Proximal attachments: External occipital protuberance, nuchal ligament, spinous processes of C1-T12.
Distal attachments: Spine of scapula, lateral 1/3 of clavicle.
Action: Flexion of the head and neck ipsilaterally, elevation of the shoulder. Scapula retraction, depression of the scapula, upward rotation of glenoid fossa.
Palpation: one of the most prominent muscles for trigger points. Using the pads of the fingers, start at the superior nuchal line, then move to the angle of the neck, on to the lateral edge of the clavicle, down to the spine of the scapula and inferiorly to T12.
Pain pattern: Upper trigger points: Temple pain, pain behind the ear and postero-lateral aspect of the neck (headache).
Middle fibers: Scapula, vertebral and posterior shoulder pain.
Lower fibers: Supra or inter-scapula regions.
Needling Technique: Patient is positioned prone for needling the posterior portion of the trapezius, however will be supine when needling the anterior portion of the trapezius. Grasp the trapezius muscle between thumb and index/middle with a pincer grip, this is important for ensuring that you do not pierce the apex of the lung causing a pneumothorax. It is best to try and position the trigger point between the thumb and fingers therefore isolating it and stopping movement of that small area of muscle. This allows the practitioner to isolate and accurately needle the area. Always direct the needle in a manner so as to needle between the fingers and not toward the apex of the lung.
Causative or perpetuating factors: overloading in lateral flexion of the neck and head. Hunching of the shoulders, whiplash.
Associated trigger points: Supraspinatus, opposite Trapezius, Levator Scapulae.
Stretch exercises: sit on a chair, hold the underside of the chair with the right arm, lean towards the left with the body, and laterally flex the neck to the left. This will stretch the right trap. Hold for 30 seconds, repeat 5 times on each side.