Back pain can be debilitating. A patient can find they have trouble moving or engaging in regular activities like lifting their children or even walking. Pain in the mid to upper back can be caused by a variety of issues, and it can have a significant impact on a person’s quality of life. Many people see chiropractors get relief from their back pain, but there are some things that chiropractic patients should know so that they can get the most out of their treatments. A common issue that people face is rhomboid muscle pain. In this article, we’ll cover the rhomboid muscle knot release techniques to help alleviate the pain.
Rhomboid Anatomy
The rhomboid helps connect the shoulder blades to the rib cage and spine. It also helps you maintain good posture. Rhomboid pain is felt under the neck between the shoulder blades and spine.
Location: The rhomboid muscle group is found between the spine and the scapula in the mid-back region. It lies deep in the Trapezius muscle and is composed of the rhomboid major and rhomboid minor muscles.
Function: In everyday life, the rhomboid muscles function to position the scapula (a.k.a. the shoulder blade) during various movements of the shoulder and arm.
Muscle Structure: The rhomboid minor is smaller than and lies above (superior to) the rhomboid major. Both muscles originate along the thoracic spine, with their fibers running diagonally downward and outward to attach along the inside border of the scapula.
Muscle Actions: Contracting as a whole, the rhomboid muscles pull the shoulder blade towards the spine. They can also act to elevate the shoulder blade and rotate the shoulder blade so that it lowers the shoulder joint.
Sometimes referred to as shoulder blade pain or upper back pain. You may feel pain in this area as a strain, a shooting pain, or some type of spasm. Other symptoms of rhomboid muscle pain may include:
tenderness in the upper back area
a popping or grinding noise when you move the shoulder blade
tightness, swelling, and muscle knots around the muscle
loss of movement, or difficulty or pain when moving the muscle
pain when breathing
Rhomboid muscle pain can also cause pain in the mid-upper back, at the backs of the shoulders, or between the spine and the shoulder blade. It can also be felt in the region above the shoulder blade.
Causes for Rhomboid Muscle Pain
Let’s look at the various reasons why your rhomboids can cause upper back pain and discomfort. Also, knowing the type of action and injuries that can result in rhomboid pain can help to prevent being a victim of chronic back pain.
Twisting body
Twisting your body the wrong way or in a jerking motion could strain your rhomboid muscle resulting in mild to severe back pain. The pain between your shoulder blades due to twisting your body could be caused by a sharp awkward movement or being in poor physical condition. Back muscle strain is often the result of the repeated lifting of heavy items or straining your spinal ligaments. For example, if you lift heavy items without using your legs for leverage, you may strain or stretch your rhomboid muscles.
Muscle injury
Any type of injury to your shoulders or upper back could cause damage to your rhomboid muscles. Depending on the extent of the muscle injury, the pain between your shoulders could become chronic and require regular massage to relieve the pain. Also, upper back pain is often the result of trauma or sudden injury. These back injuries can be caused by car accidents, sports injuries, or repetitive muscle strains.
Playing certain sports
If you regularly play sports that involve your arms, then you may end up with an injury to your rhomboids.
Any sport involving a racket or bat-like tennis, baseball, or golf can strain the muscles between your shoulder blades. Also, throwing movements in baseball, football, or bowling can cause rhomboid muscle strain and damage. This can be a result of a sudden, sharp movement, or the painful upper back condition can develop over time into a tight rhomboid muscle that feels like a knot.
Also, your rhomboid muscles are often used in sports. The rhomboids help to rotate the shoulders and also retract the shoulder blades to their normal position. The journal said that certain sports injuries can worsen shoulder movement and lead to painful conditions like “thrower’s shoulder” or “swimmer’s shoulder.”
Poor posture
Poor posture can lead to strain in your rhomboid muscles and a feeling like you need to massage the area between your shoulders. Sitting slouched at a desk or having your desk or chair at the wrong height can put extra strain on your back and cause tightness and pain in your upper back muscles.
Often, holding a fixed posture for a long time, working at computers all day, and repetitive motions can all cause shoulder pain. It was found that therapeutic exercise and massaging helped to relieve the pain and prevent the back muscles from tightening into knots and becoming painful.
There is growing evidence that sitting for long periods of time has a negative effect on your general health. Apart from being to blame for upper back pain, sitting for extended periods of time is linked to obesity, poor cardiac health, and weakened muscles. Sitting for extended periods of time can also cause lower left back pain or lower right back pain.
Compressing an upper back nerve
Your rhomboid muscles are also connected to a network of nerves, and if one of those nerves gets pinched or pressed, you can get rhomboid muscle pain. This can cause a dull ache that is felt in the middle of the upper back and along with the shoulder blades. Rhomboid pain resulting from trapped nerves is often experienced by people who frequently have their hands above their heads or outstretched for long periods. Manual workers like electricians often suffer from tension in the rhomboids. This can cause pain down the edge of the shoulder blade and muscle weakness.
Myofascial Trigger Points in Rhomboid Muscle
Trigger points in these muscles are incredibly common. This is because nowadays, so many of us spend time hunched over computers, tablets, cellphones, and car steering wheels. Poor posture and tight or rounded shoulders will turn on rhomboid trigger points, leading to muscle pain between the shoulder blades. There are three main trigger points in the rhomboid muscle. They’re all located nearer to the scapula, and they all cause pain locally between the shoulder blades.
The rhomboid minor trigger point lies just medial to the inside edge of the scapula, level with the scapular spine. Conversely, the rhomboid major trigger points lie one above the other, along the lower part of the scapular border. It should be noted that all three of the rhomboid trigger points lie beneath the trapezius muscle and may be difficult to palpate if there is tension or trigger point activity in the trapezius.
Rhomboid Muscle Knot Release
Myofascial release techniques for the rhomboid are a hands-on approach to managing pain and discomfort. Now don’t expect a gentle massage with aromatherapy and pan flute music. Instead, myofascial release can be an intense experience.
During a session, a physical therapist, chiropractor, or even massage therapist will massage, knead and gently stretch the muscles and fascia to work out knots. This bodywork technique also involves applying pressure to tight or sore areas to get them to relax. The pressure is applied with the therapist’s hands, elbows, or a massage tool like a foam roller or a ball. You might feel sore afterward, but when the soreness subsides, you’ll feel a lot looser than you did before. When done regularly, you can:
Improve your range of motion.
Reduce soreness and help assist the tissue recovery process.
Help the body relax overall.
Improve circulation.
Release tension, knots, and even stress.
Rehab Exercises for Rhomboid Muscle Strain
Rhomboid muscle pain relief exercises not only help you get back to your normal life faster, but they also help prevent the strain from recurring. While some movements can make your condition worse, there are specific exercises that are recommended for people suffering from rhomboid strain. The following list covers several of the exercises doctors tend to suggest:
Resistance row: Take an exercise band and place it around a solid object at waist height and then face the object. Standing about three feet away, hold on to one end of the band with each hand and slowly pull on the band, pulling in the shoulders until the elbows are at your sides. Repeat about ten times.
Rhomboid stretch: Stretch your arms out in front of you, placing one hand on top of the other, reaching forwards slowly. You should feel a gentle stretch between your shoulder blades. Hold for 15–30 seconds. Repeat about three times.
Neck rotation: Slowly and gently move your head to one side as far as you can without straining your neck. Hold this position for 15–30 seconds and then rotate your head all the way to the other side and hold for 15–30 seconds. Do this three times.
Neck stretch: While either standing or sitting, look straight ahead and allow the head to tip to one side, moving the ear toward the shoulder with both shoulders down. Hold this position for about 15–30 seconds. Slowly raise your head to the starting position and tip your head slowly to the other side. Hold for 15–30 seconds.
Fixed bar stretch: Grab hold of a fixed bar. Standing arm’s length away from the bar, pull your hips backward while straightening your legs. Keep your arms and spine straight. You should feel stretching in the rhomboid muscles.
Rhomboid twisting stretch: Much like a seated spinal twist, you will twist toward the inside of a bent leg instead of toward the outside. Start by sitting on the floor with legs out straight in front of you. Cross the right leg over your left. Placing the left hand on the floor behind you, reach over and grasp the right ankle with the right hand while twisting the body to the left side. You can use the elbow to push the right knee out. Repeat the twist on the other side.
Bent arm stretch: Sitting or standing, bend your left elbow and reach back behind the right shoulder. Cross the right arm under the left so that it is also bent. To increase the stretch, pull the left arm closer to your body. Repeat this on the other side of your body.
Straight arm stretch: Sit in a chair or sit cross-legged on the floor. Keep your spine straight, and then reach the left arm across the chest, keeping the arm straight. With the right hand, pull the elbow towards your chest. Your left palm should be facing behind you. Repeat this stretch on the other side.
Upper back and neck stretch: Lock your fingers and stretch them forward at chest level with your palms facing forward. Slowly bend your neck down so that your chin is touching the chest and hold for a couple of minutes. You can try moving your neck up and down for extra stretching while keeping your hands outstretched in front with fingers still in the locked position.
Shoulder blade stretch: Stand in between a doorframe, grip the sides of the frame with your palms at shoulder level, and lunge forward and then backward. This is not only good for rhomboid muscle pain but for mid back pain, upper back pain, and neck pain.
Thoracic Manual Techniques and Exercises
Here are myofascial release techniques that many physical therapists recommend to improve flexibility and relieve tension in the thoracic spine.
Hold each stretch below for 30 seconds and then release slowly. Take about 10 seconds between each stretch to rest. Repeat all stretches ideally about three to five times.
1. Back of Neck Stretch — Sitting or standing, interlace your fingers behind your head. Gently lean your head back with support from your hands as you lift your chest, then reverse and tuck your chin to your chest. Move slowly and back and forth while you breathe.
2. Side of Neck Stretch — Sit down in a chair and place your affected hand behind your head. Turn your head away from the tight side, and look down until a slight stretch is felt. Take a deep breath, and exhale slowly while holding.
3. Chest Stretch — Sit in a sturdy chair next to a table. Place your arms on the table straight in front of you. Lean forward while bending at the waist as far as possible while you extend your head and chest forward.
4. Shoulder Stretch — Stand with your back to a table and wrap your arms backward to try and grasp the edge of the table with your fingers. While facing forward, slowly bend your knees and allow your elbows to bend.
5. Pectoralis Stretch — Stand in an open doorway and lift your hands above your head to reach near the door frame. Slowly lean forward until you feel a stretch in the front of your shoulders.
Thoracic Spine Manipulation
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy techniques, trigger point therapy, and active release technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair. When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term thoracic pain or soft tissue fibrosis, or scar tissue in the injured muscle.
These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.
Chiropractic adjustments increase the movement of a joint complex. With injury, poor posture, sprains, and strains, muscles tighten up, and the joints can become locked up. This lack of movement is felt when you can not look over your shoulder without feeling pulling, dull pain, or a twinge of pain. Mildly stuck joints can be loosened up during the day with stretching and range of motion exercises. Moderately stuck joints often need a little help to restore their normal motion with chiropractic adjustments. Severely stuck joints cause a person pain whenever they put pressure upon the joint or try and move the joint complex.
There are multiple ways to get a joint moving again. The most important part is that the joint is moving in its proper range of motion and without pain. Many people think chiropractors only perform manual manipulation. Most likely, their first experience with chiropractic was years ago, and manual manipulation was the most common form of treatment. Over time and with technology, treatments have changed with the same goal of getting neck joints moving.
Thoracic Spine Mobility Exercises
Corrective exercises and mobility drills can help you keep your spine healthy, strong, and stable. Proper posture will ensure you don’t develop any spinal disorders. If you’re experiencing mid-back pain and shoulder stiffness and feel that the pain is affecting the lower back, the following mobility exercise should help address some of these issues. Follow these myofascial release techniques for rhomboids:
Thoracic Rotations:
Start on all fours, hands below your shoulders and knees below your hips.
Bring your hand behind your head, rotate out, bring your chest towards the side, and then turn inward, bringing your elbow towards your hand.
Complete 10-12 repetitions on each side.
Complete this exercise 1-2 times a day.
Open Book Thoracic Rotations:
Lie on your side with your hands stretched out in front of you.
Rest your top leg on a roller or block to stabilize your hips. We want to minimize movement at the hips and focus on spinal rotation.
Lift your top arm and rotate out until you reach behind you. Reach as far behind as you can without forcing the movement.
Complete 10-12 repetitions on each side.
Repeat this exercise twice a day.
Roller Thoracic Spine Extensions:
Lie on the foam roller. Place the roller under the upper-mid back area. Remember how we don’t want to roll the lumbar spine area.
Stretch your arms up parallel to your neck and head. Or place your hands behind your back if you’re feeling neck tension.
Roll the mid-back on the mat by extending your spine on the roller and back to a neutral position. The roller helps release any tightness in that area and mobilizes the spine.
Thoracic Extensions:
Place your forearms on the roller, bench, or chair. It doesn’t matter which tool you use for this exercise.
Stretch out your back and slightly arch your back by naturally letting your chest drop to the floor.
Then slightly lift your lower rib cage
Complete 6-8 repetitions
Wall Windmill:
Begin in a lunge position, with your forward leg closer to the wall.
Extend one or two arms in front of you
Keep one arm forward and rotate your arm in a circular motion over your head while keeping your arm closer to the wall.
Follow your arm movement with your head to ensure you’re not just moving your shoulders but your thoracic area as well.
Complete 8-12 repetitions on each side and repeat 1-2 times a day.
Cat Camel:
Begin on all fours.
Slightly arch your mid-back and disengage your shoulders so your chest drop. Avoid overarching your back.
Slowly return to starting position and start elevating your rib cage and chin towards your chest.
Focus on the middle part of the movement instead of overarching or over flexing your spine.
Breathe deeply.
Complete ten repetitions and hold the end position for 1-2 seconds.
Repeat this exercise 1-2 times a day as needed.
Dumbbell “around the world”:
Grab a light dumbbell or plate. I’m using a 10 lbs dumbbell. Use what feels light to you.
Stand with your feet shoulder-width apart. Brace your core and glutes
Keep your hips stable. Hold the weight in both hands, extend your arm, and circle the weight around your head, ending in the starting position. Then repeat on the other side.
Make sure you initiate this movement with your mid-upper back and shoulders. Your core is strong, and your hips are not moving.
Squeeze your glutes for additional lumbar support!
Thoracic Back Pain Treatment
The goal of the chiropractor treating a patient for thoracic back pain will usually focus on reducing the pain and inflammation in the area. The treatments may include:
Spinal adjustments
Specialized exercise recommendations
Ergonomic training
Distraction
Heat or ice
Traction
Electrical stimulation
The chiropractor may also recommend nutritional supplements like proteolytic enzymes to aid in managing the swelling and pain that may be caused by disc herniation and some other back injuries. They may also recommend dietary changes or weight loss to help the patient manage their pain.
Chiropractic is a safe, effective, non-invasive treatment for mid to upper back pain. Many patients experience results immediately, which is another draw for people. Most patients with back problems find their chiropractic visits beneficial for effectively managing the pain and keeping it at bay. Schedule an appointment with us and learn how we can help alleviate your rhomboid pain.