The Levator Scapulae
The levator scapula, or as I will refer to it…levator scap, runs from the upper cervical spine (neck) to the scapula (shoulder blade). As you can imagine by the name, its main function is to elevate or lift the scapula. The plural of levator scapula is levator scapulae. So if you shrug one shoulder, you are activating the levator scapula. If you shrug both shoulders simultaneously, you are activating the levator scapulae. When the neck is fixed, the levator scap elevates and rotates the shoulder blade. When the shoulder is fixed, it rotates and bends the neck to the side. Do it with me! Turn your head to one side then drop your nose towards your hip. Congratulations!!! You just used your levator scap!
Trigger points seem to be the biggest problem I am faced with in practice. The patient typically presents with pain at the base of their neck or just above their shoulder blade. Once you know all the different causes of a trigger point here, you will understand why!
1. Whiplash. When you are involved in a car accident, your head is whipped in many different directions. The most forceful depends on where the impact occurs. When the head is thrust in an unnatural direction with such force, the levator scap tries to counteract that force and becomes injured, creating trigger points. The same type of injury could occur from a hard fall as well, such as diving for a baseball, landing wrong on a trampoline, etc.
2. Sleeping on your stomach with your head turned. As a chiropractor, I must say that sleeping on your stomach is the worst position for your spine in general because it increases the lordosis or extension of the lumbar spine which leads to back pain and, since you can’t sleep with your head in a neutral position face down, you have to turn your head one way or the other. This is where the levator scap comes into play. Turning your head and bending sideways into the pillow activates that muscle for as long as you’re in that position, thus causing a trigger point to form from overuse.
3. Working at a computer. Ergonomics play a large role in the protection of the levator scap. If you are using a computer for long periods of time and have to turn your head to do so, you are overusing the levator scap. So make sure that the computer is directly in front of you. Also, if the computer screen is below your eye level, it causes a prolonged flexing of the neck which over stretches the levators adding to the problem. Propping the screen up to eye level is recommended to prevent this.
4. Holding a phone between your shoulder and head. Many office jobs involve you being on the phone while still requiring the use of both hands. This leads to the quintessential held tilt and shoulder hike to hold the phone. Both of those actions activate the levator scap and when the phone conversation continues for long periods of time, the muscle suffers…and frankly so do you. It is highly recommended to switch to a wireless headset if your job requires you to multitask while talking on the phone.
5. Carrying a heavy bag on one shoulder. Do you travel by plane and refuse to pay the ridiculous prices to check your bags? I know I do! This leads to cramming tons of stuff into one bag and for a lot of people that is a duffel bag or another bag without wheels. Carrying that overstuffed bag through the airport and while waiting in the dreaded security line causes a downward force on that shoulder thus overstretching the levator scap. Do yourself a favor…invest in a rolling carryon!
6. Emotional and mental stress. This one is very common. When you’re feeling stressed, where do you hold that stress? For me, and frankly most women, it’s in the shoulders. The more stressed we get, the closer our shoulders get to our ears. It really is a subconscious thing, but I often find myself in this posture and have to actively relax my shoulders and take a deep breath. So if you’re like me and can’t wear dangly earrings because they catch on your clothes, take stock of your posture and shoulder position a few times today and notice the release of tension through the neck and shoulders.
7. Using crutches that are too tall. This one is close to my heart as well, as I am less than 4 weeks from yet another knee surgery. Luckily for me, I have my own trusty set of crutches that I’ve used for years so I know they are fitted well. But not everyone is as lucky…or maybe unlucky…as I am. So keep in mind when you are purchasing crutches that the top pad shoulder not rest directly in the armpit when standing. The pad should be a few inches below and the hand grip placement should be at a height where the elbows are slightly bent when standing straight up. If the crutches are not fit properly, the tendency is to shrug your shoulders to support yourself during use. Having them fit by a professional will eliminate a lot of that overcompensation and make the use of crutches more comfortable.
There are a few easy ways to treat these dreaded trigger points. The first is moist heat. Applying moist heat to the back of the neck and top of the shoulders helps to relax the muscle tissue and stimulate blood flow to the affected area which promotes healing. Doing this for 15-20 minutes is all you need. After you heat, move on to stretching. As you can see in the picture on the left, to stretch the levators, turn your head away from the affected side and drop your nose toward the hip on that side. Apply light downward pressure as shown and hold for 6-10 seconds. You want to feel a light stretch without pain. If you feel pain, back off on the stretch. Make sure to stretch BOTH SIDES!!! If heat and stretch doesn’t seem to quite help enough, self-myofascial release is always a great alternative. As shown in the picture on the right, placing a tennis ball under the affected shoulder while lying down can help apply pressure to the trigger point which helps to release it. You can also perform this technique standing against a wall. Doing self-myofascial release for 1-3 minutes on each side 3 times a week can help relieve chronic tension in these muscles. Lastly, seeing your chiropractor will definitely help relieve pain associated with these muscles. Not only can we do different myofascial release techniques, we will adjust the neck and upper back to make sure the spine is aligned and there isn’t added tension on the muscles do to misalignments of the spine. Also, the adjustment will relieve pressure and irritation on the nerve that innervates the muscles allowing them to function properly. At Pro Chiropractic, we also offer corrective care to restore the natural curvature in the neck and reduce forward head carriage that can irritate the levators.