Rhomboid Muscle Sprain, Pain, and Treatment with Graston Technique, ART, and Massage Therapy
Rhomboid muscle sprains and strains are common with repetitive activity and poor posture, especially when the muscles are trying to stabilize the scapula during forceful arm and shoulder movements. When we refer to the rhomboid muscles, we are actually talking about two distinct muscle groups. The rhomboid minor muslce starts on the spinous process of C7–T-1 and sits above the rhomboid major. The rhomboid major starts on the spinous process of T2–T5. The muscles travel across the back of the thoracic cage and insert on the medial border of the scapula. The rhomboids insert on the scapula from the spine and down the medial border to the inferior angle. The rhomboid major and minor muscle action is to retract the scapula toward the spine and cause downward rotation of the scapula. The muscles are controlled by the dorsal scapular nerve which has a major branch from the C-5 nerve root. The muscle fibers run in a downward direction from the spine to the scapula.
The rhomboid muscles help stabilize the thoracic spine with standing, sitting, walking, turning, and twisting movements. Sitting and slouching at a computer for long periods of time stretches the rhomboid muscles and place excessive stress across them as they attempt to maintain spinal postures.
Symptoms and Causes of Rhomboid Muscle Pain
People commonly feel pain in their upper back and shoulders. Many times they beg their co-workers, friends, and family family for back rubs to relieve their aching muscle pain. They complain that most of their pain and muscle soreness is located between their shoulder blades.
The rhomboid muscles are commonly injured when they are overworked with poor posture, deconditioning, bending, twisting, slouching, hard coughing, carrying over-loaded backpacks, or lifting heavy weight. It is sometimes more prevalent in people with scoliosis, degenerative arthritis, gender of arthritis, thoracic compression fractures, chronic neck pain, and headaches.
Athletes in throwing or swinging sports often experience pain in the upper back related to the rhomboid muscle sprains and strains. Baseball, tennis, racquetball, pickleball, cricket, and football are common sports in which athletes experience rhomboid pain. Tendinopathy, or tendinitis, is common in the rhomboid, levator, and trapezius muscles where they insert on the scapula. With chronic poor posture, fascial adhesions or scar tissue develop between the muscle fibers and muscle bundles. Over time, scar tissue accumulates into larger patches and collections of poorly functioning muscle and tendons. Eventually muscles and tendons become sore and painful to the touch. People describe painful knots in their rhomboid and trapezius that increase in size over time.
Some people describe these knots as the first place that becomes sore, and dull pain increases with poor posture or activity. Many times upper back or neck pain begins in these knots and radiates down the back, across their shoulders, into the arm, or up to the head and jaw area. Often patients with chronic tension or migraine headaches complain of rhomboid muscle pain and trigger points that increase when sitting at a computer for prolonged periods of time.
With acute or traumatic rhomboid muscle sprains, ice therapy should immediately be applied to decrease pain and inflammation. Ice can be utilized several times a day. It should be applied for 15 minutes, then removed for 15 minutes. Repeat the cycles several times. With mild muscle sprains and strains, the pain should resolve in several days to a week. If the pain persists or increases in intensity, further evaluation may be indicated.
Evaluation and Treatment of Upper Back Pain
Your healthcare provider will conduct a thorough examination of the neck and upper back. Several questions will be asked regarding the activity in which the pain was first felt, recreational activities, work positions, previous injuries, and history.
Your chiropractor or primary care physician may or may not order x-rays, depending on physical exam findings. With soft tissue, muscle, and tendon injuries, x-rays are often not needed. If your provider feels a more severe injury may have been sustained, plain film radiographs (X-rays) may be performed of the neck and upper back for further evaluation. MRIs (magnetic resonance imaging) and CT (computer tomography) are not usually indicated in the early stages. The advanced imaging may be utilized if a patient fails to respond to care, has difficulty breathing, or has fractures to the cervical spine, thoracic spine, ribs, or scapula.
Your physician may prescribe pain medication or muscle relaxers to help with acute or chronic injuries. NSAIDs (nonsteroidal anti-inflammatory medication) such as ibuprofen may be prescribed for home use instead of prescription medication. Trigger point injections may help decrease muscle spasms and pain. Often trigger point injections are not needed, except in severe cases of upper back pain or headaches.
Conservative Management and Treatment of Rhomboid Sprains
Initial goals of treatment are to decrease pain and inflammation in the rhomboid major and minor muscles. In the clinic, therapeutic procedures utilize ice, heat, electric therapy, light stretching, and light exercise to control pain and enhance movement. Initial goals are to decrease dull and sharp pain while returning the patient to previous activity levels.
Home, work, and recreational activities may be modified depending on the injury severity. Individuals whose work or recreational activities require significant amounts of upper back, trapezius, rhomboid, or shoulder activity may be asked to avoid these positions and activities for several weeks until the muscles and tendons have a chance to heal.
Advanced sports medicine and muscle techniques can be utilized to enhance healing and recovery. Massage therapy, manual therapy, Graston Technique, acupuncture, and Active Release Technique (ART) are common treatments performed for all muscle sprains and strains. Deep massage therapy, manual therapy, and Active Release Technique are excellent at working the muscles to break up fascial adhesions and decrease muscle spasms.
The first several sessions may start with lighter intensity and progress to deeper muscle work as a patient continues to improve and recover. Graston Technique is an excellent therapy for decreasing scar tissue and fascial adhesions between muscle fibers that have accumulated over time in the rhomboid muscles. With chronic poor posture and repetitive activities, the scar tissues create patches or knots of scar tissue in the rhomboid muscles as well as on the tendon insertion on the scapula and thoracic spine. Graston Technique is better at breaking up scar tissue between muscle fibers than massage therapy or Active Release Technique. Graston Technique it is also an excellent technique for breaking up scar tissue on the tendon as it inserts on the spine or scapula.
Stronger stretching will be incorporated to enhance flexibility of the rhomboid and shoulder muscles. Neuromuscular exercises are often incorporated to increase scapular stabilization and strength. Often rhomboid, trapezius, and levator scapula muscle strains and tendinopathy occur because of lack of scapular stabilization. Specific stability exercises can be performed in the office and at home to increase strength and endurance in all the muscles of the upper extremity and to increase functional movements between the upper extremity and torso. Combining scapular stabilization with neck, upper back, and lower back strengthening exercises helps improve posture and decreases pain from prolonged sitting at work or in the car.
Shoulder stretching and back exercises can be found on the exercise pages.
Rhomboid muscle sprains and strains can successfully be treated in the office. These treatments can improve both acute and chronic rhomboid sprains.
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