Have you been experiencing a nagging discomfort, soreness, or pain between your shoulder blades? Many will consider this a pain due to the rhomboid muscle, as it is in this region. But did you know that nagging pain there is is probably due to something else? Have you tried to massage and stretch this region to have relatively no change in your symptoms? This blog post will address the likely culprit of your rhomboid pain and how to deal with it so you don’t have to put with your nagging symptoms.
Take me straight to the exercises!
**This is not medical advice. Please consult your medical provider for more information.
Anatomy of the Rhomboids
The rhomboids are a pair of quadrangular muscles located between your spine and your shoulder blade. The rhomboid minor originates from C7-T1 and the rhomboid major originates from T2-T5. Both insert onto the medial border of the scapula. The rhomboids retraction, elevate, and downwardly rotate the scapula, as well as helping prevent winging of the scapula by acting as an anchor.
Common Causes of Interscapular Pain
When we consider the anatomy of the upper back between the shoulder blades, it’s not surprising that the rhomboid muscles can emerge as the common culprit to pain in this region. However, there are other reasons there may be pain here and it is important to consider the other potential causes of pain.
Referred Pain from the Cervical Spine
Pain between the shoulder blades could be coming from the cervical spine. If you experience pain in one area of the body, but the source of the pain is coming from somewhere else, this is called referral pain. In this case, the cervical spine is the source of the pain, but you are actually feeling the pain in the thoracic spine between the shoulder blades.
There are common referral patterns from the C4-C7 facet joints that may be causing pain in the rhomboid region. This is more likely if you are currently experiencing neck pain or have had a recent history of neck pain. Symptom commonly include an aching neck pain which increased with neck movements or holding certain positions that could strain the neck or upper back.
It is important to understand this connection. If you are dealing with referred pain, treating just the rhomboid region won’t be enough to get rid of the pain. You will also have to treat the root cause, which in this case, would be coming from the cervical spine.
Referred Pain from the Thoracic Spine
Just as discussed in the previous section, referral pain can be coming from the cervical spine, but also the thoracic spine. The thoracic facet joint will commonly refer pain to the interscapular region. Now while this does seem like it is within the same region, and thus, not referral pain, it is considered a referral pattern. If the pain was just over the thoracic facet joints, this would not be considered referred pain. It may only be traveling a short distance, but the pain is being referred to a different location.
This is often the cause of pain in the interscapular region. The thoracic spine is very important and over time, most of us lose mobility in this region. Poor posture, the effects of gravity, sedentary lifestyles, and excessive use of everyday items like electronics contribute to a forward flexed posture. Over time, the thoracic spine becomes more kyphotic. Postural issues over a length of time can contribute to problems and pain within the scapular region, as well as other regions of the body.
Local Muscle Pain
Local muscle pain refers to actual rhomboid pain, either from muscle strain or a trigger point. It is important to note that trigger points are still a debatable subject amongst medical personnel as it is still not fully understood what they are. However, trigger points can still be known for causing referral pain patterns.
Aside from trigger points, muscle strain can come from an actual injury or from micro-stresses over a length of time. This typically comes from poor postural habits. Desk workers or other individuals who find themselves sitting and slouching for long periods of time my experience rhomboid pain due to these micro-stresses on the muscles. Imagine the muscles along your upper back being constantly pulled like a rubber band without being let go. This is what it is like for your muscles when you are sitting in a slumped position. After a while of being overly lengthened, they can feel tight, tender to touch, and painful with movement.
Exercises for Rhomboid Pain
It is important to work on the thoracic spine when dealing with rhomboid pain. We need to make sure it moves well and can hold an upright posture for lengths of time. Try out these exercises if you are dealing with rhomboid pain.
Alternating Shoulder Flexion on a Foam Roller
Lie on a foam roll that is placed down your spine. You can use either a full foam roll or a 1/2 foam roll. Keep your knees bent.
Start with one arm down at your side and the other arm reaching upward as far a you can go. Then alternate your arm positions – the arm that was up will go down to your side and the one that was down will go all the way up.
Alternate for a total of 30 reps.
Bear Hugs on a Foam Roller
Lie on a foam roll that is placed down your spine. You can use either a full foam roll or a 1/2 foam roll. Keep your knees bent.
Start with your arms wrapped across your body like you are hugging yourself. Then open both arms all the way out to the side like a letter “T” position. Then return them back to the start.
Perform this movement for a total of 30 reps.
Latissimus Dowel Stretch
You will use a dowel, cane, broomstick, or any other similar piece of equipment laying around the house to help you with this exercise. You will need to kneel, so place something under your knees if you need a little additional support for comfort.
While kneeling, place your elbows up on a supportive surface near shoulder height. Hold the dowel in your hands with palms facing up. Your shoulders, elbows, and wrists should all be in alignment – don’t allow your elbows to drift outside of your wrists.
Sink your hips backwards towards your feet. This will raise your elbows up higher than shoulder height. You may begin to feel a stretch at this point. You may feel that your hands want to drift inwards. Make sure to hold the dowel firmly in your hands to keep your arms in neutral alignment.
This stretch may target multiple areas depending on where you are stiff. You may feel this in the back of the shoulders near the shoulder blades, down through your lats, or in your thoracic spine. Hold the stretch for 30 seconds and repeat 2 more times.
Wall Arc
Start with your right side against a wall. You will be in a half kneeling position with your right knee on the ground. You can use a yoga mat, pillow, or foam pad to protect your knee.
Your right arm will be placed at shoulder height with your palm facing the ground. Use a small foam roll or yoga block to rest your left knee between the foam roll and the wall. This will help limit any movement from your hips if they try to compensate.
Rotate your right arm in an arc against the wall moving towards the right. Follow your hand with your eyes the entire time to incorporate the cervical spine with the movement. Slowly rotate your arm so when your arm is pointing straight up towards the ceiling, the outside of your arm and hand is against the wall. As you continue to turn towards the right, keep rotating your arm so your palm is against the wall.
Perform 2-3 sets of 10 reps, then repeat on the other side.
Prone T
This exercise will be performed face down. Roll up a towel and rest your forehead on the towel for more comfort.
With your thumbs facing the ceiling, bring your arms up to shoulder height with your elbows straight. This is your “T” position. Squeeze your shoulder blades together while keeping the back of your hands reaching upwards towards the ceiling. Your elbows and hands should lift off of the ground towards the ceiling.
Squeeze and hold your shoulder blades together for up to 10 seconds, then slowly return back to the starting position. You should feel the muscles between the shoulder blades working on this exercise.
Perform 10 sets of 10 second holds. If this is too challenging at first, hold for 5 seconds and work your way up to 10 second holds.
Preventing Rhomboid Pain
While it is impossible to prevent ourselves from ever sustaining an injury or preventing any other form of pain throughout the body, there are ways we can reduce the risk of developing pain and injuries. Here are a few different tools you can try incorporating to help prevent rhomboid pain from showing up.
The Importance of Upper Back Mobility
Thoracic mobility is important because it is an area of the body that should be mobile. For optimal function, the body alternates with areas of stability followed by areas of mobility. What happens with a lot of people is that the thoracic spine becomes stiff over time. When the thoracic spine becomes stiff, this throws off that alternating chain of mobile and stable areas of the body. To see this in action, head over to this post and check your upper back mobility.
Over time, the tendency is for the thoracic spine to become more flexed and lose its range into extension. Working on thoracic extension and rotation exercises can help address these concerns. Not only is it important for reducing the risk of developing rhomboid pain, but it can help with so many other things. This includes neck pain, shoulder pain, and low back pain.
Strengthen Your Rhomboids
While it’s important to focus on thoracic mobility, you still don’t want to forget about strengthening. So many of my patients and clients benefit from strengthening. Proper tissue loading is needed to build strength. What you want to make sure of is that you are dosing yourself appropriately and that you are targeting the correct area. This also includes emphasizing form through the rest of the body.
A physical therapist can help guide you through which exercises will target the rhomboids and be able to dose exercises appropriately for your needs while reducing the risk of injury.
If you are looking to begin working with a physical therapist about your rhomboid pain (or any other pain for that matter), contact me here. You can send me a message about any questions or concerns you may have and I’ll get back to you in a timely manner!
Don’t Forget About Posture
Posture is one of the biggest contributors to rhomboid pain. Although thoracic mobility and rhomboid strength are both necessary, posture lays the foundation for all of it.
Poor posture, especially in today’s digital age, leads to muscle imbalances. The imbalances place strain on the rhomboid muscles and contribute to both shoulder and upper back pain. To prevent this from happening int he first place, focus on your posture. It is never too late to start.
Simple adjustments in both sitting and standing can have a profound effect. Creating an ergonomic setup in your workspace can vastly help with posture. This reduces strain on your neck, shoulders, and upper back. Pair this with postural endurance exercises and this will really help with those daily aches and pains you can after a long work day.
Related Posts on Posture and the Upper Back
- Thoracic Mobility Exercises: Unlock Your Body for Pain Relief
- How to Use a Foam Roller for Upper Back Pain
- What You Should Know About Tech Neck: Relieve the Pain
- What is the Correct Sitting Posture?
TL;DR
Rhomboid pain is an issue that affects the upper back in the area between your shoulder blades. While the pain can possibly be coming from the cervical or thoracic spine, the rhomboid muscle can be the culprit. Common reasons for this are poor posture, muscle strains, and overuse injuries. This post reviews common reasons for developing pain in this region, what exercises to perform to help relieve rhomboid pain, and other tips and tricks to prevent it from occuring.
Tera Sandona is a licensed Doctor of Physical Therapy (DPT) and the founder of PT Complete. She helps high-achieving women break out of cycles of chronic pain, stress, and burnout through her Regulate and Rebuild Method, a sequenced approach that addresses the nervous system first and builds strength second. Her work focuses on helping women finally understand their bodies, rebuild strength, and create lasting resilience that fits real life.
