[Muscle Monday] Nagging Shoulder Blade Pain Got You Down? - Consider the Rhomboid Major and Minor

Have you ever wondered why you may be getting pain between your shoulder blade and spine?
For the second installment of our posture series, we will be discussing the Rhomboid Major and Minor.  While they are two muscles, they almost always work together.  Over the next few posts, we will be exploring some of the major muscles related to posture and how they work together.  If you'd like to read our previous posts about posture, click here.

Let's get things started.  Allow me to present to you the Rhomboid Major and Minor:

This dynamic duo attaches to from the spinous process of the last cervical segment (C7) and upper thoracic spine (T1-5) to the medial border of the shoulder blade.  It sits one layer underneath the trapezius muscle, which we discussed in a previous post.  The rhomboid minor is located superior/above the larger, broader rhomboid major muscle.  Both work together to pull the shoulder blade towards the spine, otherwise known as "scapular retraction."

Image source:  Complete Anatomy

This muscle is essential to the stability of the whole shoulder complex as it works to keep the shoulder blade supported during arm movements in all directions.

The rhomboids can be a common source of pain in the area between the spine and your shoulder blade. Often times people will report pain, dull, aching or occasionally sharp pain to that region. This pain is very common in people who do a lot of prolonged work at a computer (particularly in the mousing hand), as well as musicians who have to hold their instruments in one position for long durations (flutists, violinists)

One thing that should be acknowledged is that people can feel pain in other areas aside from the actual tissue source.  The picture below demonstrates some common referral patterns where people may experience symptoms when there is a trigger point on the rhomboid ('X' marks the spot).  

Image Source: Simons & Travell (1999)

It is imperative that I warn you that 'trigger points' are not the only source of pain that can refer in this location or pattern. For example, there are joint-related pain that can also refer pain to similar areas. One of the most common ways that cues clinicians like me to suspect muscle-related/trigger point pain (other than palpating the muscle) is if patients often describe the pain as coming on after a prolonged period of time and they have to fidget around or change positions frequently to find a more comfortable posture. If you are unsure, be sure to seek out help from your friendly Physical Therapist (including us) to help you navigate this issue and help steer you back onto the right path.

Cervical facet referral patterns

We will discuss trigger points and what they actually are in an upcoming post.  

When looking at overall posture, these muscles are significant because when in a slouched posture, these muscles are commonly in a stretched position. This makes it more difficult for them to generate the amount of force needed to help hold the scapula in place. Remember this image?

The harder these muscles have to work, the less time it takes for them to start to fatigue, which can be interpreted by your brain as that dull, aching sensation that you may feel.
The best way to avoid this fatigue is to make sure that you have enough flexibility in the opposing muscles, such as the pectorals and the upper trapezius, and enough strength in the supporting muscles.
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Check out our post on Instagram for some ideas of some simple exercises you can do to get things moving in the right direction.

Can't wait to share more about posture next week

Until next time, stay happy and healthy!