The levator scapulae muscle is a vital yet often overlooked muscle that plays a significant role in shoulder and neck movements. When this muscle is strained or contains trigger points, it can lead to a range of issues such as pain, stiffness, and reduced mobility.
The apparent cause of levator scapulae pain is hunching the shoulders forward.
The levator scapulae muscles are at the back of the neck, where it inserts into the scapula posteriorly. As the name suggests, the levator scapulae’s function is to elevate the scapula/ shoulder complex and descend the scapula.
In this blog post, we will explore the anatomy, functions, and common issues related to the levator scapulae muscle, as well as factors that can activate or perpetuate trigger points.
Anatomy and Functions of the Levator Scapulae Muscle
The levator scapulae is a long, thin muscle found on either side of the neck, deep to the trapezius muscle group. This muscle originates from the transverse processes of the C1 through C3 cervical vertebrae, and sometimes C4, and inserts on the superior angle of the scapula.
The primary function of the levator scapulae muscle is to position the scapula for various shoulder joint movements. However, it can also flex the cervical spine to either side.
| Anatomy | Origin | Insertion | Action |
|---|---|---|---|
| Thin, strap-like muscle | Transverse processes of C1-C4 vertebrae | Medial border of scapula | Elevates and rotates scapula |
The muscle works synergistically with the rhomboids during scapular elevation, and with the upper trapezius and scalenes during lateral flexion. The lower trapezius acts as an antagonist during scapular elevation, while the contralateral upper trapezius and scalenes are antagonistic during lateral flexion.
My shoulders hurt; could it be levator scapulae syndrome?
The levator scapulae are present at the nape of the neck. By palpating the area, you can tell if the discomfort is coming from the SCM or the levator scapulae.
- You will feel tight bands slipping through your fingers when you apply pressure; this indicates the presence of tender points or bands.
- You will also feel a constant, dull pain in the shoulders and upper back that doesn’t seem to go away with rest.
- Pain radiates between the shoulder blades and to the shoulder tip.
- There is generalized tightness in the upper back muscles, neck and shoulders.
- You will experience strain under your head and feel the head’s weight burdening your shoulders.
- Headache is commonly present, and some people also feel nauseous.
As the pain progresses chronically, the patient is seen with uneven shoulders. This is because, as a protective instinct, people tend to raise the affected shoulder in the mistaken belief that this will reduce the stress and pain they’re experiencing.
It exacerbates the discomfort by increasing the tension in the surrounding muscles.
Injury to the levator scapulae is usually to blame for the pain felt in that area. An improper form of exercise or over-exercising muscles can cause pain if you regularly or recently go to the gym.
This injury is often coupled with a rhomboid muscle injury and latissimus dorsi. You might experience pain doing overhead movements and shrugging.
Activating and Perpetuating Factors
Several factors may activate or perpetuate levator scapulae trigger points, including:
- Working at a computer with the head turned.
- Holding a telephone with the shoulder.
- Carrying a heavy bag with the strap over the shoulder.
- Chilling of the muscle during sleep.
- Sleeping on the stomach with the head turned and elevated on a pillow.
- Emotional stress, often described as “the weight of the world on their shoulders.”
- Improperly fitted crutches or a cane.
- Swimming.
- A car accident.
- The acute stage of an upper respiratory infection.
Associated Trigger Points
Trigger points in the levator scapulae muscle are often associated with those in the upper trapezius, scalenes, and the sternocleidomastoid (SCM) muscle when the head is strongly tilted to one side.
People with active trigger points in the levator scapulae are often misdiagnosed with torticollis or simply a stiff neck.
Causes and home treatments for Levator Scapulae pain
In this section, we will discuss three common reasons for levator scapulae pain and how you can address them.
1. Forward Head Posture:
One of the main reasons for levator scapulae pain is forward head posture. This posture forces the muscle to work constantly in order to support the weight of the head, which can lead to tension and pain. To alleviate this issue, you can perform the following exercises:
- Chin Tuck Stretch: Stand tall and pull your chin back as if trying to avoid a finger coming towards it. Use the webbing between your thumb and index finger to push in your chin and pull up and over with your opposite hand. Hold for 10-20 seconds and repeat 2-3 times in a single set. Do this exercise multiple times throughout the day.
- Supine Head Lift: Lie on your back and tuck your chin towards the floor. Lift your head just slightly off the floor and hold for about 10 seconds. Repeat this for 3-6 reps. Make sure to keep your tongue on the roof of your mouth and your mouth closed during this exercise.
In addition to these exercises, maintain postural awareness throughout the day to prevent further degeneration.
2. Excessive Thoracic Kyphosis:
Another cause of levator scapulae pain is excessive thoracic kyphosis, or a rounded upper back. Addressing this issue involves mobilizing the thoracic spine and strengthening the muscles responsible for maintaining proper posture.
- Thoracic Extension Over Foam Roller: Place a foam roller or a firm object along your thoracic spine and extend over it, segment by segment. This mobilizes the spinal joints and helps improve thoracic extension.
- Four-Point Thoracic Extension: In a four-point position (on hands and knees), focus on extending the thoracic spine between the shoulder blades. Keep your elbows straight and scapulae retracted. Hold this position for 30–60 seconds to activate the muscles responsible for maintaining proper posture.
3. Dysfunctional Scapular Movement
The last reason for levator scapulae pain is dysfunctional scapular movement, especially during upward rotation when lifting the arms overhead. If the muscles responsible for this movement are not functioning properly, the levator scapulae may compensate and become overworked.
The key muscles involved in upward rotation are the upper traps, lower traps, and serratus anterior.
The serratus anterior is often dysfunctional in many people, so it’s important to address this muscle when dealing with levator scapulae pain.
3 instant stretches to relieve pain in your Levator scapulae
Suppose you work on a laptop in a stooped posture or use your phone frequently. Occupational strain, stress, rounded shoulders, forward head posture, and poor body mechanics are the chief reasons that cause a tug and pull in your levator scapulae.
The levator scapulae aren’t designed to bear a lot of strain, yet when you work with your shoulders elevated in stress for a long time, it gets shortened over time.
However, these 3 easy stretches that you can perform even while seated in your office chair. They work like magic and can release tightness in just a few minutes.
Seated Stretch 1
- Sit on the chair comfortably
- Your back should be at a 90° angle
- Grab the chair by the arm of the affected site
- Relax your shoulders
- Gradually lean on the opposite side
- Hold for 3 seconds
- Repeat 3 times
This stretch helps bring the scapula downward after being held in an elevated position for a long time.
Seated stretch 2
- Maintain the seated stretch 1 position
- While leaning to the opposite, move your head downwards as if you are looking into your shirt pocket.
- Next, use your free hand to pull your head down gently.
- Apply gradual pressure for 5 to 6 seconds and then release
- Repeat 3 times
Seated stretch 3
- Sit well rested on a chair or bench
- Move the arm of the affected side at your back. This position helps prevent scapula elevation and stabilize it in place.
- Turn your head opposite and gaze down as if you were reaching inside your pocket.
- Apply slow, even pressure down for 6 seconds with your free hand.
- You’ll feel a stretch in your levator scapulae
- Repeat 3 to 5 times
It can also be performed in in standing position.
FAQs
Do I feel pain in my levator scapulae due to muscle imbalance?
Yes! Muscle imbalance is the culprit of nearly all the strains in neck and back pain. Levator scapula pain does not come alone; it is caused when a group of muscles are imbalanced. Latissimus dorsi imbalance usually causes pain in the levator scapulae.
When performing tasks like lifting weights or doing household chores, most of us favour using our dominant hand. Muscles on the dominant side get overdeveloped, leading to a discrepancy in muscle size between the two scapulae.
What do I do if I suspect levator scapulae pain?
- Do not perform any activity that forcibly puts your levator scapulae in a tug-and-pull state.
- Refrain from lifting heavy weights beyond your muscle capacity, which predisposes muscles to extended injury.
- Avoid using your affected side; hold your bag on the unaffected side, also try to grab things from the unaffected side.
- Use your affected side only for essential tasks.
- Change your pillow; the wrong sleeping position can also cause strain.
- Daily perform gentle stretches to maintain a normal range of motion and prevent adhesions.
- Apply a cold pack if you feel the muscle site inflamed, and apply a hot pack if you feel it stiff.
- Work on your posture correction
- Do not self-diagnose!
- Consult a physical therapist as soon as possible to effectively treat the injury in the acute phase.
Conclusion
Understanding the reasons behind levator scapulae pain is essential for effective treatment.
By addressing forward head posture, excessive thoracic kyphosis, and dysfunctional scapular movement, you can alleviate pain and improve your overall musculoskeletal health.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.