(3) Quick Self-Tests to Tell if You have Trigger Points in Your Upper Trapezius: Follow the instructions below to get a good idea of whether myofascial trigger points might be setting you up for a headache.
TEST 1: Head Rotation
Standing or sitting upright, turn your head to the side as far as you are able without straining or causing pain. A Passing result is when the head turns without pain far enough so that the nose is over the shoulder (80-90 degrees rotation, as shown). A Failing result occurs when the head is unable to rotate far enough or there is pain while trying to turn the head.
TEST 2: Lateral Flexion
Standing or sitting upright, tilt your head to the side (lateral flexion) as far as you are able without straining or causing pain. Do not elevate the shoulder while performing this test. A Passing result is when the head tilts to the side without pain far enough so that the ear is almost touching the shoulder (over 45 degrees of lateral flexion, as shown). A Failing result occurs when the head is unable to tilt at least 45 degrees or there is pain on lateral flexion.
TEST 3: Upper Trapezius Palpation
As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points in your Upper Trapezius muscle.
The Trapezius is divided into 3 parts on either side of the spine: Lower Trap (Red); Middle Trap (Orange); and Upper Trap (Green). The specific trigger point that causes the question mark pain pattern is in the Upper Trapezius, indicated by the blue “X”, also known as TP1.
To palpate TP1, place 2 fingers on the top of your shoulder near the base of the neck, approximately where your t-shirt collar would start. The muscle under your fingers is the Upper Trapezius. Now, slide your finger forward falling slightly off the Upper Trapezius and then push backward, down and in at the same time. Check for tenderness and tight bands of muscle tissue.
Also, take note of any Referred Pain, especially pain that occurs in the head along the “question mark” pattern. Tenderness, taut bands and/or referred pain into the neck or head are indications myofascial dysfunction that needs to be treated.
3-Step Simple Self-Care Remedies
The myofascial health of your Upper Trapezius Muscle is in your hands! If any of the tests above were positive for myofascial trigger points, the following self-care instructions can benefit you significantly. Spending a few minutes a day can reduce head pain, as well as improve the structural health of your neck and shoulders.
Step 1: Warming Up with Moist Heat (very important for headaches!)
The taut bands of muscle (trigger points) in your Upper Trapezius often relax and head pain is greatly reduced when applying moist heat to the neck and shoulders. A warm shower can help. In the picture below, the woman is lying on a warm water bag. If lying on moist heat such as this, place the filled bag underneath the upper back, neck and head. Make sure the back of the head is supported, preventing the neck from extending backward.
Step 2: Compression
You can use your hands to compress trigger points in your Upper Trapezius, but there are some self-care tools that are helpful in reaching hard to reach spots and giving you more leverage and comfort. The self-care tool demonstrated here is call a Backnobber.
Hold the middle of the Backnobber with one hand and one end with the other. Press the ball of the Backnobber into TP1 with enough pressure to feel the tenderness but not cause you to withdraw from the pain. Hold for 10 seconds while completing at least two full breaths in and out. You may continue searching for more tender areas along the Upper Trapezius.
A very effective technique for treating the Upper Trapezius is to combine stretching with compression, as shown below.
Perform the same compression, only with the head tilted to the other side. You may also rotate the head toward the same side for additional stretch.
There are also 2 more sets of trigger points that can be helpful in relieving head pain.
The first is located in the Lower Trapezius, as shown. President Kennedy’s physician, Janet Travell, called this point “The Joker” because it would cause headaches indirectly by activating TP1 in the Upper Trapezius, which would then refer pain to the head. The second point is located at the top of the neck where the Upper Trapezius inserts into the base of the skull. This point is also commonly involved in headache pain.
Treat both points using the Backnobber as you did TP1. You may do so lying down to reduce tension in the upper trap, especially if you are experiencing acute headache.
Lower Trap Upper Trap Insertion
Step 3: Stretching Your Upper Trapezius
Stretching while experiencing a headache may be counter productive and aggravate your symptoms. Stretching is better performed when there is no acute headache after performing the heat and compression steps. Simply stretch the Upper Trapezius by placing it in the Head Rotation and Lateral Flexion test positions shown previously and hold for 20 – 30 seconds to tolerance. Perform 2 sets of each stretch on each side. If there is any aggravation of symptoms, return to heat and compression and leave stretching for another day.
A number of perpetuating factors can reactivate Upper Trapezius trigger points, which is why alleviating headaches can be a tricky business in some cases. Avoiding heavy shoulder bags, using earphones instead of holding your phone to your ear, and making sure your posture is correct are good places to start. Other perpetuating factors you may need professional assistance with. A qualified trigger point therapist would be able to evaluate you and help you to resolve any of the following:
- Foot hyperpronation / Morton’s Foot
- Leg length inequality (either muscular or anatomical)
- Small hemi-pelvis
- Poor work or driving ergonomics
- Poor sleeping position