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W2057262820 abstract "In this Rehabilitation & Prevention section, the paper by Ziaeifar et al. (2014) examines the effect of dry needling on trigger points in the upper trapezius. The second paper, by Dibai-Filho et al. (2014), is a research study that looks at the role the temporalis muscle – and specifically its anterior fibres – may have in temporomandibular joint (TMJ) dysfunction; a common yet often under-diagnosed problem, which may commonly be the source of other musculoskeletal pain, especially in the neck. The trapezius muscle, (and its close cousin, the sternocleidomastoid or SCM), are unique in their innervation and action inasmuch as they’re the only muscles with direct connection spanning from trunk to head that are innervated by a cranial nerve (the Accessory, Cranial Nerve XI). A potential link between these two accompanying papers is the possible presence of a trigemino-cervical reflex, which has been studied by Milanov et al. 2001Milanov I. Bogdanova D. Ishpekova B. The trigemino-cervical reflex in normal subjects.Funct Neurol. 2001; 16: 129-134PubMed Google Scholar. This reflex may link afferent bombardment from nociceptive drives from the TMJ into the trigeminal nucleus, with sensitization of the muscles supplied by the accessory nerve; the trapezius and sternocleidomastoid (Milanov et al. 2001Milanov I. Bogdanova D. Ishpekova B. The trigemino-cervical reflex in normal subjects.Funct Neurol. 2001; 16: 129-134PubMed Google Scholar reported a stronger effect in the SCM than the trapezius upon stimulation of the trigeminal nerve.) Clinically, the trapezius, and especially its upper portion, is commonly found to be symptomatic, often generating pain and housing trigger points, as well as being implicated in muscle imbalance syndromes such as the upper crossed syndrome. With more detail, Ziaeifar et al. (2014) explain that trigger points may be present in somewhere between 21 and 93% of patients presenting clinically, and that the upper trapezius specifically is a common site for such trigger point development. The question, as bodyworkers and movement therapists, is why? Manual therapists often find their patients requesting massage to, and stretching of, the upper trapezius fibres; and indeed many therapeutic modalities (from soft tissue practices, to NMT, from MET to strain-counterstrain) are routinely applied to the upper trapezius in practice, yet Sahrmann S, 2002.Sahrmann S. Movement Impairment Syndromes. Mosby, 2002Google Scholar highlights that, commonly, the upper fibres of trapezius are found to be too long rather than too short. So, why stretch? Perhaps strengthening is more important to optimize the function of the upper trapezius? From a strength and conditioning perspective, the upper trapezius has traditionally been targeted using the shrug exercise and overhead loading; indeed any exercise that creates a downward load on the arms and shoulder girdle, requiring a reciprocal elevatory action. Nevertheless, the literature (Johnson et al., 1994Johnson G. Bogduk N. Nowitzke A. House D. Anatomy and actions of the trapezius muscle.Clin. Biomech. 1994; : 44-50Abstract Full Text PDF PubMed Scopus (199) Google Scholar) suggested some 20 years ago that the upper fibers of trapezius are aligned almost horizontally – not obliquely as is often depicted in the textbooks – the implication being that the upper fibers of trapezius do not elevate the scapula. So if this is the case, why are strength & conditioning coaches still prescribing shrugs for trapezius conditioning, and manual therapists still needling, inhibiting and stretching the upper trapezius routinely to ease patients' neck pain? Aside from its normal anatomy book description (detailed below under Classic Anatomy), the trapezius also has several other functional actions. Acting on the shoulder, the trapezius can facilitate respiration as an accessory muscle. As such, it is key for optimal aerobic sports performance and may become over-worked in people with breathing issues, such as asthma, emphysema or breathing pattern disorders. Other accessory respiratory musculature positioned anteriorly on the neck and rib cage (such as SCM and scalenes), work synergistically with the trapezius to maximize respiratory tidal flow; though, due to their lines of action, the net postural effect of this loading will be to draw the head into a protracted or “forward head” posture (Neumann, 2003Neumann D. Kinesiology of the Locomotor System: Foundations for Physical Rehabilitation. Mosby, 2003Google Scholar). Reciprocally, the trapezius, acting on the neck from a stable or loaded shoulder girdle requires counter-balancing force generation from the anterior musculature of the neck to avoid its contraction pitching the head backward into extension. The optic, otic and occlusal plane reflexes are instrumental in keeping their respective special senses and masticatory functions on the plane of the horizon, which is key to optimal vision, balance and feeding mechanics; essentially core survival functions of the organism. The musculature best placed to counteract posterior loading from the trapezius is the supra- and infra-hyoid groups, the masticatory muscles (predominantly masseter, medial pterygoid and temporalis) and the deep cervical flexors. This is where Dibai-Filho et al.'s (2014) findings; that patients with greater chronicity of TMJ dysfunction have lower blood flow through their anterior temporalis (due to greater recruitment and tension) is also of relevance to the trapezius discussion. The reason being, these two muscles work as antagonists (or neutralizers) in stabilization of the neck and, therefore, in loading of the shoulder girdle. If there is increased tone on one side of the joint, there must be a reciprocal increase in tone on the other side of the joint, if it is to retain optimal function. One of the features of the anterior temporalis not described in the Dibai-Filho et al. (2014) paper, is the understanding that the temporalis – and specifically the anterior-most fibers – is involved in function of temporomandibular joint mechanics as it has an insertion into the lateral pterygoid. During initiation of opening in the functional TMJ, the anterior temporalis contracts, creating a spindle stimulation in the lateral pterygoid which, in turn, pulls the disc anteriorly as the head of the mandible moves anteriorly with it (McDivett, 1989McDivett E. Functional Anatomy of the Masticatory System. Butterworth, London1989Google Scholar). In this way the anterior temporalis works a little like the transversus abominis in a feed-forward capacity, contracting initially, to stabilize and stimulate action elsewhere in the kinetic chain. Overactivity of the anterior temporalis may either increase risk of anterior dislocation of the temporomandibular disc, or ultimately may create myofascial creep and desensitization of this delicately orchestrated mechanism. By way of modeling, Chek, 1993Chek, P., 1993. Personal Communication: the Totem Pole Hierarchy of Survival Reflexes.Google Scholar suggested, and Macphail, 2013Macphail K. Is there a hierarchy of survival reflexes?.Med. Hypo. Oct 2013; 81: 638-642Abstract Full Text Full Text PDF Scopus (3) Google Scholar has further investigated the evidence for, a series of what might be termed “higher” reflexes, which neurologically speaking may act hierarchically in determining organismal posture. This hierarchy, depicted pictorially as a totem pole (see Fig. 1) with “higher” reflexes at the top, is designed to act as a clinical guideline for what “higher” influences may be driving compensatory patterns lower down the totem pole. Chek, 1993Chek, P., 1993. Personal Communication: the Totem Pole Hierarchy of Survival Reflexes.Google Scholar places breathing as the highest reflex due to the fact that breathing is so imminently fundamental to the organisms survival, while, for example digestive function (whilst key) could be compromised for weeks without direct threat to survival; so features lower. Chek also includes the occlusal, optic and otic plane reflexes high on the hierarchy, depicted as the jaw, eye and vestibulo-auditory systems. This suggestion has some face validity from the perspective that the head houses the special sensory platforms that are key for accurate processing of information received from the environment in order to make executive decisions in the motor cortex and cerebellar regions of the brain sending efferent drive to the locomotor system. The simple presence of the head-righting reflexes strongly implicates their importance to our locomotor function, and hence the likelihood that their function will be maintained, potentially even at the expense of optimal function lower down in the system. For example, if trigger points, muscle shortness/hypertonicity or joint restriction were holding the head in a rightward tilt or “roll” in the frontal plane, then the vision, balance and bite would be brought back onto the horizon by compensation lower down the kinetic chain (such as shifting the pelvis to the right in the frontal plane). This would increase loading through the right sacro-iliac joint and right leg, increasing stress (and potentially cumulative microtrauma) through these structures. In this instance the visual, vestibular and masticatory functions have been spared and the sacro-iliac and lower limb functions have been compromised. With highly complex interactions between the vestibular, visual and proprioceptive systems (especially from the suboccipital muscles, densely packed spindles cells) during dynamic events, the body needs a highly functional and responsive set of muscles that have both the information and the leverage to stabilize the control centre. Much like trying to control a falling tree, the weight of the head with its inertial load when the body changes direction must be controlled by “reins” that are distant to the neck's (or in this analogy the tree trunk's) axis of rotation; not “reins” that run down the length of its “trunk”, close in to its axis of rotation. From the perspective of bipedal function and the utilization of the arms to facilitate balance, being the only muscle connecting the back of the head (or “special sensory control centre”) to the arm, the trapezius' role, is likely key. Perhaps, the innervation of the trapezius and sternocleidomastoid by the accessory nerve is part of what allows the correct information to reach these superficial, yet largely tonic muscles (Niemi, 2011Niemi K. A Brief Review of the Trapezius Muscle.2011http://www.kineticcontrol.com/page.php?Plv=1&P1=16&Blog=18Google Scholar) in a timely manner. 1Note: tonic motor neurons have a low threshold to stimulus which makes them extremely fast reacting, meaning the fibres they feed will contract early and rapidly. The closer to the target muscle is to the brain, the quicker the impulse will arrive; enhancing response time. However, muscles classified as tonic (or more accurately have a preponderance of tonic fibers – hence “tonic dominant”) are typically deep, yet the trapezius and the SCM are exceptions to this general rule. Irrespective of the accuracy of Chek's model, it is interesting to note that the trapezius is fundamentally associated with each of the top 5 components of the model – breathing (as an accessory muscle); mastication (as an antagonist/neutralizer to the masticatory musculature); to the TMJ, vision and vestibular system as part of both the head-righting reflex and connecting the upper cervical spine as part of the proprioceptive function and reactive head positioning during movement the upper limbs. Traditionally, Anatomy the trapezius has been described, for example in Gray's Anatomy (1991) and Williams (1991), as a muscle that steadies the scapula. With serratus anterior, its lower and upper portions upwardly rotate the scapula. With the rhomboids, the trapezius' middle portion retracts the scapula. With levator scapulae, its upper fibers elevate the scapula – though, as mentioned above, this has been challenged by Johnson et al., 1994Johnson G. Bogduk N. Nowitzke A. House D. Anatomy and actions of the trapezius muscle.Clin. Biomech. 1994; : 44-50Abstract Full Text PDF PubMed Scopus (199) Google Scholar. And finally, with the shoulder fixed, the trapezius may bend the head and neck posteriolaterally. The origins of the trapezius are on the occipital ridge and the nuchal ligament in the cervical spine and all the way down the supraspinous ligament from T1 to T12. The insertions of the trapezius are found on various aspects of the scapula and on the lateral superior aspect of the clavicle. The trapezius is innervated by the Accessory Cranial Nerve XI and the ventral rami of cervical nerves 3 and 4 (Niemi, 2011Niemi K. A Brief Review of the Trapezius Muscle.2011http://www.kineticcontrol.com/page.php?Plv=1&P1=16&Blog=18Google Scholar). However, this point remains contentious (or at least clouded) even today; as, it would appear, does the actual function of the trapezius. More recent anatomical studies (Niemi, 2011Niemi K. A Brief Review of the Trapezius Muscle.2011http://www.kineticcontrol.com/page.php?Plv=1&P1=16&Blog=18Google Scholar, Johnson et al., 1994Johnson G. Bogduk N. Nowitzke A. House D. Anatomy and actions of the trapezius muscle.Clin. Biomech. 1994; : 44-50Abstract Full Text PDF PubMed Scopus (199) Google Scholar, Hammer, 2004Hammer W. The upper trapezius does not elevate the shoulder.Dyn. Chiropr. February 26, 2004; 22Google Scholar) suggest that a deeper look into the function of the trapezius may be important. For example, the upper fibers attaching into the scapula have a very poor mechanical advantage for hitching or elevating the shoulder; and so it is stated by Hammer, 2004Hammer W. The upper trapezius does not elevate the shoulder.Dyn. Chiropr. February 26, 2004; 22Google Scholar that they do not (and cannot) elevate the shoulder girdle – instead acting more as a scapula retractor with middle trapezius and the rhomboid group. The uppermost cranial fibers, which attach into the lateral clavicle, it is suggested, act primarily as controller of elevation by exerting an upward moment on the clavicle at the cost of compression loads at the sternoclavicular joint. Through this mechanism, the weight of the upper limb and any weight it carries are not borne by the scapulo-cervical fibers of trapezius. These transverse fibers help to balance the loads through the sternoclavicular joint caused by the vertical load on the shoulder (see Fig. 3).Figure 3Infant Feeding Behavior, neck thrust & tongue thrust. One of the earliest and most instinctive motor patterns is the tongue thrust pattern, which has deep phylogenic roots. The trapezius-SCM complex (or ancient cuccularis muscle), works to thrust the mouth forward, while the projectile muscles of the tongue, the genioglossus, hyoglossus and styloglossus, synergistically thrust the tongue forward to suckle on the breast. Reciprocally, the pressure of hyoglossus upward against the breast/roof of mouth, creates a relative “insertion” – a point of stability – against which the infrahyoid musculature can contract to create cervical flexion and initiate the next cycle of tongue thrust/protraction (with head thrust/upper cervical extension) followed by head nod and tongue retraction. The repetition of, and strength required for, effective breast-feeding conditions muscles of the tongue and establishes a functional tongue-thrust pattern where the tongue pushes upward against the roof of the mouth. This pattern is retained through development to maturity and stimulates growth of the palate and bony mid-face; facilitating optimal dental development and nasal respiratory mechanics.View Large Image Figure ViewerDownload Hi-res image Download (PPT) It may be of interest to note then, that control around synovial joints containing fibrocartilagenous discs is the domain of muscles supplied by cranial nerves only. Presumably exquisite control is required to manage forces across these high load-bearing joints. Sometimes to glean further insight into the way a component of the body should function, to look back at how it was made (embryology/ontogeny) and to look at what shaped its development (evolutionary anatomy/phylogeny), can offer greater clarity. The innervation of the trapezius, gives one such clue. A recent paper by Benninger and McNeil, 2010Benninger B. McNeil J. Transitional nerve: a new and original classification of a peripheral nerve supported by the nature of the accessory nerve (CN XI).Neurol. Res. Int. 2010; 2010: 1-15Crossref Scopus (19) Google Scholar) posits that instead of describing the accessory nerve as a cranial nerve, or as a somatic nerve, a third classification: a “transitional somatic efferent” (TSE) nerve could more accurately be used, which combines characteristics of both cranial and spinal nerves. They similarly propose the SCM and Trapezius could be termed transitional muscles; a new category of muscle between the head and neck; based on the fact that, embryologically, they are composed of interwoven and composite tissues; some usually used to make the tissues of the head (neural crest cells), and others usually used to make tissues of the body (somitic mesoderm). As Benninger and McNeil, 2010Benninger B. McNeil J. Transitional nerve: a new and original classification of a peripheral nerve supported by the nature of the accessory nerve (CN XI).Neurol. Res. Int. 2010; 2010: 1-15Crossref Scopus (19) Google Scholar state: The interaction between the two embryonic cell populations, mesoderm and neural crest, creates a remarkable interaction, whereby the myotubes and endothelial cells are mesodermally derived, while the connective tissue, tendons, epimysial, and endomysial are formed from neural crest cells. And this may be the case for a very good reason. Digging back into deep evolutionary time, studies of comparative anatomy highlight that the trapezius and sternocleidomastoid are derived from a single and expansive muscle tissue known as the cuccularis in fish (Beach, 2010Beach P. Muscle, Meridians and the Manipulation of Shape. Elsevier, 2010Google Scholar). This ancient elevator of the gill arches is found in fish (Kent and Carr, 2001Kent K. Carr T. Comparative Anatomy. McGraw-Hill, 2001Google Scholar), but it wasn't always present. The lamprey, an eel-like creature, is one of the earliest known vertebrates, and it lacks both an accessory nerve (though cranial nerves IX and X are present) and it also lacks a cuccularis muscle (Benninger and McNeil, 2010Benninger B. McNeil J. Transitional nerve: a new and original classification of a peripheral nerve supported by the nature of the accessory nerve (CN XI).Neurol. Res. Int. 2010; 2010: 1-15Crossref Scopus (19) Google Scholar). In addition to this, the lamprey has not developed pectoral fins and a shoulder girdle. The exact appearance of the accessory nerve is difficult to ascertain, but it can be found in what might be considered the next evolutionary jump in vertebrates – the skates. The skates are one of the first species to develop a shoulder girdle with large flattened pectoral fins, and corresponding cucullaris muscle. The skate (an early relative of the shark) may therefore open an insight into the function of the cucullaris – and it's modern day homologs the trapezius-SCM complex. This insight can be seen to connect the trapezius-SCM complex deeply with respiratory function and pectoral girdle stability. Embryologically, the trapezius grows from the limb bud, which in humans goes on to form the arm, but in skates and later fish would form the pectoral fin. Both the muscle and its eveloping fascia reach across to insert directly into the spine or supraspinous/nuchal ligaments creating a bridge from the extremity to the midline axis of the body (Willard et al., 2012Willard F. Vleeming A. Schuenke M. Danneels L. Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations.J. Anat. Anatom. Soc. 2012; : 1-30Google Scholar). Interestingly, in the skate, the accessory nerve is composed of axons traveling exclusively within the intestinal ramus of the vagus nerve. This may be of some relevance to us today as the accessory nerve in humans still anastomoses with vagus nerve branches that innervate palatal, pharyngeal and laryngeal muscles including the levator veli palatine, palatoglossus, palatopharyngeus and usculus uvulae – as well as the superior, middle and inferior pharyngeal constrictors. This could explain the mechanics of how and why someone with a food intolerance may experience the gag reflex (a common symptom of food intolerance) when that offending food is consumed; and may also explain why gagging is normally accompanied by protraction of the head. Travel and Simons, 1999Travel J. Simons D. Myofascial Pain and Dysfunction: the Trigger Point Manual.second ed. Upper Half of Body. vol. 1. Williams & Wilkins, 1999Google Scholar) also explain that their experience shows active trigger points in their patients' SCM's may contribute to motion sickness, with patients often complaining of a “sick stomach” a sense of nausea and a loss of appetite. This anastomosis and common shared pathways of the vagus and accessory nerves implicate a level of both structural and functional integration. A further line of thought around the development of the cucullaris muscle is that it may have evolved in conjunction with shoulder/limb skeleton in vertebrates specifically to provide a greater degree of flexibility in the heads of predatory vertebrate (Ericsson et al., 2013Ericsson R. Knight R. Johanson Z. Evolution and development of the vertebrate neck.J. Anat. 2013 Jan; 222: 67-78Crossref PubMed Scopus (36) Google Scholar). In relation to this, an aspect of trapezius function that is rarely described is that contraction of trapezius bilaterally (and especially in conjunction with contraction of SCM's) will result in a forward thrusting motion or protraction of the head on the neck. Moving from the sea, onto the land, the accessory nerve seems to be present universally in amphibians and is often associated with feeding behaviour including both tongue-thrust and head-thrust. Benninger and McNeil, 2010Benninger B. McNeil J. Transitional nerve: a new and original classification of a peripheral nerve supported by the nature of the accessory nerve (CN XI).Neurol. Res. Int. 2010; 2010: 1-15Crossref Scopus (19) Google Scholar explain that in salamanders, the accessory nerve innervates the cucullaris and cephalodorsubpharyngeus – muscles crucial for both the neck thrust associated with feeding as well as optomotor tracking. The majority of salamanders use a tongue thrust in conjunction with a forward thrust of the head to capture prey. In human infant development (ontogenic development) it may be of value to note that tongue-thrust is key in creating optimal stability of the neck, optimal dental and palatine growth and optimal function of the temporomandibular joint. Indeed, when one watches a baby breast-feed, both the created by the trapezius/SCM complex and the tongue thrust generated by the supra-and infra-hyoid group, induces early motor pattern development in order that the correct feeding and swallowing motor patterns are engrained into the motor cortex (see Fig. 3). It is the act of breast-feeding that initiates a functional tongue thrust pattern in human babies, whereas bottle feeding often creates a dysfunctional tongue thrust impacting negatively on the development of the upper arch, dentition, mid-face and subsequently on TMJ function and breathing pattern (Rocabado and Iglarsh, 1990Rocabado M. Iglarsh Z. Musculoskeletal Approach to Maxillofacial Pain. Lippincott Williams & Wilkins, Philadelphia1990Google Scholar). Functional tongue thrust patterns are key in bony development of the mid-face, which, in turn, is key in development of functional breathing patterns (in terms of nasal airway patency and nasal breathing patterns). Hence, again, there is a very a very close association between the trapezius and its integrated function with the components at the very top of the reflexive (totem pole) hierarchy. Back to phylogenic development', as vertebrates transitioned to land, the cell bodies of the accessory nucleus appear to have gradually shifted from the brain stem downward into the spinal cord. This may be accounted for by the theory of neurobiotaxis; which proposes that cell bodies migrate toward their greatest source of stimulation. Since most sea-based creatures do not have a “neck” per se, as land-dwellers started to both develop a neck and the flexibility within it, a proportional level of motor control was also required within the cervical cord. Several studies, both in animals and in humans, have demonstrated the importance of the spinal accessory nucleus in coordinating head and eye movement, such as visual tracking, which terminate in the region of the upper cervical spinal cord at the level of the spinal accessory nucleus (Benninger and McNeil, 2010Benninger B. McNeil J. Transitional nerve: a new and original classification of a peripheral nerve supported by the nature of the accessory nerve (CN XI).Neurol. Res. Int. 2010; 2010: 1-15Crossref Scopus (19) Google Scholar). Finally, the cranial accessory nerve proper seems to be present in all mammals with the notable exception of some ungulates (giraffe, camel, lama) whose long necks demand a greater local segmental control, and therefore neurobiotaxis, it appears, has seduced the accessory cell bodies of these creatures entirely into the cervical cord. Interestingly, it is these same creatures, the ungulates, due to their relatively heavy heads on long necks, who also posses a nuchal ligament running longitudinally down their cervical spinous processes. In addition, there are several other mammals who possess this elastic ligament too, and they have one feature in common; they are endurance specialists (Lieberman D, 2011Lieberman D. The Evolution of the Human Head. Belknap Harvard, 2011Google Scholar). Humans have a well-developed ligamentum nuchae, while it is barely present – or altogether absent – in most mammals, including the great apes. The ligament can be functionally divided into 2 parts: the deep part which attaches from the just below the nuchal crest on the occiput to the spinous processes and interspinous ligaments of each of the seven cervical vertebrae; and the superficial part which runs from the external occipital protuberance (or “bump of knowledge” and attaches to the spinous process of C7 without any insertions onto the other spinous processes en route (Johnson et al., 1994Johnson G. Bogduk N. Nowitzke A. House D. Anatomy and actions of the trapezius muscle.Clin. Biomech. 1994; : 44-50Abstract Full Text PDF PubMed Scopus (199) Google Scholar). From a tetrapedal viewpoint, the function of the elastic component of the nuchal ligament is to store and recoil energy from the natural pitching of the head forward into flexion, with each forelimb footstrike. However, as bipeds, humans have the benefit of a better mechanical advantage in their neck extensors to counteract the same forward pitching (flexion) on footstrike, though they do have the challenge of minimizing vertical loading directly up from ground contact into the base of the skull (achieved largely through employing transverse plane mechanics through the spine and trunk into the arms). The upshot of these transverse plane mechanics, where the pelvic girdle turns in the transverse plane one way, and the shoulder girdle turns the opposite way in the transverse plane, means a need to effectively decouple the motion of the head from the motion of the body below (Gracovetsky S., 2003.Gracovetsky S. The Story of the Spine. Royal Geographical Society, London2003Google Scholar) – see Fig. 4. Niemi, 2011Niemi K. A Brief Review of the Trapezius Muscle.2011http://www.kineticcontrol.com/page.php?Plv=1&P1=16&Blog=18Google Scholar and Hammer, 2004Hammer W. The upper trapezius does not elevate the shoulder.Dyn. Chiropr. February 26, 2004; 22Google Scholar cite Johnson et al., 1994Johnson G. Bogduk N. Nowitzke A. House D. Anatomy and actions of the trapezius muscle.Clin. Biomech. 1994; : 44-50Abstract Full Text PDF PubMed Scopus (199) Google Scholar showing that the fascicles from C3–T1 comprise over 50% of the total physiological cross-sectional area of the trapezius muscle and that, since their orientation is almost horizontal, the primary role of the upper trapezius must be to retract of the scapula – and potentially unload (or control loads through) the SC joint in doing so (see Fig. 4b). However, the clavicular fibers are largely left out of the discussion; which, indeed do have a good mechanical advantage to hitch (or shrug) the lateral shoulder. However, it can only effectively draw the lateral point of the clavicle upward engaged, if in conjunction with the stabilizing action of the lower trapezius (see Fig. 2). And additionally, if we remove the context of the fascia, which acts as an enveloping connective tissue sheath, we ignore the mechanical advantage that may be offered to the clavicular fibres as they take a nearly 90° turn from their insertion on the clavicle to their origin on the occiput, using the investing fascia as a fulcrum about which to generate upward force. It should also be noted that, although a part of the argument for the “upper trapezius” (or more accurately stated, the “scapula fibers of upper trapezius”) as not forming a role in the hitching or elevation of the shoulder is that it is attached to the rather elastic, unstable fibers of the nuchal ligament (not ideal for force genera" @default.
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W2057262820 title "The trapezius – Clinical & conditioning controversies" @default.
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