Upper Trapezius Strength Test

The Upper Trapezius Strength Test is a manual muscle testing (MMT) technique used to assess the strength and integrity of the upper trapezius muscle, which is responsible for scapular elevation (shrugging) and assists in head/neck lateral flexion and rotation. This muscle is commonly overactive in postural dysfunctions, yet can also be weak after trauma, nerve injury, or chronic pain.

How the Test is Performed

• Client position: Seated, with arms at sides (or arms slightly abducted to reduce activity from levator scapulae/rhomboids).

• The client is asked to shrug the shoulders upward (scapular elevation).

• The therapist applies downward resistance on the shoulder while stabilizing the occiput or lateral head, often rotating the head away from the tested side and extending it slightly.

• The therapist may also resist simultaneous shoulder elevation and ipsilateral head side flexion for isolation.

• Normal result: The client maintains the elevated shoulder against resistance without excessive compensation or dropping.

• Weakness: Inability to maintain shoulder elevation, visible drooping, or strong recruitment of compensatory muscles.

Clinical Significance

• Weakness of the upper trapezius may result from accessory nerve (cranial nerve XI) injury, C3/C4 root issues, muscle imbalance, or chronic postural problems.

• Overactivity may also be found with chronic stress, tension headaches, and upper-crossed syndrome. This is an important finding for manual therapy planning.

• Symmetry is important: always compare both sides and look for scapular winging, altered elevation, or compensatory muscle use.

Assessment

• Use this test for clients presenting with:

  • Neck pain

  • Shoulder elevation/asymmetry

  • Posture complaints (forward head, rounded shoulders)

  • Suspected nerve injury

• Document side-to-side differences, the client’s endurance/ability under resistance, onset of fatigue, and compensation.

Treatment

• If weakness is present:

  • Incorporate strengthening, neuromuscular retraining, and functional scapular elevation exercises into care, progressing from isometrics to more dynamic movement.

  • Pair with soft tissue mobilization to overactive compensators (such as levator scapulae, SCM, upper traps) and postural re-education.

  • Educate on ergonomic set-up, posture, and strategies to minimize overload (e.g., avoid prolonged holding of heavy bags or excessive phone use on the shoulder).

• If tenderness, spasm, or myofascial restriction is found, focus on gentle relaxation and muscle lengthening as clinically appropriate.

Safety and Referral

• Refer for further evaluation in cases of suspected nerve injury, severe weakness, new onset scapular winging, or rapid change in muscle function.

• Always respect pain limits and avoid forceful resistance in acute injury.