Evidence based trapezius exercise

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Upper Trapezius

The highest Maximal Isometric Voluntary Contraction (MVIC) is achieved with elevation of scapula. It also helps the scapula move upward.. During scapular abduction, UT activity progressively increases from 0° to 60° and from 120° to 180° of abduction.(1)

Researchers have found that the highest electromyographical (EMG) activity occurs in the following exercises:

unilateral shoulder shrug(9)
rowing(14)
scaption (8)

shoulder abduction in the scapular plane above 120° (9)

UT weakness is very rare (unless secondary to neurological involvement), clinicians focus on strengthening middle and lower trapezius and normalizing the activation ratio of UT to the lower two trapezius (MT and LT).

Middle Trapezius

MT is often activated with scapular retraction. The highest MVIC for the MT has been recorded during the following exercises:

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horizontal abduction (14)
prone full-can (9)

horizontal abduction with external rotation(14) scaption (8)

When UT compensates for a weak MT or LT, it may be beneficial to use exercises with a good UT:MT ratio which are as follows :

side-lying forward flexion
side-lying external rotation
prone shoulder extension (5)

Lower Trapezius

LT impacts scapular upward rotation, external rotation, and posterior tilt, its strengthening yields better results than that of UT and MT.(17)

This connection has been confirmed by many studies of the LT weakness and its association with pain near inferior angle of scapula.

 LT MVIC has been significantly higher during the following exercises:

Arm raised overhead in line with the LT muscle fibers (9)

External rotation at 90° of abduction (15)

Horizontal abduction with external rotation5
Prone shoulder abduction(5)

A study by Cools and colleagues determined that the following exercises have the best UT:LT ratios:

Side-lying forward flexion
Side-lying external rotation
Horizontal abduction with external rotation5
In a similar study by McCabe et al., the following exercises activated the LT over the UT:

Seated press-up
Unilateral scapular retraction
Bilateral shoulder external rotation13

References:

1. Bagg SD, Forrest WJ. Electromyographic study of the scapular rotators during arm abduction in the scapular plane. American Journal of Physical Medicine. 1986; 65: 111-124.
2. Bhatt JB. Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(11):841–847.
3. Cagnie B, et al. The Relevance of Scapular Dysfunction in Neck Pain: A Brief Commentary. Journal of Orthopaedic & Sports Physical Therapy. 2014; 44(6): 435–439.
4. Cools AM, Declercq GA, Cambier DC, Mahieu NN, Witvrouw EE. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian Journal of Medicine & Science in Sports. 2007; 17(1): 25-33.
5. Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of Scapular Muscle Balance: Which Exercises to Prescribe? American Journal of Sports Medicine. 2007; 35(10): 1744–1751.
6. Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. British Journal of Sports Medicine. 2014; 48: 1327-1333. doi:10.1136/bjsports-2014-093702.
7. Day JM, et al. Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy. 2015.
8. Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ. Serratus Anterior Muscle Activity During Selected Rehabilitation Exercises. American Journal of Sports Medicine. 1999; 27(6): 784–791.
9. Ekstrom RA, Donatelli RA, Soderberg GL. Surface Electromyographic Analysis of Exercises for the Trapezius and Serratus Anterior Muscles. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33(5): 247–258.
10. Jull G, Barrett C, Magee R, Ho P. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia. 1999; 19(3): 179-85.
11. Lawrence RL, Braman JP, LaPrade RF, Ludewig PM. Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 1: Sternoclavicular, Acromioclavicular, and Scapulothoracic Joints. Journal of Orthopaedic & Sports Physical Therapy. 2014; 44(9): 636–A8. doi:10.2519/jospt.2014.5339.
12. Lucado AM, Kolber MJ, Cheng MS, Echternach JL Sr. Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy. 2012; 42(12): 1025–1031. doi:10.2519/jospt.2012.4095.
13. McCabe RA. Surface electromyographic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects. North Amican Journal of Sports Physical Therapy. 2007; 2(1): 34-43.
14. Moseley JB. EMG analysis of the scapular muscles during a shoulder rehabilitation program. American Journal of Sports Medicine. 1992; 20(2): 128–134.
15. Myers JB, Pasquale MR, Laudner KG, Sell TC, Bradley JP, Lephart SM. On-the-Field Resistance-Tubing Exercises for Throwers: An Electromyographic Analysis. Journal of Athletic Training. 2005; 40(1): 15–22.
16. Petersen SM, Wyatt SN. Lower Trapezius Muscle Strength in Individuals With Unilateral Neck Pain. Journal of Orthopaedic & Sports Physical Therapy. 2011;41(4):260–265. doi:10.2519/jospt.2011.3503.
17. Reinold MM. Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature. Journal of Orthopaedic & Sports Physical Therapy. 2009; 39(2): 105–105.

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