Anatomy of an Injury: When Pain isn't the Problem

I woke up last Saturday with a sharp pain in the middle of my back. After four days of Jennifer digging her elbow into my left lower trapezius to work out an enormous knot, I had nothing to show for it but a slight bruise and a stiff, painful, and very persistent spot of tension in the muscle. So instead, I performed a quick ART release to the upper trap, and a day later I'm feeling 100% better.

Huh?

When a strain persists even after treating the area of the muscle tension, chances are that the strain is a result of something else, and not a direct trauma to the tissue itself. In my case, Jen and I had just made the trip up to Boston to visit with her brother and his family, and 4 hours in the car doing little more than sitting probably affected my posture in subtle ways. Because treatment to my lower trap, where I was feeling the pain, wasn't actually resulting in any long-term relief, I looked in other directions.

Normally, the first place that I would look would be for an underactive synergist (muscles that would assist in the actions of the lower trap). However, I didn't injure myself from a sport or exercise...I injured myself from driving and then sleeping wrong! I can't believe that I just admitted that. Anyway, another possible place to investigate could be in an overactive antagonist (muscles that opposes the actions of the lower trap). There is one muscle, in particular, that can do both: the upper trapezius.

The upper trap will work in combination with the serratus anterior and lower trap to produce upward rotation of the scapula/shoulder blade (the action that occurs to your shoulder blade when you raise your hand overhead). The upper trap will also oppose the lower trap's ability to depress (lower) the scapula by elevating it. If the fibers of the upper trap were stiff (from driving with an elevated shoulder for 4 hours, for instance), this would do three very important things: first, it would keep the shoulder blade in an elevated, lifted position, causing the lower trap to be weaker and over-excited as the body attempted to re-stabilize the normal position of the shoulder blade. Secondly, it would also weaken the upper trap's ability to assist in upward rotation, leaving more of the burden on an already weakened lower trap. Lastly, my ability to stabilize the shoulder blade during any motion would be severely compromised as two very important muscles would be weak and ineffective in resisting unwanted movement of the scapula.

Sure enough, when I examined the muscle texture of my upper trap close to the neck, there was a second palpable mass of tension (technically, called a "trigger point"). As might be expected, there was also increased tension in my levator scap, an antagonist muscle in not only scapular elevation but in downward rotation of the shoulder blade as well (therefore directly opposing two of the lower trap's three actions: scapular rotation, depression and retraction).

After clearing the muscles with a few ART treatments, my shoulders were finally able to relax, and my lower trap returned to its normal resting length and alleviated the pain. A little bit of soreness from four days of tensing the muscle was all that was left.

When we feel persistent aches and pains in our muscles, our body is trying to tell us something. Often enough, the pain or discomfort that we feel is only a sign that something is going wrong. Like a detective in a mystery novel, a therapist should be able to follow the clues and discover the true cause of the problem and correct it so that it is permanently addressed.

-Jonathan