What is the recommended treatment for a patient with a strain of the trapezius muscle?

Treatment of Trapezius Muscle Strain

Begin immediate relative rest with activity modification, apply ice for 10-20 minutes multiple times daily, and start early mobilization with gentle range-of-motion exercises as soon as tolerable, while using topical NSAIDs as first-line pain management. 1

Acute Phase Management (First 48-72 Hours)

Relative Rest and Activity Modification:

• Reduce repetitive loading activities that stress the trapezius muscle, but avoid complete immobilization as this leads to muscle deconditioning and delayed recovery 1
• Maintain gentle movement within pain-free ranges while avoiding activities that provoke pain 1
• Complete immobilization worsens outcomes and delays recovery 1

Ice Application:

• Apply ice and water mixture surrounded by a damp cloth for 10-20 minutes, 3-4 times daily for acute pain and swelling relief 1
• Never place ice directly on skin to prevent cold injury 1
• This provides immediate pain relief in the acute phase 2

Pain Management

Pharmacological Treatment:

• Topical NSAIDs are the first-line pharmacological treatment due to superior safety profile, particularly in older adults 1
• Oral NSAIDs may be used for short-term pain relief (limited duration) when topical agents are insufficient 1
• Avoid traditional "muscle relaxants" as they lack evidence for benefit in muscle strains 1

Common Pitfall: Avoid prolonged use of oral NSAIDs beyond short-term symptom control due to systemic side effects, including gastrointestinal hemorrhage risk 1

Subacute to Chronic Phase (After 72 Hours)

Exercise Therapy:

• Begin exercises as soon as tolerable to restore function and prevent chronic dysfunction 1
• Eccentric strengthening exercises are particularly effective and may reverse degenerative changes if strain becomes chronic 1
• Progress from gentle range-of-motion to strengthening exercises as pain allows 1
• Lower trapezius strengthening exercises specifically improve dysfunction, postural alignment, muscle thickness, and contraction rate 3

Critical Point: Do not rely on passive modalities alone; active exercise is essential for recovery 1

Adjunctive Therapies (Optional)

Manual Therapy:

• Moderate pressure massage applied to shoulders and neck reduces upper trapezius muscle activity by approximately 19% 4
• Ischemic compression therapy provides pain relief using either low pressure (pain threshold) for 90 seconds or high pressure (average of pain threshold and tolerance) for 30 seconds 5
• Hot pack plus active range of motion combined with stretch techniques shows effectiveness for easing pain and increasing cervical ROM 5

Patient Education

Prevention and Self-Management:

• Educate on ergonomic principles, pacing of activities, and proper posture to prevent recurrence 1
• Teach pain neurophysiology to improve self-management, particularly if symptoms persist 1
• Avoiding excessive fatigue and performing adequate warm-up before intense exercise helps prevent muscle strain injury 2

Red Flags Requiring Immediate Referral

• Severe or worsening pain despite conservative management 1
• Neurological symptoms including weakness, numbness, or altered sensation beyond expected muscle strain 1
• Signs of accessory nerve (CN XI) dysfunction if hypertrophy or asymmetric weakness develops 1

Follow-Up and Monitoring

Reassessment Timeline:

• Reassess at 2-4 weeks to evaluate response to conservative management 1
• Monitor for development of chronic pain patterns requiring adjustment of treatment strategy 1
• Use functional outcome measures to track progress including pain scales, range of motion, and ability to perform daily activities 1

When Conservative Management Fails:

• Refer to a pain specialist or physiatrist if no improvement occurs after 8-12 weeks of conservative management 1

Expected Outcomes

• Most muscle strain injuries fully recover within three to six months 2
• The long-term outcome after muscle strain injury is usually excellent, and complications are few 2