The Levator Scaupla[e] muscle is a reasonably deep shoulder mover, extending from the neck to the shoulder blade. Tightness here can replicate issues with the Trapezius muscle, but they are rooted down deeper. This is a muscle that I find issues with in about 90% of my clients. Because of this, I would argue that it is not only worth learning about, but it could actually be quite important for people to notice that this muscle can cause so much grief – especially if you have a desk job!

Continue reading to learn more about what this muscle does; how dysfunction within it can hinder every day living; as well as how best to perform a stretch on your lev. scap.

 

 

 

Let us first look at the fundamentals of this muscle! We can then look at some perpetuating factors that lead to dysfunction within the lev. scap. After which, we will touch upon other areas that are often secondarily affected. To close this post we will get into how you can perform an effective and safe stretch, as well as noting some miscellaneous information.

→ If you are just searching for this page to get a refresher on the stretch (i.e. if I have already given it to you as homecare) then you may skip down to the stretch by clicking here.

 

ACTIONS:

~ Unilaterally ~

— elevate the scapula (this muscles namesake and primary action)

— laterally rotate the scapula (more of an accessory movement)

— rotate the head & neck (to the same side / chin to that sides shoulder; weak action)

— move the head & neck via side flexion (weak action)

~ Bilaterally ~

— extend back the head & neck

Simplified: for that specific side this muscle helps to suck your shoulder blade up towards your neck.. but while this happens, the bottom point of your shoulder blade also swivels out slightly towards your side;

looking over your shoulder while driving, as well as bringing your ear towards your shoulder (as if to hold a phone) are two movements that I mentioned as “weak.” This is because the lev. scap. only slightly helps with these actions (it is not the prime mover of them);

With the same muscle working on both sides, they work together to help with the movement of craning your head & neck backwards.

 

Image sourced from the iPad app ESSENTIAL ANATOMY 5 by 3D4Medical

ORIGIN:

Transverse processes of 1st through 4th cervical vertebrae

Simplified: the top to middle of your neck, but attaching on the side of your spine.

 

INSERTION:

Medial border of the scapula

→ between superior angle and superior portion of spine of scapula

Simplified: the top corner of your shoulder blade (the portion closest to your head and spine).

 

 

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INNERVATION:

Generally speaking: Cervical nerves (C3 & C4); but also the dorsal scapular nerve (C5)

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How Does This Information Help You?

— There is quite a bit of additional knowledge to be gained simply by learning the fundamentals of any given muscle. For starters, knowing what actions a muscle does will inform us on what other muscles may also be affected. This could mean muscles that do the same action, but it could also apply to muscles that do the opposite action as well (i.e. flexion to extension; or internal rotation to external rotation).

When you affect one this will invariably effect the opposite movement as well. However, I simply want you to take away from this that there is rarely one muscle that solely does an action, and that there are usually many muscles involved in any given movement.

 

— Simply knowing where the muscle operates allows us some clarification on how it is able to do those actions. Meaning: if there is something that is in the way (like scar tissue from a surgery, or a large bruise) you can easily understand why it would restrict the specific muscles ability to contract (or even fully relax).

At the same time, this will also inform how the specific posture of this muscle should be. Overuse of the muscle or sustained actions (including the opposite ones to what the lev. scap. can do) will lead the muscle to poor biomechanics which will lead to poor posture, which can lead to all sorts of problematic and cascading issues – both chronic and acute.

 

— Knowing which nerves supply the muscle will inform you on what other specific muscles could be weakened or are in the process of weakening. This is because nerve branches supply more than one muscle at a time; meaning that if multiple muscles with the same innervation are feeling numbness, tingling, stabbing pain, or general weakness: it would be more than reasonable to look along the nerve for some sort of impingement up above the issue(s) at hand.

An example of this (unrelated to the lev. scap. though) is numbness & tingling in ones hand actually coming from tightness in someones pectoral muscles. The tightness compresses the nerves of the brachial plexus, which pass through the shoulder as they extend down to where it needs to go (in this case: down the arm and to the hand).

Another example (this time related to the lev. scap.) could be that the dorsal scapular nerve (branch of C5) also goes to the rhomboids. If there is weakness in the lot of muscles, that narrows down which nerve (and specific branch) is the problem. This also makes it easier to identify where along the track the specific issue may be.

 

Knowing the above, there are certain things below that will be easier to understand. But there are also things below that won’t seem to make much sense at all either. Hopefully I have organized it in a satisfactory way so as not to be too confusing!

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Typical Pain Pattern

The primary point of pain is generally most obvious at the curvature of where your neck meets your shoulder. Less frequently pain is noted at the top of the shoulder blade, closer to the inside of the back, and can extend (generally) to the midscapular region.

Some one with trigger points or dysfunction within the levator scapula may also experience referral pain to the base of the skull / occipital region, or down the shoulder blade. However certain individuals may only experience this referral when a trigger point is physically being worked on; for instance: during a therapeutic massage treatment.

At the extreme end of lev. scap. dysfunction, you may also observe issues with the respiratory system. This can be either a partial cause or a symptom of the dysfunction.

 

Image sourced from INFORMED TOUCH by Donna & Steven Finando

Causes / Perpetuating Factors:

— sustained rotation of the head or neck to one side (i.e. reading, using your phone / tablet in bed, head looking to the side while working on your computer)

— motor vehicle accident (especially if looking to one side when it happened)

— whiplash (potentially from the above MVA, but could also come from an incident with a trampoline or snowboarding)

— muscle strain

— coughing fit

— respiratory infection

— related disorder (i.e. “wry neck”)

— carrying a heavy bag (with strap over one shoulder)

— poor posture (especially in bed, as touched upon earlier)

— cold environment (usually causing poor posture, as noted above)

— mental / emotional stress

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What Does This Teach Us?

Essentially, you just don’t want an excess of the above. Try your best to not let little things stress you out. Do your best to enable your body with ample time to get quality sleep. There are plenty of things that we can do to help with stressors in our lives, but I would like to bring a spotlight on proper and effective breathing (AKA diaphragmatic breathing).

If you are in a situation where many of these contributing causes are present, don’t fret.. try to slowly remedy one or two things at a time. An immediate relief should be noticeable, but it could also take a bit of time. I would suggest waiting a week or two before trying to remove or remedy any additional things after the first one or two. Otherwise you simply won’t know which thing it was that was the worst, you are just going to assume that they were all equally as bad.

Counter to the above, you could completely change everything at once, and then slowly work back in certain things. For example: maybe you are fine to have your monitor off to the side on you desk at work. I doubt it, but there is a bit of a grey area with regards to posture (and it takes into account personal preferences or lifelong habits). There is also the argument to be made that too many changes too quickly can be detrimental to your body and health. Because of this I would suggest exercising caution with this approach.

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Common Satellite Trigger Points

Other areas / muscles that are likely to be affected by trigger points, dysfunction, or general tension within the lev. scap. include (but are not limited to):

a) Scalenes (perhaps more frequently in the posterior scalene)

b) Splenius Cervicis

c) Iliocostalis Cervicis

d) Trapezius (specifically the upper fibers)

 

Stretching

Will be added at the end of September (with an option to download a printable PDF as well). I am just trying to have some good quality pictures for the progression(s).

 

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Miscellaneous Information

— More often than not, issues are completely different from side to side. One lev. scap. may be in severe dysfunction, while the other may be alright or just mildly aggravated. The one worse off will usually present with an elevated (and perhaps laterally rotated) scapula. This would be easiest to see when looking at someone from behind.

— Because of how the muscle is situated, it is easily susceptible to trigger points. By this I simply mean that the muscle essentially twists around itself, creating an excess of tension. The upper attachments of the muscle at the neck move down to connect to the bottom aspect of the shoulder blade attachment area. This then means that the lower attachments in the neck move down and attach on the upper portion of the shoulder blade.

This is easy to notice in the illustration above. Now you should see why the scapula’s inferior angle swivels outwards toward your side when the movement of the scapula as a whole is actually elevating towards the ears. As was noted in the “Actions” portion (near the beginning) of this post; this is actually more of an accessory movement, but it is because of the muscles structure and fiber direction that this happens! The structure of the muscle itself leaves it open to not just trigger points (as noted above), but also is quite easily affected by poor biomechanics and posture too.