Chronic Rhomboid Pain

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Written By Dr. Andrew Park

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Rhomboid pain is a type of discomfort that affects the muscles between the shoulder blades, known as the rhomboid muscles. This condition can cause mild to severe pain that can be felt on one or both sides of the upper back.

Rhomboid pain can occur due to various reasons, such as poor posture, injury, or stress. The symptoms of rhomboid pain can be debilitating, making it difficult for individuals to carry out daily activities.

In this article, we will explore the causes, symptoms, and treatments for rhomboid pain.

Rhomboid Pain

Did you know that rhomboid pain usually comes from an injury?

The rhomboid muscles are located in the upper back, between the shoulder blades (scapulae), and play an essential role in moving the upper limbs and their area.

In addition, these muscles are essential for postural reeducation, which is necessary to obtain a proper spine posture.

In this way, any sign of an injury is enough to generate discomfort and pain in the rhomboid. Rhomboid pain may indicate myofascial pain (muscle pain).

Emotional factors also have a deep connection with muscle pain, overwork and responsibility in the face of some situations that cause pain in the trapezius muscle (over the shoulders), and in the rhomboid muscle.

When tension is located in the Rhomboid Muscle, the pain is usually very uncomfortable as it can reflect or affect other nearby muscle groups such as the intercostal muscles, causing pain when inhaling deeply and fatigue.

There are specific treatments for this type of injury and exceptional exercises for muscle pain relief.

Where are the rhomboid muscles located?

The rhomboid muscles are located in the upper back (back) and between the shoulder blades. Its function enables shoulder and arm movements to elevate the upper limbs above the head. The rhomboids also assist in maintaining correct spine posture.

So when a muscle strain occurs, common in some sports, we have rhomboid tendinitis.

Symptoms of rhomboid muscle tendinitis

First and foremost, the main symptom of tendinitis, or rhomboid injury, is a pain in the upper part of the spine. Other signs of this type of injury are spasms and muscle tension in the shoulder blades, for example.

When this tendinitis evolves into a severe condition, the patient may notice the presence of bruises, swelling, or a lump in the region. Another sign of the problem is pain that worsens with movement and even breathing.

Chronic rhomboid pain symptoms

Symptoms include

  • pain in the upper part of the spine;
  • spasms and muscle tension in the shoulder blades (scapulae);
  • evolution of tendinitis: bruises, swelling or nodule in the region, in addition to pain that worsens with movement and even breathing.

Leading causes of chronic rhomboid pain

The most common cause of rhomboid pain is overuse of this muscle, or abrupt movements, such as carelessly raising your arm above your head.

Carrying objects with excessive weight, such as bags and backpacks, can also cause injury.

Other factors linked to the problem include:

  • Inadequate and frequent posture;
  • Sports that force this musculature, such as rowing, tennis, golf, volleyball;
  • Lack of physical warm-up before playing sports;
  • Sedentary lifestyle;
  • Aging.

What are the recommended treatments?

First, when noticing pain in the rhomboid muscle region that does not stop, you should look for a spine specialist. The professional will do the clinical analysis and exams to detect the real cause of the symptom.

Thus, with the diagnosis of tendinitis confirmed, the first therapeutic step is rest and ice packs. Anti-inflammatory drugs will contribute to the improvement of pain and general condition in a few days. Remember that medication use should only be done with the recommendation of your doctor.

In the acute phase of distension of the rhomboid muscle, the necessary rest and application of ice are recommended to improve the pain. The patient should start Physiotherapy early, so that the physiotherapist can start applying techniques and procedures that help to relax the muscle.

Sometimes, following up with physical therapy and massage therapy sessions may be necessary. These techniques can reduce strain on the injured muscle and strengthen the area.

Finally, untreated rhomboid tendonitis can progress to a more complex and chronic injury. In the most severe cases (very rare), there may even be a rupture of the tendon that makes up this region, treatable only with surgical intervention.

Posture Modifications

Finding the right posture is a trial and error process, but it’s crucial to prioritize comfort and symptom reduction over the perception of “correct” posture.

Avoid excessive forward or backward motions and experiment with different positions throughout the day that alleviate symptoms.

Exercises to Improve Thoracic Mobility and Alleviate Neck Symptoms:

Perform the following exercises 4-6 times a week, with 1-2 sets of about 8 repetitions. Focus on the exercises that are most effective for you.

  1. Thoracic Cat-Camel: On your hands and knees, rock back onto your heels and round your upper back towards the ceiling, pulling your chin down towards your sternum. Then extend your upper back and thoracic spine upwards, keeping your neck neutral.
  2. Thoracic Rotation: Start in the same position as the previous exercise, placing one hand behind your head. Press down with your arm and rotate your hand and upper back towards the ceiling, emphasizing the stretch on your upper back.
  3. Seated Thoracic Extension: In a seated position, interlock your fingers behind your neck and arch your upper back, keeping your neck neutral and elbows in. Minimize arching in your low back and focus on the upper thoracic spine.
  4. Wall Extension: Stand away from a wall with your hands at shoulder height. Press your hands into the wall while pressing your torso through your arms, extending through the upper back and keeping your neck neutral.
  5. Prone Thoracic Extension: Lay on the ground with your forearms flat, elbows bent. Pull your chin up towards the ceiling, pressing your forearms down and squeezing your shoulder blades together, while keeping your neck neutral.

Other Strategies to treat at home

The exercises are divided into two parts: stretching to tackle tightness and strengthening to build stability and improve posture.

Part 1: Stretching Exercises to Tackle Tightness

  1. Door Frame Stretch

This exercise aims to lengthen the rhomboid muscle and reduce tension. To perform the door frame stretch:

  • Stand close to a door frame with your feet together.
  • Reach across your body and grasp the other side of the door frame with one hand.
  • Lean away from the door frame, using your body weight to create a stretch in the shoulder blade area.
  • Rotate your body away from the door frame to deepen the stretch.
  • Hold this position for 20-30 seconds, then repeat on the other side.
  1. Door Frame Opener

The door frame opener targets the rhomboid and shoulder blade muscles differently:

  • Stand facing the door frame with your toes against it.
  • Crisscross your arms and grip the door frame with your thumbs pointing down.
  • Tuck your chin toward your chest and lean back, lowering your body until you feel a good stretch between your shoulder blades.
  • Hold this position for 20-30 seconds and repeat three times.

Part 2: Strengthening Exercises to Build Stability and Improve Posture

  1. Scapular Push-Up

The scapular push-up is a great exercise for targeting the rhomboid and shoulder blade muscles:

  • Begin in a plank position with your forearms supporting your body weight.
  • Pinch your shoulder blades together and allow your chest to lower toward the floor.
  • Hold for 5 seconds, then lift your chest and upper back toward the ceiling.
  • Perform 10 repetitions, increasing the challenge by moving into a full push-up position if desired.
  1. Dolphin Press

The dolphin press helps build stability in the shoulder blades and shoulders:

  • Start in a plank position and walk your legs in toward your hands.
  • Tuck your chin toward your chest and lower your head toward the floor while lifting your hips toward the ceiling.
  • Hold for 5 seconds, then relax.
  • Perform 10-15 repetitions, increasing the intensity with each rep.
  1. Wall Exercise for Posture and Pain Relief

This exercise helps improve upper back posture and alleviate rhomboid pain:

  • Stand with your back flush against a wall or door, feet angled out in front of you.
  • Squat down slightly and engage your leg and glute muscles.
  • Bend your elbows at 90 degrees and press them into the door, lifting your body forward.
  • Pinch your shoulder blades together and hold for 5 seconds.
  • Perform 10 repetitions, increasing the challenge with each rep.

Can rhomboid pain be a sign of something more serious?

It is possible for rhomboid pain to be a sign of something more serious, such as a herniated disc or spinal stenosis. In these cases, the pain may be more severe or persistent than usual and medical attention should be sought.

Can rhomboid pain be prevented?

Yes, by maintaining good posture, stretching regularly, and avoiding overuse of the rhomboid muscles, you can help prevent rhomboid pain. Additionally, weight management and regular exercise can help reduce the risk of developing conditions that might cause rhomboid pain. Specific exercises and stretches can help strengthen and stretch the rhomboid muscles, improving their ability to support the spine and shoulders, and reducing the risk of pain.

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MD. Physiatrist at University of São Paulo

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