Patients who want to reduce trapezius area muscle pain or gain a longer-looking neck inject the neurotoxin Botulinum (Botox) into their trapezius muscles—a practice known colloquially as “Traptox.” 

It’s important to note that there are several different types of Botulinum toxin, although Botulinum Toxin Type A (BTxA) is the most common, and it is also the type used in studies pertaining to Traptox.

 Walker TJ, Dayan SH. Comparison and overview of currently available neurotoxins. J Clin Aesthet Dermatol. 2014;7(2):31-39.

 

According to Sergio Alvarez, MD, a board-certified plastic surgeon and CEO of Mia Aesthetics in Miami, FL, injecting the trapezius muscles—“which start in your neck and extend partway down your back on either side of your spine, forming a trapezoid shape”—with Botox can “prove a great help if you’re experiencing back pain or problems.” 

The procedure’s popularity is booming as of late. Alvarez says the practice may have gained popularity after celebrities allegedly underwent the procedure. 

 

Botox and muscular pain

 

A study examined BTxA for pain reduction in the myofascial trigger point in the upper trapezius muscle. In the study, 33 patients with moderate to severe pain in the upper trapezius muscles were randomly chosen and blinded to receive injections of either a single dose of 0.2 ml (20 IU) of BTxA or 0.2 ml of 0.9% NaCl solution (sodium chloride) at their “most tender trigger point” on the upper trapezius muscle.

Kwanchuay P, Petchnumsin T, Yiemsiri P, Pasuk N, Srikanok W, Hathaiareerug C. Efficacy and safety of single botulinum toxin type a (Botox®) injection for relief of upper trapezius myofascial trigger point: a randomized, double-blind, placebo-controlled study. J Med Assoc Thai. 2015;98(12):1231-1236.

 

All of the patients were asked to stretch and use ergonomic adaptation throughout the duration of the study. They were analyzed at 3 and 6 weeks after injection.

The results were mixed. Both BTxA and the control groups demonstrated statistically significant differences in visual analog scale and increased pressure point threshold after three and six weeks compared to pre-treatment. However, BTxA “showed statistically significant more increases in pressure pain threshold at six-week after injection without severe adverse effects.” 

Both groups experienced “mild degree side-effects” that all resolved within one week. There were no serious side effects reported.

Research also suggests that BTxA could help relieve migraine and headache.

Oliver M, MacDonald J, Rajwani M. The use of botulinum neurotoxin type A (Botox) for headaches: a case review. J Can Chiropr Assoc. 2006;50(4):263-270.

In a study, “the percentage of patients with over 50% reduction in headache days per month was greater in the BTA group versus placebo.” The subjects received approximately 190 units of BTxA (or BTA) not only in the trapezius but in the forehead, scalp, and neck. 

 

 

Botox and aesthetics

 

Traptox is also commonly sought after for aesthetic purposes, Alvarez says. Many people (especially women), “are now undergoing the procedure for cosmetic reasons, since Botox injections relax these muscles, making the neck look longer and giving the shoulders a more slimmed appearance,” he says.

According to Aesthetic Plastic Surgery, which explored BTxA injections in patients with bilateral trapezius hypertrophy, the procedure was found safe and effective for aesthetic reconstruction of the upper trapezius in people with bilateral trapezius hypertrophy.

Zhou RR, Wu HL, Zhang XD, et al. Efficacy and safety of botulinum toxin type a injection in patients with bilateral trapezius hypertrophy. Aesthetic Plast Surg. 2018;42(6):1664-1671

The study’s subjects include women with a “short neck shape.” In a post-injection questionnaire, 53% of subjects said the procedure “very much improved” their look, while 13% said it was “much improved” and 27% said it was “improved.” 

 

It is important to note that healthcare practitioners were also given the questionnaires, and a lower percentage (27% versus 53%) said the procedure led to “very much improvement.”

 

The risks associated with traptox

 

Botox itself may be uber-popular and considered generally safe, but that doesn’t mean it comes without risks. It’s also not FDA-approved for use in the trapezius muscles for cosmetic purposes, Alvarez adds. Rather, it’s used off-label for the trap muscles. 

According to Pharmacology, a number of serious adverse events have been associated with general use of botulinum toxin, including “dysphagia, respiratory compromise, generalized muscle weakness, marked bilateral ptosis, pseudoaneurysm of the frontal branch of the temporal artery, necrotizing fasciitis, sarcoidal granuloma, Fournier gangrene, and cervical kyphosis.”

Yiannakopoulou E. Serious and long-term adverse events associated with the therapeutic and cosmetic use of botulinum toxin. Pharmacology. 2015;95(1-2):65-69.

Furthermore, you’ll want to know that Botox may be contraindicated in patients with a history of sensitivity to the toxin, or patients with neuromuscular disorders.

 

The traptox procedure specifically presents its unique risks, too. Administered by an unqualified or inexperienced provider, the procedure could prove dangerous, says Anil Shah, MD, board-certified plastic surgeon and owner of Aesthetic Skin Chicago. The injections are “near vital respiratory and central nerve control centers and—one of the few places that can lead to fatal outcomes in botox,” Shah says. “Don't fall into the trap of an unqualified provider here."

Alvarez warns that traptox can lead to asymmetry as well. “If the two muscles respond to the Botox differently, it could result in a lopsided appearance,” he says—requiring further injections to amend the issue. 

Alvarez suggests MDs chat with their patients about all the options—from traptox to exercise and stretches that can lengthen the neck and reduce pain.

For MDs offering traptox, it may be worthwhile to explore research published in Surgical and Radiologic Anatomy. The researchers worked with 26 specimens from embalmed Korean cadavers and found that “injecting into 6 points separated by 2 cm in sections b and c of the upper trapezius muscle” led to optimal outcome of BoNT injection.