The levator scapulae (luh- VAY- ter SCAP- yuh- lee) is another hardworking muscle that everyone has trouble with. “Levator” is from the same Latin root as “elevator.” “Scapula” is Latin for “shoulder blade.” The name tells its job: it lifts the shoulder blade. (In common usage, “levator scapulae” is often pronounced as though it were spelled “levator scapula.”)
Symptoms
Trigger points in levator scapulae muscles cause pain and stiffness in the angle of the neck and upper back (figure 4.20). When sufficiently active, they also refer a lesser degree of pain along the inner edge of the shoulder blade and to the back of the shoulder (not shown). A levator scapulae trigger point is what keeps you from turning your head to look behind you when you’re backing up in your car. You may not be able to turn your head at all toward the side that has the trigger point. Turning your
head to the opposite side may also cause pain (Simons, Travell, and Simons 1999).
Causes
The lower end of each levator scapulae muscle attaches to the inner edge of the top angle of the cor- responding shoulder blade. Its upper end attaches to the sides of the top four neck vertebrae (figure 4.20). This arrangement allows the levator scapulae to help raise the shoulder blade and thereby raise the shoulder. This function is the very one that gets the muscle into trouble. When stress and bad posture habits keep your shoulders up, you can be sure that the levator scapulae muscles are doing much of the work.
Figure 4.20 Levator scapulae trigger points and referred pain pattern
A detailed description of how to use the ball-against-the-wall technique is included in chapter 8, in the treatment section “Superficial Spinal Muscles.”
Chapter 4—Head, Face, and Neck Pain 73
Many things can make trouble for the levator scapulae, including sleeping on your side without support for your head, typing while looking at your copy out to one side, sitting in a draft of cold air, and holding the phone clamped between your head and shoulder. Backpacks and purses suspended from shoulder straps are as bad for levator scapulae muscles as they are for the trapezius. Both have to stay strongly contracted to counter the downward pull.
Levator muscles are also stressed by overexercise, emotional tension, and armrests that are too high or too low. The levator is one of many muscles that are strained by whiplash. Trigger points set up by an auto accident or a fall can persist undetected for years, the unknown sources of chronic pain and disability (Simons, Travell, and Simons 1999).
As a pair, the levators serve as a checkrein for the head when it hangs forward. They are consequently severely abused by habitually carrying the head forward. Levator scapulae and trapezius muscles can be strained beyond endurance by habitually reading with your book or e- reader flat on the desk, since all the muscles of your neck and upper back have to remain contracted all the time your head is hanging forward in that position. Prop your book up with a couple of other thick books when you read so you can keep your head up. E- readers really need an acces- sory such as an incline case that will allow the device to be used at an angle. Several styles of book stands can be found in any college bookstore or online. Habitually interacting with a cellphone or smartphone held at chest level will also wear out your levator scapula muscles. Periodically lift your shoulders up toward your ears and then stretch them down to allow these muscles to fully contract and then stretch. This will help avoid trigger points when your smartphone is too much fun to put away.
Treatment
The most accessible levator scapulae trigger point is located just above where the muscle attaches to the upper angle of the shoulder blade. To find this place accurately, you must first be able to locate the upper, or superior, angle. To feel the superior angle move under your fingers, place the heel of your hand on your opposite collarbone (see figure 5.11). Let the fingers lie relaxed across the top of your body. Glue the hand here and don’t let it move down your back. Now swing your free arm loosely forward and back. As you do the movement, you will feel the underlying superior angle of the shoulder blade bump up under your index or middle finger. Using your hand, you won’t be able to effectively massage the trigger point that is located just above the angle here. To be most successful, use a Thera Cane, Backnobber, or other hook- type tool. Replace your fingers at the superior angle for the knob on the hook end of the tool. Apply pressure or do a tiny moving stroke across
the sore trigger point found just above the angle. See figure 4.21 for the hand position and figure 4.22 for specific treatment of the lowest levator scapulae trigger point. A description of how to use the cane tools can be found in the treatment section of trapezius number 2 above.
Unfortunately, the lowest trigger point in the levator scapulae isn’t the one that causes most of the trouble. It is good to work this spot, but it may not get rid of all your neck pain and stiffness. The middle (central) trigger point is an important one to go after. It can be found at the base of the neck just in front of the upper trapezius. Reach across the front of your neck with your opposite hand. Place your fingertips right in the middle of the angle where the neck meets the body. Press your middle finger into the base of your neck just in front of the trapezius, which is the big muscle you can feel contract when you raise the shoulder. If you strum forward to back here, you might feel a tight rope of muscle going up the side of your neck. Press this rope- like band into the underlying transverse process (side of the underlying vertebrae) at the very base of the neck. If you don’t find it at first, allow for a careful search for this very tiny point. It may surprise you that the knobby hard bumps there under your fingers are the bones of your
neck. You won’t likely feel knots, only tight muscles and bone. You can Figure 4.21 Position of hands and Thera Cane for treating upper back muscles
massage this point with your fingertips. Support the tool hand with the other hand for additional pressure. A Thera Cane or Backnobber also works well (see figure 4.23). If you don’t have a hook- type tool, lean forward against a door frame or convex corner to place the ball on the top of your shoulder (figure 4.17). Leaning into a ball on a wall behind you also works for the lower point. Don’t neglect the highest trigger point, high on the side of the neck, just behind the top of the sternocleidomastoid muscle. Work it with supported fingers or a hook- type cane.