Clinical Tips and Tricks: Chronic Rhomboid Pain

We see a lot of patients with recurrent aches and niggles commonly described as ‘between’ or ‘under’ the shoulder blades. It’s often the same area and typically one sided.

Common strategies to treat this include:
  • addressing any joint dysfunction through the thoracic spine
  • treating locally by using soft tissue therapy, dry needling etc through the trapezius and rhomboids
  • stretching out the pecs and other internal rotators of the shoulders
  • prescribing rhomboid strengthening exercises and other postural corrections where applicable
  • checking for dorsal scapula nerve entrapments around the scalenes and levator scap
These are all great strategies, but there is another key link to this problem and one that is often overlooked and forgotten: Serratus Anterior. This muscles has a direct myofascial connection to the rhomboids via the Spiral Line of fascia (described by Thomas Myers in Anatomy Trains). So much of what we do in the modern world see us in sustained postures which lead to short, tight and weak Serratus Anterior muscles. Think sitting, driving, typing, texting, the list goes on. This shortened position of the Serratus Anterior is combined with a rhomboid that is overstretched and eccentrically loaded. Enter the chronic pain cycle and that niggle in the back that won’t quit.

Any patient with pain around the rhomboids should be an alert to check Serratus Anterior. Address this stubborn muscle and lasting results will come.
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