PREVENTION
BY CATHERINE LOGAN, MSPT

&

POSTREHAB

Repetitive Stress Injury: The Upper Trapezius
Whether your clients are sports participants, musicians or simply casual computer users, they may suffer from this common condition.
Repetitive stress injuries (RSIs)–sometimes referred to as “repetitive strain injuries”–are a group of conditions usually caused by placing too much stress or strain on a joint or musculoskeletal tissue. RSIs are often associated with performing recurring motions, whether on a computer, on the telephone or in a sports activity such as tennis or squash. RSIs may even occur in children if they spend multiple hours on the computer or play video games and/or musical instruments for long stretches of time. RSIs can include a range of injuries– from upper-trapezius strain, carpal tunnel syndrome, tendonitis and postural dysfunction to lumbar-spine sprains and herniated disks (Anderson 1997). Depending on the way an overuse injury presents itself, it may be managed by one of a list of healthcare professionals, including primary-care physicians, neurologists, pain specialists, orthopedists, or physical and occupational therapists. For example, a patient who suffers from a neck or upperextremity injury and subsequently has a loss of sensation in the hand will likely be treated by a neurologist. A patient who has elbow tendinitis due to repetitive stress may be cared for by an orthopedist or a primary-care physician. This column will focus on a common RSI, upper-trapezius strain.
ANATOMY REVIEW

scapula and to extend, rotate and sidebend the neck.
CAUSES OF INJURY

How often do you hear clients complain of “knots” or “tightness” in their upper traps? An upper-trapezius strain can be triggered quite easily by consistently overusing the muscle group, even at a low intensity. Because repetitive motions do not allow the affected tissue to rest between movements, they can cause stress and irritation. The members of today’s work force don’t often get up to sharpen a pencil, fax documents or walk to the post office to deliver a package. The easy and convenient access of working tools promotes inactivity and therefore a rise in RSIs associated with desk and computer work. Simple, everyday movements–like habitually holding a telephone between the ear and shoulder–can trigger palpable tightness and tenderness in the upper traps. Carl Gustafson, RPT, CSCS, a licensed athletic trainer with more than 20 years’ experience in sports medicine and conditioning, explains that no matter what shape someone is in, muscles that are in a stagnant position all day can go into spasm. Spasms don’t necessarily occur just because a muscle is too tight or too weak; they can also occur simply from lack of movement. The fittest athlete at your gym may suffer from this malady. A primary tool for preventing or treating RSIs is exercise. By correcting the postural dysfunctions and muscle imbalances that promote these conditions, personal trainers and group exercise instructors can have a significant effect on people who suffer from RSIs.
GENERAL GUIDELINES

movement. You can greatly influence your clients’ behavior outside the gym–and therefore their susceptibility to RSIs–by educating them on proper posture and ergonomics in all their daily activities. For example, we know that, when lifting, there is an optimal joint angle that provides the greatest mechanical advantage. If you are holding a gallon of milk in your hand with your elbow extended and arm in abduction, there is an optimal angle at which to bend your elbow. Your biceps muscle is most effective at carrying the milk with a shorter-lever arm. If your elbow remains extended (and the biceps is lengthened), it is difficult to hold the gallon container. This muscle “lengthening” causes what is called passive insufficiency. The opposite situation, when the muscles are shortened beyond their optimal length, is called active insufficiency. It is easy to understand how the upper trapezius could be in a state of active insufficiency in certain situations; for example, when the shoulder is elevated and the neck is extended, side-bent and rotated, as when you are cradling a phone between your ear and shoulder. Throughout the day, the upper trapezius might be actively insufficient, while, alternatively, the rhomboids might be passively insufficient (when the shoulders are rounded).

red flags
Refer your clients back to a physician if they experience any of the following symptoms: