nocturnal position can promote the onset of the trapezius contracture.
The external and, consequently, muscular temperature of the district also plays its part; however, it is difficult to establish how the classic "blow of air" can affect the onset of the trapezius contracture, but we cannot certainly ignore the multitude of cases in which patients report having been injured after exposure to cold temperatures, above all after sweating or getting wet.
In more severe cases, which more often involve the lower or descending portion of the trapezius, these can cause the so-called "chronic cervical syndrome".
Diagnosis
Trapezius contracture diagnosis
Without pulling it too long, the trapezoid contraction is characterized above all by:
- Localized pain but not highly specific, almost always tenuous and continuous, intensified by the movements that recruit the fibers concerned
- Sensation of stiffness, tension and hardness of the fibers involved, objectively verifiable by touch, which aggravates the pain.
The diagnosis or recognition of the condition should be made by a specialist, then by a physiatrist - to whom the GP will refer the patient - or a physiotherapist. The objective examination is almost always sufficient and adequate; any aids such as imaging (for example, ultrasound) can be used for differential diagnosis.
Always these figures will treat and treat the trapeze contracture, while a good sports technician (motor scientist) will have the role of drawing up a preventive program to limit relapses in the future; no rehabilitative or post-rehabilitative procedures are necessary.
Care and Treatment
Treatment and treatment of trapezius contracture
Unlike injuries in which it is necessary to obtain a vasoconstriction to limit blood flow and edema - severe strain but above all tear - in the trapezius contracture it is not recommended to use cryotherapy (cold therapy, in this case in the form of compresses). On the contrary, many benefit from trying to "dissolve" the contracture by keeping the trapeze warm, or even warming it up with a hot water bottle.
The remedies are the same as those used against other types of muscle contracture. If the pain, which generally does not exceed the average intensity, becomes difficult to tolerate, it may be necessary - under advice or medical prescription - to take anti-inflammatory painkillers from the NSAID group; steroid substances are not recommended. The lighter products are for topical use, in gel or other spreadable forms, but in some cases it is preferred to associate them with the systemic ones for oral use.
There are also specific medical therapies, which are generally manipulative for muscle relaxation. A physiotherapist should always perform them, since, although of a minor entity, they are in any case of an accident. Being massaged by a person who does not have the right knowledge, the risk is that of being able to get worse - without considering that only a competent figure is capable of making an adequate diagnosis.
When a sportsman is suffering from a trapeze contracture, it becomes necessary to impose a minimum stop of 3-7 days. It is then advisable to reactivate the muscles in a gentle, progressive manner and maintaining an aerobic cellular metabolism; Aerobic warm-up, general activation, mobility exercises and flexibility are therefore a real boon.
Nutrition does not play a decisive role, even if there is a doubt that a malnourished person may have greater muscular suffering and therefore a greater chance of encountering injuries. On the other hand, overweight subjects, especially obese, have a very high possibility of muscle injury, including of course the trapezius contracture.
Prevention
How to prevent trapezius contracture?
It is soon said. It is enough to respect the list of "things to do" and that of "things not to do". So far we have seen the factors involved in the onset of the trapezius contracture and those necessary for its treatment. We will now highlight the most important elements:
- In case of obesity, restore normal weight
- Correct postural failure and optimize position during work
- In sedentary subjects, progressively commencing the desirable motor activity, preferably in a promiscuous (aerobic and anaerobic) type and with complex, multi-articular gestures
- Avoid burning the stages of training progression; respect recovery times and super compensation
- Avoid moving cold - including stretching and joint mobility - or skipping the activation or approach phase to more intense movements
- Taking care of sports techniques, especially in the disciplines of strength, speed, explosiveness and elasticity
- Develop a protocol to improve muscle flexibility and general joint mobility, with particular reference to the upper back, neck and trapezius
- Improve sleep, both in position and in the choice of pillow, mattress and net - without, however, falling into commercial fishing
- Cover yourself properly and avoid exposure to drafts if your clothes or skin are wet.
Anatomy
Trapezium anatomy
- The upper or descending fibers of the trapezius originate in the spinous process of the seventh cervical vertebra (C7), in the external occipital protuberance and in the medial third of the superior nuchal line of the occipital bone (both behind the head), and in the nuchal ligament. They then proceed downwards and laterally, to fit into the posterior edge of the lateral third of the clavicle.
- The medial or transverse fibers of the trapezius originate medially and superiorly from the spinous process of C7 (in the back of the neck) and from the spinous processes of the first, second and third thoracic vertebrae (T1, T2 and T3). They then insert into the medial margin of the acromion and into the upper lip of the posterior margin of the scapula spine.
- The lower or ascending fibers of the trapezius originate from the spinous processes of the remaining thoracic vertebrae (from T4 to T12). They then proceed upward and laterally converging near the scapula and ending in an aponeurosis that slides on the smooth triangular surface at the medial end of the vertebral column, to fit into a tubercle at the apex of this smooth triangular surface.
At its occipital origin, the trapezius is connected to the bone by a thin fibrous lamina, firmly adherent to the skin. The superficial and profound epimysium are continuous; the deep fascia invests the neck and also contains both sternocleidomastoid muscles.
In the center, the muscle is connected to the spinous processes by a broad semi-elliptic aponeurosis, which goes from the sixth cervical to the third thoracic vertebral and forms, with that of the opposite muscle, a tendinous ellipse. The rest of the muscle arises from numerous short tendinous fibers.
You can feel the muscles of the upper trapezoid become active by holding a weight in one hand in front of the body and, with the other hand, touching the area between the shoulder and the neck.
innervation
Trapezium innervation
The motor function is provided by the accessory nerve - the XI pair of cranial nerves, which has both a cranial and a spinal origin. The sensitivity of the trapezius, including pain and proprioception, travels through the ventral branch of the third (C3) and fourth (C4) cervical nerve. Being a muscle of the upper limb, the trapezius is not innervated by the dorsal branches, although it is positioned in the external loggia and in the posterior part.
Function
Motor function of the trapezius
The trapezius muscle contraction can have two effects:
- Shoulder movement, when spinal origins are stable
- Spinal column movement, when the shoulder blades are stable.
Its main function is to stabilize and move the scapula .
Scapular movements of the trapezius
The upper and lower fibers rotate the scapula around the articulation of the sternoclavicular so that the acromion and the lower angles move upward and the medial border moves downwards. This rotation takes place, substantially, in the opposite direction to that produced by scapular elevators and rhomboids.
The medial fibers retract the scapula.
The upper and lower fibers also work in synergy with the anterior serratus muscle to rotate the shoulder blades upwards, as during a distension above the head. When activated together, the upper and lower fibers also support the intermediate fibers - along with other muscles such as the rhomboids - with scapular retraction / adduction.
Spinal movements of the trapezius
When the shoulder blades are stable, a co-contraction of both sides of the trapezius can extend the neck.
Exercises
Trapeze exercises
It is a common belief that the upper portion of the trapezius can be developed by raising the shoulders. This is only partially true, in the sense that the muscle certainly enters in contraction, but not in a primary way; most of the work is actually performed by the scapula lifts and rhomboids. However, the most commonly suggested exercises based on this movement are the clean, especially the hang clean .
The central fibers of the trapezius develop mainly by adducing the scapulae - a movement that also recruits the upper and lower fibers (so to speak).
The lower fibers can be developed by pulling the shoulder blades downwards, keeping the arms almost straight and taut.
The trapezoid is mainly used in the movement of the launch, in synergy with the deltoid muscle and the entire rotator cuff.
