Preventing Rhomboid Pain: Posture and Exercise Techniques

Understanding Rhomboid Pain

The rhomboid muscles, is located between the shoulders and below trapezius muscle, play a vital role in stabilizing and moving your shoulders.

Assessment and Diagnosis

As a physiotherapist, the first step is to assess pinpoint root cause of rhomboid pain. It includes observing posture, analyzing the movement patterns, and discussing daily activities to understand the triggers. This personalized approach allows the physiotherapist to create a tailored treatment plan.

The physiotherapist can ask questions related to following points given below:

• Posture - rounded shoulders or forward head posture can contribute to rhomboid pain.
• Forward Shoulder Posture - leads to a rounded upper back and a hunched appearance which can exacerbate the issue by placing additional stress on the neck and upper back.
• Head Position - forward head posture is a common compensatory mechanism for maintaining balance when the upper back is rounded which contribute to headaches, neck pain, and even further postural imbalances.
• Decreased Thoracic Extension - causes the upper back to become flatter
• Impaired Scapular Movement - results in a phenomenon called "scapular dyskinesis," where the scapulae don't glide smoothly along the ribcage.
• Muscle Imbalance - the pectoral muscles and the upper trapezius, might become overactive to compensate
• Breathing Patterns - Shallow breathing or chest breathing may become more common, which can perpetuate tension in the neck and upper back muscles.
• Range of Motion - Limited mobility or pain during certain movements
• Shoulder Blade Squeezing - Retracting the shoulder blade can aggravate rhomboid pain
• Reaching Forward -  Activities like working on a computer or driving, can cause discomfort due to the prolonged activation of the rhomboids
• Carrying a Backpack - can lead to asymmetrical loading of the shoulder muscles
• Arm Movement - Activities that involve raising the arms forward or overhead, such as reaching for objects on high shelves, can elicit pain
• Sleeping Position - Sleeping on your stomach with your arms extended overhead can place strain on the rhomboid muscles.
• Improper Lifting - Lifting objects with improper technique, such as using your back instead of your legs, can strain the rhomboids.
• Overhead Activities - activities like tennis or swimming can exacerbate rhomboid pain due to the demand placed on the upper back muscles.
• Palpation - to identify areas of tenderness, knots, or trigger points.
• Muscle Strength - Evaluate the strength of the muscles surrounding the shoulder blades. Weakness in the rhomboids could be contributing to the pain.

Special Tests

Depending on the findings from the physical examination, the physiotherapist might consider specific tests to further narrow down the diagnosis. These include:

Provocation Tests:

This involve maneuvers that replicate the patient's pain. For example, the patient perform movements that involve the rhomboid muscles to see if pain is reproduced.

Scapular Dyskinesis Assessment:

Evaluating the movement patterns of the scapula (shoulder blade) during different shoulder movements. Abnormal scapular movement can contribute to rhomboid pain.

 

Differential Diagnosis

It involves considering other potential conditions that could be causing symptoms similar to rhomboid pain. This is important to ensure an accurate diagnosis and appropriate treatment. Here are some conditions that might be included in the differential diagnosis of rhomboid pain:

Muscular Causes

• Muscle Strain: Overuse or sudden movements can cause strain in the muscles around the shoulder blade area, leading to pain similar to rhomboid pain.
• Trapezius Muscle Pain: Pain in the upper trapezius muscle, which is adjacent to the rhomboids, can sometimes be mistaken for rhomboid pain.

 

Skeletal and Joint Causes

• Cervical Spine Issues: Conditions like cervical radiculopathy (pinched nerve in the neck) or cervical facet joint dysfunction can refer pain to the upper back and shoulder blade area.
• Thoracic Spine Issues: Conditions affecting the thoracic spine, such as thoracic facet joint dysfunction or a vertebral compression fracture, can also cause upper back pain.
• Rib Dysfunction: Dysfunction or irritation of the ribs, such as costochondritis or rib fractures, might mimic rhomboid pain.

 

Visceral Causes

• Gallbladder Disease: Gallbladder issues, like gallstones or inflammation, can cause referred pain to the upper back and shoulder blade region.
• Cardiac Issues: In some cases, heart conditions like angina or heart attack can cause pain that radiates to the upper back area.

 

Nerve-related Causes

• Brachial Plexus Issues: Conditions affecting the brachial plexus, a network of nerves that controls arm and shoulder movements, can lead to pain in the upper back area.
• Pancoast Tumor: A tumor at the top of the lung (Pancoast tumor) can cause referred pain to the shoulder blade region.

 

Lung and Pleural Causes

• Pleural Conditions: Pleuritis (inflammation of the lining of the lungs) or other lung-related issues can cause pain that is felt in the upper back area.

 

Referred Pain

• Referred Pain from Abdominal Organs: Issues with abdominal organs like the liver, spleen, or stomach can sometimes cause referred pain to the upper back.

 

Psychological Factors

• Psychogenic Pain: Emotional stress, anxiety, or depression can sometimes manifest as physical pain, including pain in the upper back area.

 

Treatment Strategies

Stretching Exercises

Gentle stretches and mobility exercises are essential to maintain flexibility and relieve tension in the rhomboid area.

Rhomboid Stretch

1. Stand up straight maintaining a good posture.
2. Cross one arm over your chest at shoulder level.
3. Use the opposite hand to gently press the elbow of the crossed arm towards your chest.
4. You should feel a stretch in the upper back between the shoulder blades.
5. Maintain this position for 15-30 seconds and repeat on the other limb.

 

Neck and Shoulder Release

1. Sit or stand up straight.
2. Gently bring your head towards your shoulder.
3. Use your hand on the same side to apply a gentle downward pressure on your head.
4. You should feel a stretch along the side of your neck and upper trapezius muscle.
5. Maintain the stretch for 15-30 seconds and repeat on the other limb.

 

Doorway Stretch

1. Stand in a doorway with your arms at a 90-degree angle, placing your forearms on the doorframe.
2. Step forward slightly, allowing a gentle stretch in your chest and front shoulder muscles.
3. Keep your head and spine aligned.
4. Hold the stretch for 15-30 seconds.

 

Cat-Cow Stretch

1. Begin on your hands and knees in a tabletop position.
2. Inhale as you arch your back, lifting your tailbone and head (Cow Pose).
3. Exhale as you round your back, tucking your chin to your chest (Cat Pose).
4. Move gently between these two positions for several repetitions, focusing on the movement of your upper back.

 

Shoulder Blade Squeeze

1. Sit or stand up straight.
2. Bring your shoulders together by retracting them.
3. Hold the position for a few seconds, then relax.
4. Repeat this movement for 10-15 repetitions.

Wall Angels

1. Stand against a wall, feet about six inches away.
2. Arms against the wall, elbows bent at 90 degrees.
3. Slowly slide your arms up the wall, maintaining contact with the wall.
4. Then, lower your arms back down.
5. Perform 10-15 repetitions.

 

Strengthening Exercises

Strengthening the muscles surrounding the rhomboids can provide enhanced support and stability. 

Prone Rows

1. Lie face down on a bench or exercise ball, holding a light dumbbell in each hand.
2. Arms should be hanging down.
3. Engage your shoulder blades to lift the dumbbells towards your hips while keeping your elbows close to your body.
4. Lower the dumbbells back down and repeat for 10-15 repetitions.

 

Thera Band Rows

1. Attach a thera band to a sturdy anchor point at waist height.
2. Hold the ends of the band in each hand, arms extended in front of you.
3. Pull your hands towards your hips, squeezing your shoulder blades together.
4. Slowly release and repeat for 10-15 repetitions.

 

Prone "T" and "Y" Raises

1. Lie in prone position.
2. For the "T" raise, extend your arms out to the sides, forming a "T" shape. Lift your arms while squeezing your shoulder blades.
3. For the "Y" raise, extend your arms at a diagonal above your head, forming a "Y" shape. Lift your arms while squeezing your shoulder blades.
4. Perform 10 repetitions of each.

 

Isometric Rhomboid Contraction

1. Sit or stand up straight.
2. Squeeze your shoulder blades together as if you're trying to pinch something between them.
3. Hold this contraction for 10-15 seconds and then relax.
4. Repeat for 3-5 sets. 

Manual Therapy Techniques

Hands-on techniques such as myofascial release and trigger point therapy can work wonders in releasing muscle knots and addressing muscular imbalances that contribute to rhomboid pain.

Screw Manipulation Technique

It's called 'screw manipulation' because the movement resembles the turning of a screw. The idea is to gradually encourage the joint surfaces to glide and rotate properly, just like they're meant to. The application of force is in the posterior anterior direction.

The direction of the manipulation is identified by applying springing test which is done to evaluate the mobility and condition of the spinal joints. During the springing test, a controlled and subtle pressure, is applied, in the direction of the spine. The physiotherapist looks for any differences in movement, resistance, or tenderness between the spinal segments.

Normally healthy spinal joints have a certain amount of elasticity, allowing them to move smoothly and absorb forces. However, if the joint feels restricted, stiff, or if there's any discomfort, it could suggest issues like joint restriction, inflammation, or even potential structural problems.

Manual Pressure Release (MPR)

It is the application of slowly increasing, nonpainful pressure over a trigger point TrP until a tissue resistance is encountered. Pressure is then maintained until the tissue barrier releases, and pressure is increased again to reach a new barrier to eliminate the tension and tenderness.

Post Isometric Relaxation (PIR)

It is a muscle energy technique, which involves inhibition of a muscle before stretching. This approach involves the introduction of an isometric contraction to the affected muscle, producing post isometric relaxation through the influence of the Golgi tendon organs (autogenic inhibition).

1. Initial Positioning - in a way that places the target muscle is in a stretched position. 
2. Isometric Contraction - the contraction is held at a submaximal level, usually around 20-30% of your maximum effort. The key is to engage the muscle without causing strain.
3. Hold and Relax - hold the isometric contraction for about 20-30 seconds. Then relax completely and let go of the contraction. 
4. Enhanced Stretch - As the muscle relaxes, gently go into a deeper stretch. Since your muscle is already warmed up from the contraction, this can help improve its flexibility and tolerance to stretching.
5. Hold the New Stretch - hold this new stretch for about 20-30 seconds. Focus on breathing and allowing your muscle to gradually relax and lengthen.

Prevention and Lifestyle Changes

To prevent future episodes of rhomboid pain it is important to implement some healthy ideas into daily living, this includes adopting healthy ergonomic practices, integrating regular movement breaks, and incorporating stress-relief techniques to manage emotional tension that might exacerbate the pain.