Section 01 of 20
Introduction
Levator scapulae is a strap-like muscle on the back and side of the neck. It runs down and slightly backward from the upper cervical vertebrae to the upper part of the scapula, deep to the upper trapezius and sternocleidomastoid.
Its name describes its main job: it elevates the scapula. It also helps turn and bend the neck when the scapula is stable, which is why it is often tense in people who hold the shoulders up or the head forward.
Section 02 of 20
Origin
| Origin | Transverse processes of C1 and C2 and the posterior tubercles of the transverse processes of C3 and C4. |
|---|
Section 03 of 20
Insertion
| Insertion | Medial border of the scapula from the superior angle to the root of the spine of the scapula. |
|---|
Section 04 of 20
Actions
No dedicated action video is currently available. This movement is explained below and video will be added when verified source media becomes available.
| Primary action | Scapular elevation. |
|---|---|
| Secondary actions | Downward rotation of the scapula; lateral flexion and ipsilateral rotation of the neck when the scapula is fixed; neck extension when both sides act. |
| Movement at the joint | Scapulothoracic movement and the cervical spine. |
| Heads / fiber groups | Single strap-like muscle with slips from C1–C4. |
| Functional examples | Shrugging; carrying a bag; holding a phone against the shoulder; turning the head to check over the shoulder. |
Scapular elevation
Lifts the scapula, as in shrugging.
Downward rotation of the scapula
Tips the glenoid cavity downward, as when lowering the arm or reaching behind the back.
Neck movement
With the scapula fixed, it bends the neck to the same side, and one side helps rotate the head to the same side; both sides help extend the neck.
Section 05 of 20
Nerve Innervation
| Nerve | Dorsal scapular nerve (C5) and branches of the cervical spinal nerves C3–C4. |
|---|
The dorsal scapular nerve runs through the scalene muscles to reach the muscle, so it may be affected by neck posture or scalene tension. Weakness in scapular elevation with pain that shoots down the arm may reflect a nerve problem, not only muscle tightness.
Section 06 of 20
Blood Supply
| Blood | Dorsal scapular artery (from the transverse cervical artery), with branches of the ascending cervical and occipital arteries. |
|---|
Section 07 of 20
Pictures and Visual Anatomy
Section 08 of 20
Functional Movement
Levator scapulae is active when shrugging, carrying a bag, holding a phone against the shoulder, working at a desk, and reaching behind the back. It also helps turn the head to check over the shoulder.
Section 09 of 20
Synergists and Antagonists
Synergists: upper trapezius (elevation) and the rhomboids (elevation and downward rotation); the scalenes, splenius cervicis, and sternocleidomastoid help with neck movement. Antagonists: lower trapezius and serratus anterior (scapular depression and upward rotation), and the opposite-side neck flexors.
Section 10 of 20
Palpation and Location
Client position and technique
Position the client supine or seated with the head supported. Locate the superior angle of the scapula, then follow the muscle upward along the side of the neck toward the upper cervical vertebrae. Ask the client to shrug lightly to feel the tendon near the scapula. Contact the cord-like belly between the upper trapezius and the scalenes.
Protect nearby structures
Stay off the front of the neck. Avoid deep sustained pressure on the cervical transverse processes and near the brachial plexus and carotid pulse, and stop if the client reports tingling, dizziness, or sharp pain.
Section 11 of 20
Massage Therapy Relevance
Levator scapulae is one of the most common muscles involved in stiff neck and neck-and-shoulder tension, especially with a forward head posture and desk work. It is also a frequent site of tenderness at the superior angle of the scapula, although many other structures cause similar pain.
Section 12 of 20
Dysfunction: What Happens When Movement Goes Wrong
Changes in how a muscle works can change how a joint moves. The points below describe possibilities that may be associated with altered muscle function; they are not diagnoses, and one muscle is never assumed to be the sole cause of a problem.
When the muscle is weak
Weakness may reduce scapular elevation and neck side-bending strength and may shift work to the upper trapezius.
When it is tight or shortened
Tightness may be associated with stiffness at the corner of the neck and shoulder, limited head rotation to the opposite side, and an elevated shoulder posture.
When it is overused
Prolonged desk work, carrying loads, and holding the shoulders up may overload the muscle and may contribute to neck and shoulder blade ache.
When it is strained
A strain may cause sharp pain with turning or looking over the shoulder; cervical spine problems can look similar.
When it is inhibited or others compensate
Reduced activation may be associated with more work by the upper trapezius and the neck extensors.
When it does not coordinate well with synergists and antagonists
Poor coordination with the upper trapezius, rhomboids, and serratus anterior may alter scapular position and may be associated with neck and shoulder symptoms.
Section 13 of 20
Conditions, Pathologies, and Pain Relationships
Stiff neck and trigger points
Tender points in the muscle may be associated with pain at the corner of the neck and shoulder blade and limited head rotation, particularly after sleeping in an awkward position.
Forward head posture
Sustained forward head and elevated shoulders may keep the muscle under load and may be associated with neck and upper back pain.
Superior angle scapular pain
Pain at the top inside corner of the shoulder blade may involve the muscle attachment or a bursa, and can also come from the neck or thoracic spine.
Differential considerations
Cervical disc and facet problems, cervical radiculopathy, thoracic outlet syndrome, and shoulder problems can all cause similar neck and scapular pain.
Section 14 of 20
Example Clinical Relationship
An office worker reports a stiff neck that hurts when turning to look over the right shoulder, with tenderness near the top inside corner of the right shoulder blade. Levator scapulae may be involved, and the pattern may be associated with posture-related tension or a trigger point, but cervical disc, joint, and nerve problems can look similar. Gentle work along the muscle may support comfort, while sudden severe neck pain, dizziness, or arm weakness needs referral.
Section 15 of 20
Massage and Treatment Approaches
For healthy, non-acute tissue, position the client supine with the head supported or side-lying. Begin with light effleurage over the neck and upper shoulder, then use gentle kneading and slow longitudinal strokes along the muscle, and consider gentle neck movement within comfort.
| Movement | Use comfortable neck rotation and side-bending, and shoulder blade movement; never force the neck. |
|---|---|
| Regional work | Consider upper trapezius, rhomboids, the scalenes, splenius cervicis, and the muscles around the superior angle of the scapula when assessment supports it. |
| Avoid | Deep pressure over the front and side of the neck, the transverse processes, or any point that reproduces arm tingling. |
Section 16 of 20
Precautions and Contraindications
Precautions and contraindications
- Recent neck injury or whiplash, suspected fracture, or instability.
- Use caution with severe osteoporosis, anticoagulant use, or easy bruising.
- Avoid strong neck rotation or extension in clients with dizziness or vascular concerns.
- Stop if pressure causes sharp pain, arm numbness, or tingling.
Section 17 of 20
Red Flags and When to Refer
Red flags and referral
- Sudden severe headache or neck pain, especially after neck movement or trauma.
- Dizziness, vision changes, slurred speech, or facial numbness.
- Progressive arm weakness, numbness, or loss of coordination.
- Neck pain with fever, stiffness, or unexplained weight loss, or chest pain with arm pain.
Section 18 of 20
Study Summary
Attachments
Origin: transverse processes of C1–C4. Insertion: medial border of the scapula (superior angle to spine root).
Actions
Elevates and downwardly rotates the scapula; side-bends and helps rotate the neck.
Supply
Dorsal scapular nerve (C5) and C3–C4; dorsal scapular artery.
Section 19 of 20
Instructor Narration
Open narration transcript
Levator scapulae is a strap-like muscle on the side and back of the neck. It runs from the upper cervical vertebrae to the top of the scapula.
It arises from the transverse processes of C1 and C2 and the posterior tubercles of the transverse processes of C3 and C4, and inserts on the medial border of the scapula from the superior angle to the root of the spine.
It elevates and downwardly rotates the scapula, and with the scapula fixed it bends the neck to the same side. The upper trapezius and rhomboids help it, and the lower trapezius and serratus anterior oppose it.
The dorsal scapular nerve, C5, and branches of C3 and C4 supply it, and the dorsal scapular artery provides its blood.
Palpate with the client supine, find the superior angle of the scapula, and follow the muscle up the side of the neck. Avoid deep pressure on the front of the neck and the transverse processes.
Stiff neck, trigger points, and pain at the superior angle of the scapula are common, and disc, nerve root, and shoulder problems can overlap. Refer sudden severe neck pain, dizziness or vision changes, progressive arm weakness, or neck pain with fever.
Remember: C1 to C4 transverse processes to the medial border of the scapula; elevation and downward rotation; dorsal scapular nerve.
Section 20 of 20