Muscle Minute TUESDAY - Meet the Levator Scapula

Have you ever experienced a burning pain at the base of your neck, especially after you have been looking down at your phone or have carried a bag or purse on one shoulder for a prolonged period of time? Chances are you are experiencing the referred pain of an active trigger point in the levator scapula. It looks like a neck muscle and it lies at the core of a lot of chronic neck pain, but it’s greatest influence is on the scapula. Let’s dive in…

Origin	transverse processes C1-C4
Insertion	superior medial border of the scapula
Action	scapular elevation and downward rotation
Innervation	cervical n. (C3, C4) and dorsal scapular n. (C5)
Antagonists	lower trapezius, serratus anterior

The Real World Levator Scapula

The levator scapula is one of the key downward rotators of the scapula, along with the rhomboid and pec minor. Scapular downward rotation is often associated with rotator cuff tendonitis, as this position “pulls the chair out” (glenoid fossa) from under the humeral head at rest, requiring increased activity of the supraspinatus to stabilize the glenohumeral joint.

It also elevates the scapula, as its name implies. It is common to see scapular elevation on the involved side of cervical and shoulder pain. Do the mirror test. Stand in front of the mirror, close your eyes and wiggle your arms around to settle them into your neutral position. Now open your eyes. Is one shoulder higher? If you aren’t near a mirror, then ask yourself which shoulder do you usually carry a bag or purse on? That is your higher shoulder and chances are you have a levator scapula trigger point.

Remember, trigger points set up in muscles that are chronically short. Here is the trigger point chart for levator scapula:

This study compared three groups of people with chronic neck pain: a neck exercise group, a scapular exercise group, a combined exercise group and a control. Results showed that patients with chronic neck pain benefitted most from neck therapy exercises COMBINED with scapular exercises and the only two stretches included in the study were a stretch to levator scapula and pec minor (included in the scapular exercises). They didn’t include a group that just did the scapular exercises, but if they did, I bet they would have come up with favorable results.

If you google “levator scapula stretch” you will get proof that the internet is not always right. In fact, I found only a couple of sources that demonstrated a correct levator scapula stretch, which should include arm elevation to upwardly rotate the scapula.

If you are a clinician, check out this method to release levator scapula. I can appreciate the use of the practitioners forearm pronation combined with passive opposite rotation of the neck to stretch the fascia and muscle in one move.

Here’s a short list of why this matters:

Trigger points in levator scapula can cause neck and shoulder dysfunction
Trigger points in the levator scapula will weaken (inhibit) the lower trapezius and serratus anterior, key muscles in arm elevation.
Exercises should include stretching of levator scapula and activation of the lower trapezius and serratus anterior. (Hint: press your arms overhead and you will activate both of these muscles).

Conventional thinking says: If you have neck pain, you should do neck exercises.

Real World Thinking says: Most chronic neck pain is associated with abnormal scapular position and one of the key muscles to consider is the levator scapula.

Because nobody has time to be in pain.

Until next time…