THE DREADED CORNER levator scapulae trapezius rhomboids FIG. 1 ANATOMIST’S LEVATOR LEVATORSCAPULAE 80 MASSAGE & BODYWORK • OCTOBER/NOVEMBER 2001 o single muscle takes more blame for the problems of bodywork N clients (or the occupational strains of bodyworkers themselves) than the poor, benighted levator scapulae. rectus capitis lateralis Many clients will roll their heads and point or dig at the base of their necks, urging us to put our fingers into this longus capitis hard-to-reach place. If you are sitting down and a massage therapist comes up longus colli behind you, they are more than likely going to squeeze your traps a few times, and then start after the gold at the top of anterior scalenes the scapula. And there’s nearly always gold to find when they get down to the anterior scalenes superior angle. Why is this such a univer- posterior scalenes sally sore area? The situation has become so serious Stone Phillips is preparing a Dateline seg- ment titled “Levator Scapulae: Threat? Or Menace? You decide!” And Anne Robinson has declared the levator “the weakest link – goodbye.” Okay, bad jokes. But what is the cause of the persistent ten- sion, annoying trigger points, and fibrotic fascia in the levator scapulae? Most clients will say it’s stress. I suppose they are describing the daily stresses which pile up brachial plexis FIG. 2 into distress – a distress that involves feel- ings of fear or withdrawal. Lifting the shoulders to “turtle” the head is a protec- Fig. 2: (Above) tive response, ergo: lifted shoulders and Neck from the constantly overworked levators. front. MOTOR CYLINDER MAKEUP In the spirit of the times, shouldn’t we The front of the try to understand the levator scapulae in he levator scapulae is one of the motor cylinder terms of its context? Go into its upbring- muscles of the “motor cylinder” of shows us the two ing, socio-economic background and pre- T the neck – that inner core of cer- longus muscles vious traumatic episodes? Surely, in these vical stabilizing muscles deep to the outer and the scalene days of relativism, we can’t actually sleeve of the trapezius, sternocleidomas- group. blame anybody, or even any muscle, can toid and platysma. The motor cylinder Fig. 1: (Facing) surrounds the entire cervical vertebrae, we? Of course not, so this article is a plea Levator scapulae for tolerance, an expansion of our under- creating movement through their contrac- from behind. standing of the stresses the levator itself tion, but also stabilizing the cervical spine is working under, and a call to build the like the guy wires on your local radio self-esteem of levators everywhere. So the tower or sailboat mast. Depending on following is my only slightly different the- how you count, there are about a dozen ory as to why the levator is so commonly major muscles in the motor cylinder, overloaded, but the theory leads to a dif- most with multiple slips to several of the ferent plan of treatment. Here goes. bones, including the occiput; that is ➝ By Thomas Myers • Illustrations by Andrew Mannie OCTOBER/NOVEMBER 2001 • MASSAGE & BODYWORK 81 anatomist’s corner FIG. 3 not counting the really small one- and two-joint muscles of the transversopinalis. An astonishing number of muscles manage to find attachments to the transverse pro- cesses (TPs), though some attach to the spinous process (SPs). Beginning from the front, we have the longus capitis and longus colli, which seem to lie in front of the bodies of the vertebrae, but which actually attach to the very rectis capitis lateralis front of the TPs. These muscles act to flex the neck vertebrae and pos- turally to prevent neck hyperexten- longissimus capitis sion. They are intrinsic to the longus capitis splenius cervicis spine in that they do not have longus colli attachments anywhere else, though the longus colli reaches down levator scapulae through the thoracic inlet to the anterior scalenes third or fourth thoracic vertebra. medial scalenes The next muscles back in the motor cylinder are the scalene posterior scalenes group. The scalenes form a skirt scapulae around the side of the neck, and are clearly felt as hard, wiry mus- cles when you push in from the side of the neck. All three attach to the TPs, but the anterior scalene attaches to the anterior tubercle of the TP, and passes down and for- ward (remember that, it’ll be on the quiz later) to the anterior surface of the first rib just under and behind the medial part of the collarbone. Fig. 3: Neck from the side, showing scalenes and levator. The middle and posterior scalene The levator scapulae is set right behind the scalenes, reaching down, back and (which I think of as one muscle in out from the transverse process to the apex of the scapula. terms of treatment) come from the posterior tubercle of the TP, pass- ing straight out to the side to the first and second ribs. These guy wires create lateral flexion in movement, but act posturally to stabilize the side-to-side move- ments of the neck vertebrae. The nerves of the brachial plexus, by the way, go out through the trough See Levator, p84 82 MASSAGE & BODYWORK • OCTOBER/NOVEMBER 2001 anatomist’s corner Levator, from p82 between the anterior and posterior FIG. 4 tubercle, and therefore between the anterior and middle scalenes, a subject we will return to when we talk about palpation. Right behind the scalenes comes the levator scapulae. This thin band of muscle actually starts as four slips from each of the first four cer- semispinalis capitis, lateral vical vertebrae, from the TPs like the rest, which blend into one mus- cle. The longus muscles attached to semispinalis the vertebrae themselves, the capitis, medial scalenes attached to the ribs. What next? The next logical place from splenius capitis which to stabilize the neck is the scalene, medial scapula, and there the levator goes, and posterior attaching right to the upper inner splenius cervicis corner known as the superior angle. supraspinatus Because we want to concentrate nuchal ligament on the levator, we will give short shrift to the rest of the motor cylin- levator scapulae der, which consists of the erector spinae muscles – reaching down from the head and the posterior part of the cervical TPs and into SPs of vertebrae way down the back. The first ones are the large bandages of the splenius muscles (these, too, will be on the quiz). Splenius passes back and down, angling in sharply and acting like the reins of a horse: shorten the splenius on the right side, and the head will turn to the right. Splenius capitis comes from the side of the occiput and temporal bone (the TP of the skull, if you will) and cervi- cis from the first two cervical verte- Fig. 2: Neck from back. brae, the atlas and axis. The posterior part of the motor cylinder, behind the levator, is taken up with Inside the wrapping of the the spinal muscles – the longer erector spinae and the shorter transversospinalis splenii, we have the continuations muscles. of the erector spinae from the back: the iliocostalis most laterally, the longissimus in the middle, and the heavy band of the semispinalis closest to the SPs. Deep to these three are the smaller and shorter multifidus, and other little guys of the transversospinalis, but these muscles are intrinsic to the neck See Levator, p86 84 MASSAGE & BODYWORK • OCTOBER/NOVEMBER 2001 anatomist’s corner FIG. 5 rectus capitis lateralis levator scapulae Fig. 2: Deep Back arm line. Consider the levator’s fascial supraspinatus connections, and we see it connected from the skull, via the tiny rectus capitis lateralis, to the little finger, via the supraspinatus. triceps and ulnar periosteum. Levator, from p84 is that the ubiquity of levator scapu- At the top, the levator scapulae and have less to do with the guy- lae pain and dysfunction has more to connects to one more tiny muscle, wire action we are talking about. do with the neck than with shoulder the rectus capitis lateralis, which To summarize, we have guy-ropes use. But you’re right. To be fair we connects from the TP of the atlas to arrayed around the neck: the longus should detail the connections the the TP of the occiput, so that the muscles along the front, the scalene levator has to the shoulder before we levator is fascially connected to the muscles around the side, the levator spout off about neck balance. skull, even though it cannot directly to the shoulder blade, and the erec- The levator, as we have noted, goes act on it muscularly. At the bottom, tors down the back. Over these are from the TPs of the first four cervical the supraspinatus muscle, that the more superficial trapezius and vertebrae to the apex of the scapula. abducting member of the rotator sternocleidomastoid, which can also If we continue in either, via the con- cuff, is the continuation of the leva- act as stabilizers, but are more con- necting fascia, what other muscles is tor scapulae, and these connections cerned with moving the shoulder it connected to? (This is a favorite carry on out the back of the arm to and rotating the head respectively. game of mine called the Anatomy the little finger. Now why are you carrying on Trains, which was explained in Clearly problems in the arm, tri- about the neck when the levator Massage & Bodywork (April/May ceps or rotator cuff could show up scapulae is clearly a shoulder mus- 2001), and in a recently published in the levator scapulae, but I don’t cle? Because, dear reader, my theory book of the same name.) See Levator, p88 86 MASSAGE & BODYWORK • OCTOBER/NOVEMBER 2001 anatomist’s corner Considered as a Levator, from p86 The scapula starts to creep up the think that is what’s happening most ribs, the structural balance of the neck guy wire, the levator of the time.