Rhomboid Pain (Shoulder Blade Discomfort)

Welcome to E3 Rehab. I’m Dr. Marc Surdyka, physical therapist.

Today, I’m going to discuss “rhomboid pain”, why it’s actually probably not your rhomboids, and recommend some practical lifestyle modifications and exercises to help. Let’s get into it!

Do you experience a deep, dull aching pain along the medial border of your scapula, or that area between your shoulder blade and spine? Have you tried stretching or rolling this area with a lacrosse ball or foam roller only to get temporary relief? Considering the location of the rhomboids, many individuals are led to believe that their discomfort originates from a strain or trigger

point associated with these muscles. However, the rhomboids are rarely the culprit so in order to find a long-term solution, we should take a step back and consider a more holistic approach.

So if it’s not your rhomboids, what is it and why are you experiencing discomfort in this area?

A landmark study by Dr. Ralph Cloward in 1959 applied stimuli to different aspects of the cervical intervertebral discs on conscious patients and had them report where they experienced discomfort. As you can see from the images, a common location for pain was in this interscapular area.

Other studies have replicated this finding as it relates to the discs such as Slipman et al in 2005. And Dwyer et al 1976 is well known for stimulating the zygapophyseal joints in asymptomatic subjects and mapping their reported pain.

The last consideration, and kinda the focal point of this video, relates to irritation of the lower cervical nerves. You might generally associate this irritation with neck pain and pain down the arm in a nice dermatomal distribution, but Murphy et al 2009 found that occurs in less than ⅔ of cases and around 50% of people report pain in that rhomboid area.

In fact, Tanaka et al. 2006 reported “scapular region pain is generally the initial symptom in radiculopathy and can persist alone before the arm or finger symptoms develop.”

And in some cases, it might be the only symptom that ever really occurs.

So although you might be experiencing discomfort in the rhomboids, that sensation is likely more of a secondary response.

Also, I understand that issues with the neck or a nerve sound scary to a lot of individuals, but it doesn’t mean anything is damaged, pinched, etc. I just like to think of it as something being sensitive.

A key tenet in rehabilitation is to modify the modifiable contributing factors. For example,

if you’re worried about experiencing a heart attack, your age and family history are non-modifiable risk factors. You can’t change those. However,

you can change your smoking, dietary, or exercise habits. Those are modifiable.

In the case of this scapular pain, three aspects of your life worth examining are stress, sleep, and prolonged inactivity as they might be contributing factors. However,

I also understand that sometimes these things aren’t really modifiable secondary to unique circumstances like a newborn child or a deadline at work. Change what you can, don’t worry about what you can’t. And I know these things aren’t a sexy quick fix, but they’re really important.

For prolonged inactivity, keep it simple - if you know you’re going to be stuck at the computer for hours on end, plan some active rest breaks if you’re able to like walking or the exercises I'm going to outline. As far as posture goes, don’t try to maintain a quote on quote perfect posture.

You might feel better sitting up tall while someone else feels better slouching, but more than likely, you’re going to frequently alternate positions and find what’s comfortable for you. Trying to maintain your shoulders down and back all day can actually exacerbate symptoms.

for you. Trying to maintain your shoulders down and back all day can actually exacerbate symptoms. Poor sleep quality and/or quantity can magnify symptoms as well and discomfort can also make it difficult to fall asleep. Once again though, if your sleep is impaired for reasons out of your control, no worries. However, if it’s impaired because you’re drinking caffeine at night or staring at your phone in bed, those might be things worth changing.

Now if you can’t get comfortable, this recommendation is similar to posture - there’s not a perfect neck position. So explore options: lying on the affected side, on the unaffected side, 1 pillow, 2 pillows, flat on your back, or head and neck elevated. There are various reasons why different positions can help alleviate symptoms for different individuals,

but the most important thing here is making sure you’re comfortable Finally, Stress can also increase the sensitivity of nerves so if you notice your symptoms are triggered by high stress situations, you can try to alter the situation or your reaction to it.

But if you can’t, no big deal. Plenty of other things to focus on.

I’m going to provide a sample exercise progression and relevant parameters but I need to highlight that the theme here is based on a simple, practical quote from Louis Gifford - Start easy, build slowly.

For a sensitive nerve, more isn’t always better so unlike many other exercise recommendations, the goal here isn’t instantaneous relief - it’s a long-term plan. The

movements should be tolerable and shouldn’t cause an exacerbation of symptoms later on or the next day. If they do, you probably just need to scale back a bit.

The first exercise is this side lying thoracic rotation which will guide your cervical spine through rotation and your thoracic spine through extension and rotation while also moving your shoulder and nervous tissue through a large range of motion. To progress this, you can perform this movement in half kneeling against the wall.

The second exercise is just a global cat/cow to take your cervical and thoracic spine through flexion and extension while moving your scapula into protraction and retraction.

To progress this, you can slow down the movement and focus on the upper back and neck by sitting onto your heels.

The last exercise is a serratus wall slide to take your shoulder through flexion and protraction using a foam roller or pillowcase.

To progress, you can move to a weight bearing alternative such as the dolphin pose.

I recommend these movements periodically throughout the day, every couple of hours or so, to help break up those prolonged periods of inactivity and you can just do each movement for 30-60 seconds to focus on quality and see what feels good for you.

Well that’s it. Thank you so much for watching. Please, if you liked the video, leave a thumbs up, subscribe, leave some comments or questions down below, and head over to our website e3rehab.com to check out our blogs, podcasts, programs, and more. Peace!