Rhomboid Pain (Shoulder Blade Discomfort)

Blog with all references: e3rehab.com/blog/rhomboidpain

Intro (0:00)

Rhomboid Pain (0:15)

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.

It’s Not Your Rhomboids (0:45)

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 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.

Lifestyle Modifications (2:17)

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.

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.

Exercises (4:35)

Outro (6:41)

Continued at the blog: e3rehab.com/blog/rhomboidpain

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Disclaimer: The information presented is not intended as medical advice or to be a substitute for medical counseling but intended for entertainment purposes only. If you are experiencing pain, please seek the appropriate healthcare professional.

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