Improving Low Trap Strength With Manipulation

As my clinical knowledge and understanding of the nervous system continues to develop, I am finding that "muscle strength" is a relative term. In a previous post, Chris discussed how performing repeated movements can immediately improve an individuals strength. Similar to repeated movements, joint manipulation has shown similar results clinically. The exact mechanism by which a manipulation works is unknown. The most recent evidence suggests that it is multi-factorial. 

Some proposed effects of manipulation include: 
1) Mechanical- breaking up intra-articular lesions
2) Neurological- "resets" nocioceptive pathways and mechanoreceptors 
3) Hydraulic- changes in synovial fluid viscosity
4) Relaxation- alter muscle tonicity & restore blood flow
5) Psychological- both laying hands on the patient & hearing a "pop" are strong influences 

A clinical example you can test tomorrow is assessing lower trapezius strength, then performing different manipulations, and reassessing the strength after each manipulation. The three manipulations I recommend performing are a supine thoracic manipulation, a CT junction manipulation, and C3-C4 manipulation. I want to note that restrictions may not always be found in these regions. Remember: neurophysiological effects can have a profound impact on pain and function. 

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Why Perform These 3 Manipulations?

Supine Thoracic Manipulation
Manipulating the thoracic spine has shown to change sympathetic nervous system activation. Additionally, due to the muscle insertion of the lower trap, manipulating the lower thoracic spine should have direct mechanical effects.

CT Junction Manipulation
Manipulating the CT Junction can have mechanical and relaxation effects on the lower trapezius muscle. Many people rest in a forward head posture which allows the CTJ to become hypomobile. Since the trapezius runs from the occiput to T12, the muscle is placed on extra tension across the CTJ.

C3-C4 Manipulation
The trapezius muscle is innervated by the spinal accessory nerve & cervical spinal nerves 3 and 4. Manipulating C3-C4 can change the tonicity of the trapezius muscle, allowing for better muscle firing. 

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