Tight Upper Traps: A Devil & Puzzle in Medicine. You Can Knock It Out in A Breeze

I am in a journey of seeking a clarification of a myth: why a jewel of wisdom healing art in ancient China ended up today a quackish stone. The journey involves deeply digging the history. In this course I am constantly encountering puzzles which can not be resolved without grasping a big and clear picture of the entire world of medicine.

A Single Puzzle in Acupuncture

For acupuncture, as a healing art it involves a single and widely known puzzle which lies in its explanation of the cause of a disease. In acupuncture world, diseases will happen when the energy flow in MERIDIANS in the body are blocked. No matter whatever the illness is, from a common cold to a later-stage cancer, the cause is always the same: meridians are blocked.

But what is a “meridian”? Unfortunately, no body knows for sure what it is. Whether “meridians” exist or not is just a myth, neither proved nor disproved, although our advanced science today can see nanoparticles and atoms in a cell of our body.

Countless Puzzles in Modern Medicine

While a single puzzle exists in the healing art acupuncture, there are countless puzzles, myths and fallacies in our modern medicine in terms of how to explain the causes of health disorders and the resultant interventions.

There are a myriad of myths invented with no proof of their existence. In musculoskeletal medicine world,

• “… musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected (such as trigger points, sacral torsions), and they have developed and perpetuated treatment paradigms (such as ‘correcting’ upper body posture and muscle imbalances) that do not conform to current research evidence” (Jeremy Lewis et al, 2018).
• The biomechanical model (BMM) for “the effectiveness of manual therapy in the treatment of pain makes many unproven assumptions, has many obvious demonstrated flaws and lacks prior biologic plausibility and thus, should seriously be questioned” (Frédéric Wellens, 2010).

Tight Upper Traps: A Devil Frustrating Everyone

In this post, I zoom in on a very common complaint from patients who visit a musculoskeletal clinic: tight upper traps (TUT).

“The devil is in the details, the trapezius ...”, a title of a podcast on the official website of Associated Bodywork & Massage Professionals (ABMP, May 26, 2001). The podcast goes:

“Is it the devil? Or is it the solution to so many questions that are buried?in all those details? ” The author is Allison Denney, an American certified massage therapist from Long Beach, CA, who describe herself as “Rebel Therapist, Rebel against ineffective techniques, and Rebel against boring anatomy lessons”.

Stretching & Massage Not Work

According to Functional Performance Physical Therapy (FPPT):

• “Stretching and massage does not get rid of upper trap pain”.
• “Correct movement is the best medicine of all”
• “Good posture is key”.

However, critical thinkers or skeptics have a different opinion on whether correct movement or posture is the key or not.

Invented Myths

Particularly in musculoskeletal medicine world, there is no consensus with strong confidence on anything as regards what is the cause of a disorder and which intervention is superior to others. Everything is in uncertainty. The disorder TUT is no exception.

For TUT, we can find at least the following invented puzzles:

• poor posture,
• muscle tightness,
• knots,
• upper crossed syndrome,
• overactive upper trapezius,
• upper trapezius trigger point.?

But none of them are proved to be true or disproved to be untrue. Exactly the same scenario as “meridians” in acupuncture world.

Dr Anrew, an American physiotherapist from Charlotte, NC, is a critical thinker among many. His post “Is the Upper Trap the Devil?” goes:

• I regularly hear physical therapists telling patients that this muscle is ‘too tight’ or ‘over active’ and so it’s the cause of their chronic pain. I hear massage therapists explaining how they can feel or see that this muscle is knotted and tense, ... needs to be released, loosened and stretched.
• I also see and hear many practitioners (chiros, PTs, trainers) choosing exercises to help reduce upper trap activity, by focusing on the lower traps to restore the balance between them.
• I argue the exact opposite approach is needed ...Stop smashing, poking, rubbing, and stretching …

Australian physiotherapist Nick Ilic is another skeptic. He argued:

• Patients ask me all the time: “Can you feel that tightness”. My answer is always the same: “No, but you can”.
• Tightness is a feeling. Not a physical thing. There are no “knots”. “Knots” are a feeling.

Throw The Devil Back to GPs for NSAIDs

Nick Ilic advised:

Whatever it is, whenever someone with upper traps tightness comes to me and it has a Cervical Spine influence (99% of the time), I don’t pretend to be a hero for the next 2–3 months and try to manage it on my own, I get help from their GP. I will refer to their GP and ask for help via oral NSAIDS (usually Meloxicam or something similar) for at least 2 weeks.

...for someone who has had long-term (>3 months) upper traps tightness or cervical spine referred pain they usually need pharmaceutical assistance.

Can We Knock The Devil Out? Yes, Just in A Breeze

I admire the critical thinkers' penetrating insight into the “tight upper trap” myth. But do we have a tangibly effective solution? The answer is definitely YES. All clinicians in the world who have the chance to see tight trap patients can vanquish the devil in a breeze if only they knew the truth of acupuncture science.

Trapezius myalgia, trap spasm, trap pain, trap tightness, trap strain, no matter what the “mystery” is called, 99% for sure it will subside by at least 70% or even completely melt away in 5 seconds upon your needle in (not into the traps! That is what DN or TCM acupuncture do). Permanent cure will follow with 85% of certainty.

Knock It Out within 5 Seconds

There are numerous spots on the body which once pricked will produce an instant relief more or less for any specifically localized spot of tightness or pain on upper trapezius. None of them is located locally but far distally from upper back.

Compared to knee joint, elbow joint or shoulder joint, upper trap is a big area on the body. To obtain an instant relief with 99% certainty, the upper trap on either side need to be divided into at least 6 to 9 sub-regions (the smaller the size of each sub-region, the higher the effectiveness and certainty). Where to insert needles can only be determined case by case depending on in which region the tight or painful spot or “knot” felt by patients is located, and on the location of pressure points you identified on a body part which is far distal to upper back.

Remember, to treat traps, you need to forget the “traps” (Don't let the golden rules in Dry Needling or TCM Acupuncture mislead you!).

In this post, to make things easier for my readers who want to try and verify, let me give you a “one size fit all” fool-proof approach which will instantly reduce the trap tightness or pain by at least 50% with 70% certainty. You just need 4 needles, no need to subdivide the traps, no need to do palpation to identify the tender spots on the distal body parts for needle insertion.

Ready? Get Your Patients Puzzled

On the dorsal side of MTP joint area of each foot, you will insert 2 needles (0.18 x 15 mm) horizontally to the skin. One on the lateral side of MTP joint of big toe, the other on lateral side MTP joint of 3rd toe. See the picture.

Keep patients fully dressed (only socks off) and in a sitting position. Then gently insert the 4 needles into the feet as described above, without any stimulation (try your best not let the patients feel anything about the needle insertion!). After insertion of the 4 needles, ask the sitting patient to squeeze shoulder blades toward the spine. Within a few seconds he or she will stare at your eyes with a puzzled face, wow!

Before insertion of needles, be sure to ask your patient “how much tightness or pain do you feel right now, on a scale of 1 to 10?” This is for a comparison which will let you know how much your needles worked instantly after the needle insertion. Five seconds within the needle insertion, the patient may tell you no tightness or pain any more, or much less than before, (in this case) at least 50% better .... Ask patient to rank the tightness or pain level again on a scale of 1-10.

Now let your patients lie down on the treatment table face up with knees lift up with a pillow, a shot nap time in a soft background meditation music! The needles will stay for 20 to 30 minutes.

Depending on the severity and/or chronicity of the initial condition, the tightness or pain may come back in a few days or a few weeks. For a moderate TUT which has been there for 1 to 2 years, 4 to 8 sessions at once or twice per week would eliminate the symptom permanently (at least for a few months without relapse depending on patients' occupation demanding).

Using the procedure described in this post, you may fail in 30% of TUT cases, but it is still way better than kicking your patients back to GPs for NASIDs. You made a happy patient! You became a magician in your patients' eyes! You won a big trust!

Knowing the truth of acupuncture, even just 1% of it, as a musculoskeletal clinician, there are no more devils that can make troubles to you!

References

ABMP Poscast, The Devil is in the Details, The Trapezius: “The Rebel MT” with Allison Denney, 05/26/2021 https://www.abmp.com

Andrew on Charlotte Athlete , The Myth of “Upper Trap Tightness”: Is the Upper Trap the Devil? https://thecharlotteathlete.com (Accessed on Apr, 6, 2023)

FPPT, Stretching and Massage Does NOT Get Rid of Upper Trap Pain. https://fpphysicaltherapy.com/upper-trap-neck-pain-treatment-prevention/ (Accessed on Apr. 4, 2023)

Jeremy Lewis et al, J Sports Med December 2018 Vol 52 No 24

Nick Ilic, Some ideas on the management of Tight Upper Traps. Aug 12, 2021 https://physioclinician.medium.com