Are you dealing with a nagging discomfort in between your shoulder blade and your spine? No matter how many stretches you do, or how much time you spend foam rolling it, does it still persist? Pain in this area often gets labeled as a rhomboid issue because it is a relatively superficial muscle that you can appreciate from any anatomy chart. However, how to fix rhomboid pain sometimes may actually have little to do with the rhomboids. In this article, you’ll learn the ultimate secret of how to fix rhomboid pain by taking a look at a very specific movement!
Endless Nagging Between Your Shoulder Blades?
If there was only one movement assessment I had to pick when it comes to evaluating interscapular pain, I’m going to look at thoracic rotation mobility. Be sure to watch the full video to learn not just how to assess, but also how to improve thoracic rotation mobility and potentially fix rhomboid pain!
Manage your Rhomboid Pain With Thoracic Mobility!
Poor thoracic rotation mobility can wreak havoc on the body and can definitely lead to pain and discomfort in the rhomboid region. Poor thoracic rotation mobility is often coupled with poor scapular mobility/stability, which can only contribute to more issues like neck pain or shoulder pain! I have found that simply improving thoracic rotation mobility can improve interscapular discomfort. Yet, the average person is bound to be stiff and limited in this region and the rest of their mid-back! We can blame 21st-century workplaces and lifestyle habits, but the good thing is the thoracic spine and mid-back region respond extremely well to the right dose of exercise. We have a proven program to improve your thoracic spine mobility designed to get you moving better and feeling better! Learn more HERE.
Understanding Interscapular Pain & Anatomy
Rhomboid pain is labeled as pain in between your shoulder blade and your spine (interscapular pain) that can even refer up to the base of your neck or down the middle of your back. It is often described as a nagging dull ache or pain, pressure, knifelike, pulling, or even a burning sensation (is that really rhomboid pain? Food for thought). You’ll often find people dealing with discomfort in this area wanting to fidget around in an effort to feel better – moving their head and neck around trying to stretch, rounding their shoulders, squeezing their shoulder blades back, or twisting their upper back, you name it. The occasional soreness in this region is nothing to be concerned about, especially if you did a hard upper back workout or carried a backpack for a long time. However, dealing with constant discomfort or pressure in this area can become a real nuisance.
Speaking of trying to ‘loosen’ up the muscles around the shoulder blades, some people even try foam rolling. Should you even be doing this? What does foam rolling actually do physiologically? Listen to the podcast below to find out.
LISTEN: SHOULD YOU BE FOAM ROLLING?
Trigger Points: What Are They and Do They Exist?
For some people with chronic cases of mid-scapular pain, they may have been told they’re dealing with Myofascial Pain Syndrome (MPS), which is typically a diagnosis of exclusion (meaning everything else has been ruled OUT). MPS is tricky and complicated because it can include a wide variety of symptoms, but it is often labeled as symptoms that cause pain in different parts of the body. Specifically, people will say they have ‘trigger points’ in their muscles, which are really sore and sensitive to touch and pressure. For some, the rhomboid region can get really sensitive and feel this way (1)!
A forewarning, ‘trigger points’ is a sensitive subject amongst clinicians (pun intended) and can cause a ton of heated debate about whether they are real or not and if we can actually palpate them because we still don’t fully understand what they are. However, we cannot and should not deny people from acknowledging what they’re feeling and how they’re trying to describe and communicate that to us! There also may be a connection to pain and discomfort in the rhomboid region when doing continuous computer work, here is an interesting read on it (2). With that being said, we wanted to set the record straight on posture and computer work.
If you believe your rhomboid issue is related to your posture and your computer work, definitely check out the read below.
READ: THE PERFECT WORKING DESK POSTURE
What Else Can Contribute To This Pain Between Your Shoulder Blades?
Just because you’re dealing with discomfort in between your shoulder blade and your spine doesn’t mean we have to point the finger at the rhomboids every time! To fix rhomboid pain, we need to take a look at and consider all of the other anatomical structures in the area. This includes…
- Thoracic spine
- Ribs
- Scapulothoracic joint & shoulder joint posture/alignment
- Cervical and thoracic nerves
- Cervical & thoracic discs
- Scapula nerves (dorsal scapular nerve entrapment)
- Paraspinal, Trapezius, Pecs, & Serratus Anterior muscles
This list can seem overwhelming, but it is definitely worthwhile to consider all potential contributing anatomical structures so that nothing is missed (especially in chronic cases that have failed targeted treatments) (3). However, we know improving thoracic spine mobility can definitely help with interscapular pain! Below you will find some great exercises to get you started.
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Exercise Promoting Thoracic Rotation Mobility
Open Books With Pillow Support
Sample Thoracic Spine Mobility Overhaul [P]Rehab Program Exercise
Rhomboid Stretches
In efforts to fix rhomboid pain, you can’t rule out the rhomboids after all! Below you’ll find our favorite rhomboid stretch that hits the muscles like no other!
Doorway Stretch
Sample Thoracic Spine Mobility Overhaul [P]Rehab Program Exercise
Fix Rhomboid Pain With Serratus Anterior Activation Exercises
When speaking of muscle actions, the rhomboids are responsible for scapular elevation and downward rotation. The ideal scapula position is not excessive downward rotation, however, this is not uncommon and it can cause mid-back, neck, and even shoulder issues. An important antagonist of the rhomboids is the serratus anterior, which according to some schools of thought has a myofascial connection to the rhomboids.
Along with improving thoracic rotation mobility and rhomboid stretching, we always give serratus anterior exercises for optimal scapula mobility and stability! Below you will find one of our favorites to help fix rhomboid pain.
Shoulder Flexion On Wall With Foam Roller
Get Rid Of That Pain Between Your Shoulder Blades For Good!
The thoracic spine is often a missing culprit in the realm of exercise; however, it plays such a crucial role in other areas of our body working at 100%. Particularly, our neck, shoulders, and believe it or not, even our low back, all require adequate mobility from the mid-back! This program will teach you how to maximize mobility throughout your mid back that not only will help relieve that nagging pain between your shoulder blades, but also optimize your movement experience with everyday activities!
Closing Thoughts
Interscapular pain can be a real nuisance, however, you now have a better idea of what can be contributing, what to assess (thoracic rotation), and what exercises to follow up to ultimately fix rhomboid pain! If you are looking for extra guidance and the ability to communicate with us, definitely check out our Neck & Mid Back [P]Rehab Program!
References
- Desai MJ, Saini V, Saini S. Myofascial Pain Syndrome: A Treatment Review. Pain and Therapy. 2013 June; 2(1): 21-36
- Yoo WG: Changes in pressure pain threshold of the upper trapezius, levator scapular and rhomboid muscles during continuous computer work. J Phys Ther Sci, 2013, 25: 1021–1022.
- Sultan HE, Younis El-tantawi GA. Role of dorsal scapular nerve entrapment in unilateral interscapular pain. Arch Phys Med Rehabil. 2013;94:1118-1125.
About The Author
Craig Lindell, PT, DPT, CSCS
[P]rehab Co-Founder & Chief Content Officer
Craig is a South Jersey native & Penn State Kinesiology Alumni. When the opportunity came, Craig packed his bags and drove to California to pursue his Doctorate in Physical Therapy from the University of Southern California. With [P]rehab, Craig oversees all digital content creation and multi-channel publication that reaches millions of people on a weekly basis. As a PT, Craig has a wide array of experience from working with various neurological conditions to working with collegiate & professional athletes across the Big Five in North American sports. Experiencing physical therapy first-hand as a soccer player in high school, Craig has a passion & special interest in adolescent athletic development working with young athletes to overcome injuries. In his spare time, Craig enjoys exercising, playing golfing, hiking, traveling, watching Philly sports, and spending quality time with his family.
Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.
About the author : Craig Lindell PT, DPT, CSCS
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Love your articles team – excellent stuff! Hey thought you’d be interested to know – I’ve had bouts of “rhomboid pain” over the years and I think I’ve found a permanent fix in ELDOA.
happy to hear that you have sound relief from your pain!!!!
As an FYI to others in search of an answer. I’ve had “rhomboid” area pain for almost 2 years. Multiple physical therapists, and 2 MRIs. Poking, prodding, neck & scapular & shoulder stretching and strengthening, a Cortisone shot … all did nothing.
FINALLY, a non-professional suggested it might be nerve damage (entrapment), and it was. If all else is failing, you should consider a Nerve Conduction Study,
What’s stunning to me is that the possibility it was nerve related was never brought up by a physical therapist. I understand they probably aren’t proficient in the area, but should be aware.
It is typically a diagnosis by exclusion, meaning we rule out everything else first! So glad you were able to get it diagnosed correctly and sorted out, but that’s why we mention this as a potential culprit! Awareness is key
Physiotherapists absolutely should be aware of nerve impingement and how to assess nerves. I often treat nerve related pain, probably just as often as I treat muscles or joints. This is pointed out above where The Prehab Guys (physiotherapists) are addressing that nerve pain is often a culprit. Hopefully your physiotherapist learned something new and will use it to be more successful in the future!
Great comment, thank you!
Question about the side-lying open book exercise: Should there be increased hip and lumbar flexion in order to feel more motion in the thoracic area? Or neutral lumbar is recommended? Thanks!
I originally fell in such a way that my left shoulder took the brunt of hitting the ground. Years passed until I had chiropractic would pop the spine into alignment about 1/3rd the way down the thoracic. Never stayed in place for more than a few days. Is there a preferred order for doing the exercises? Any one in particular I should work into cautiously?
Hey Gary, you can try out the exercise order however you’d prefer! There is no right or wrong, just a matter of easing into the movements and range of motion to make sure your body feels ok!
Absolutely! The more hip flexion and lumbar flexion – the harder it is to compensate and move from these areas!
I’ve had nagging pain in this location for about 12 yrs. PTs concentrated on ROM of shoulders and strengthening traps. A few nights ago, I was leaning with my forearms on the back of a chair, bent at hips at almost a 90 degree angle, watching a movie, and started swinging my left leg in front of my right, sort of like a thread-the-needle with legs. The slight twisting motion felt really good in my mid back so I started researching what was happening there, which led me to rhomboids and further search took me here. I started doing these exercises and I’m feeling SO much better. It’s true about exercising in limited planes. These 3 exercises feel so good. Thank you for demonstrating them!
So glad you’ve found success with these exercises! You’re most welcome
Love this page; thanks very much. Have been struggling all week, and these have really loosened me up :) you deserve a medal!
Thank you for the kind words Gareth!! We truly appreciate your support and we are happy to help you out!
Hello!
I’ve been having interscapular pain for the past 2 and a half years. I have been to physiotherapists and they recommend me doing mostly neck and back stretches. They never looked at my thoracic mobility. I just did the self-assessment exercises and noticed that my right side (the side that has the pain) is the one with less mobility.
My question is, would you recommend for me to still workout while having this pain? ( I would also be doing the recommended exercises to help relieve the pain.). Or would you suggest for me to stop working out until the pain is fully gone?
Thank you in advance!!!
Hello! Thank you for your question! Unfortunately we are not able to answer your specific question as we are not allowed to legally.
However, in regards to exercising with pain, I would read a couple of our articles that can give you more clarity on this topic:
1) https://theprehabguys.com/is-no-pain-no-gain-true/
2) https://theprehabguys.com/pain-science/
Also, you could follow up with a physical therapist who could evaluate you in-person and help guide you with a focused exercise plan as well! Hope that this is helpful :). All the best!
I find this interesting and helpful…I have had pain for close to two weeks now and the VA is setting me up for pt. This information just might help them help me. Thank you Sincerely Jack
We are very glad to hear that you found this interesting and helpful! We are very appreciate of your positive response. Best of luck to you with your PT!!!
How often should one do these exercises for rhomboid pain?
Mobility exercises such as the ones shown in this article can be done each day, up to 2-3 times a day!
James Jack
What is the best type of specialist/professional to see for Nerve Entrapment? Thank you
Hello! Thank you for your question! If the nerve entrapment is related to a movement problem, a physical therapist would be a great start. However, if you seek an evaluation from a physical therapist and he/she believes you would benefit from a further consult, usually appropriate referrals are to a neurologist. Also, there are physical therapists who specialize in EMG (electrodiagnostic medicine). You can search for physical therapists in your area at the website below. We hope this is helpful!
https://aptaapps.apta.org/APTAPTDirectory/FindAPTDirectory.aspx
Thanks so much you guys are AMAZING!
You’re most welcome! Thank you for your support!!!
@NT Murphy did your pain go away after they found out it was the nerve that was entrapped ?
I’m very interested in trying these to see if they’ll give me some relief with my recurring mid scapula pain. Would these be safe considering I’ve had: 4 Cervical surgeries to include fusion & 5 Lumbar surgeries with fusions as well?
Hi Sharon!
Thank you for taking the time to interact with our content, we are so appreciative! In regards to your questions about the safety of performing these exercises, we suggest you discuss this with the surgeon who managed your neck and low back, as we are unable to provide direct medical advice on this platform due to legality. In addition, the surgeon will know your anatomy best, as well as what is safe for you to engage in from an exercise perspective at this time. Generally speaking, lower level exercises that focus on mobility and strength are safe following spine surgeries, but again, we would advise you speak with your physician first before proceeding. If you have any other questions or comments after that discussion, please email us at info@theprehabguys.com, and we would love to help in any way we can!
All The Best,
Team [P]rehab
That first exercise was so helpful for me. I was doing a cat cow this morning without warming up & my back immediately locked up and had pain in the R rhomboid. I thought it was a first rib issue, but wasn’t. I’m so glad I found this video. I’m a PTA and still didnt know this.
Hi Yvonne!
We are so happy that this has helped you. All the best to you!
Team [P]rehab