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I have a way of knowing when my neck nerves are ramped up and my neck stabilizers are off line. My left upper trapezius muscle gets tight. This is a super common thing and most patients believe it has something to do with the actual muscle. So they stretch it and stretch it, only for the tightness to come right back. What if this was due to something else?

The Trapezius Muscle

The trapezius, or trap, muscle lives in the top of the shoulder and connects the shoulder blade and thoracic spine to the head. It’s a large, major muscle of the upper back, and it helps stabilize the shoulder blade. Weightlifters can experience tightness in this muscle while doing exercises such as lifting deadweights or benching, but trap pain when lifting isn’t the only manifestation of the problem. Anyone can have pain and tightness in the trapezius just with the motion of lifting the arms over the head (e.g., reaching up to grab a plate from a kitchen cabinet or lifting your arms to wash your hair). Sometimes the trap can be chronically tight due to a forward-head posture, so stretches that open up the chest may help (watch the video above for a good chest-opening stretch).

However, if trap tightness and pain are persistent, weak neck muscles may be the culprit.

What Happens When Neck Muscles Go Off-Line

We often see patients who have trapezius problems due to neck-stabilizing muscles that have atrophied (shrunk) and become weak due to neck injuries or pinched nerves. The neck-stabilizing muscles are individual small multifidus muscles (e.g., splenius capitis, longissimus capitis, etc.) that live deep in the cervical spine and keep each vertebra, or neck bone, stable and perfectly aligned when you turn or bend your head and neck. When they atrophy and become weak, they can go off-line, causing abnormal motion between the neck bones, which causes the large trapezius muscle (along with other large muscles, such as the levator scapula and scalenes) to jump in to help stabilize the neck—something the trap and other large back muscles are not designed to do. This leads to a stiff and tight trapezius muscle and pain with lifting.

Your body may otherwise feel very strong, and you may not be aware of any issues other than the trap pain when lifting and tightness (though accompanying neck pain, a heavy-head feeling, or a headache may be a good sign). However, if it continues to happen despite efforts to stretch it out and relieve it, the neck muscles may be atrophied and may need to be addressed before further damage is done. When the trap muscle has to do its own job plus cover for the neck muscles, this can create problems in the shoulder as well, such as shoulder impingement.

Be sure to watch the video to see a side-by-side comparison of normal muscles that help provide stable movement and protect the neck joints, discs, and nerves and small, weak muscles that cause unstable movement that hurts neck joints, discs, and nerves.

Treatment Options for Weak Neck Muscles

There are nonsurgical options for weak neck-stabilizing muscles that should help relieve the pressure and loosen the overworked trap muscle. These include the following:

• Slow range-of-motion neck exercises with arms at your sides twice a day
• Specialized physical therapy
• Platelet-rich plasma (PRP) injections in the neck joints at the levels of weak muscles
• PRP or stem cell injections to tighten loose neck ligaments

We don’t recommend turning to drugs such as nonsteroidal anti-inflammatories (NSAIDs) to relieve pain symptoms, such as trap pain when lifting, neck pain, or headaches, due to the dangerous side effects associated with these drugs. Likewise, Botox injections for headaches may cause further muscle damage and steroid injections for any type of pain relief are also high risk and should be avoided.

The upshot? So that tight trap muscle that won’t let go may be due to weak neck muscles. I personally use it as a way to know when to back off of the weights until it goes away. Why? Because I know that the weight I’m lifting is overwhelming the ability of my neck muscles to stabilize my neck. This means more wear and tear on facet joints, discs, and ligaments. So you too may want to use this tightness as a sign that your neck muscles need work!

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile