Rhomboid Trigger Points and Referred Pain Patterns

Before you read on about trigger points in the rhomboid major and minor muscles, you may want to learn more basic information about the rhomboid muscles.

As stated in the article linked above, the rhomboid major and minor muscles are active when performing exercises like the pullup or when drawing back on a bowstring. In other words, they are active anytime you lower your arms forcefully or pull back and down with them. They are also active during walking and during throwing movements.

One of the most popular strength training and muscle building exercises, the shrug, is meant to strengthen and add mass to the upper trapezius. However, this exercise may just as likely overemphasize the rhomboids because the shoulders are held in downward rotation, making the rhomboids active over the upper trapezius and lower trapezius, which cause upward rotation. This can also contribute to levator scapulae dominance in the same way.

Trail Guide to the Body's Quick Reference to Trigger Points 1st (first) Edition by Biel, Andrew published by Books of Discovery (2012)
Trail Guide to the Body’s Quick Reference to Trigger Points

This leads to short and overactive rhomboids. It may be better for some people to perform overhead shrugs so that the scapula are upwardly rotated, thus emphasizing the upper trapezius, which cause upward rotation. The activity of the serratus anterior muscle must also not be overlooked, as it is a force couple with the upper and lower traps, upwardly and laterally rotating the scapula. It is also the major scapular abductor, in direct opposition to the rhomboids, thus may become weak or even paralyzed. the serratus anterior holds the shoulder blade flat against the ribs and if not functioning properly as a scapular stabilizer, causes many problems with shoulder movement.

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The TriggerPoint GRID Foam Roller Is Great for Rhomboid Pain

Habitually working in in a slumped-forward, round-shouldered (protracted) position, as with computer or other desk work and many other occupations cause the pectoralis major and minor to become shortened and hypertonic, thus stretching out the rhomboids and causing them to become very tired, leading to overwork, weakness, and trigger points. Too much bench pressing with shoulders protracted as well as too much internal rotator work in general help lead to this same problem.

Rhomboid Trigger Points Causes and Symptoms

Several common causes of rhomboid problems, trigger points, and pain, are discussed above. Tension in the upper body, that keeps the shoulders raised causes rhomboid strain just as it does many other muscles in this area, such as the trapezius, levator scapulae, etc. Other problematic habits and activities are:

  • Military posture – continually pulling the shoulders back
  • Throwing a ball, as in baseball pitching
  • Rowing a boat
  • Anything that requires you to repeatedly raise and lower the shoulders
  • Upper thoracic scoliosis
  • Tight pec muscles (as mentioned above)

Those with a round-shouldered kyphotic posture should first work on their tight and over-active pectoralis major and minor. Stretching these muscles out and deactivating the trigger points in them must be done first, before you can begin to relieve the pain caused by the rhomboids. When the pecs are tight, the rhomboids will be stretched and in a continual eccentric contraction, being stretched while trying to pull back and counter-act the pull of the pecs. If you stretch the rhomboids when they are in this shape, you’ll only add to their problems. You may not feel any pain as a result of the pectoralis problems, but the strain caused in the weaker interscapular muscles will cause pain in this area.

Rhomboid muscle trigger points
Rhomboid Trigger Points

Trigger points in the rhomboids refer pain nearby to the inner edge of the scapula, which manifests as a superficial, aching pain between the shoulder blades, closer to the scapula than to the spine. Snapping, grinding or crunching sounds when the scapula is moving may mean that the rhomboid is involved 1Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 425-430. but it can be difficult to distinguish exactly when the rhomboids are causing between the shoulder blades pain because there are actually ten other muscles which also refer pain to this region: the levator scapula, scalenes, infraspinatus, latissimus dorsi, serratus anterior, lower trapezius, iliocostalis thoracis, serratus posterior superior, and thoracic multifidi. 2Ferguson, Lucy Whyte., and Robert Gerwin. Clinical Mastery in the Treatment of Myofascial Pain. Philadelphia: Lippincott Williams & Wilkins, 2005. 213-217.

Trigger points in these muscles may need to be treated before rhomboid trigger points become apparent. Paraspinal muscles can also cause pain in the same area of the back but this will be closer to the spine.

Rhomboid Trigger Point Treatment

Rhomboid trigger points can be treated with a massage ball, tennis ball, Thera Cane or Body Back Buddy.

To use a tennis ball, place the ball against a wall and place your back against it so that it makes contact with the area just inside your shoulder blade. You may want to first place the ball in a long sock so that that end of the sock can act as a handle. Roll up and down letting the ball massage the muscles in this area. You can also lie down on the ball and roll on it but this will not work as well for heavier people since the ball will deform. A lacrosse ball can be used for more pressure, as treatment is extended and you can withstand a harder tool and more pressure. A spikey massage ball also feels fantastic on the rhomboids. When you find a particular trigger point, which will be hypersensitive and may even be palpable as a knot, concentrate on that area and apply more pressure. Treat several times a day for several minutes.

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For treating this area and getting to the trapezius and underlying serratus posterior, the Grid Foam Roller works well and provides great general trigger point massage. But don’t rely on this completely as you’ll want a precision tool to find and treat individual points.

For more information on finding and treating associated trigger points see the Trigger Point Therapy Workbook. 3Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004.,4Hertling, Darlene, and Randolph M. Kessler. Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. Philadelphia: J.B. Lippincott, 1996.,5Sahrmann, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, 2002.,6Kendall, Florence Peterson, and Florence Peterson Kendall. Muscles: Testing and Function with Posture and Pain. Baltimore, MD: Lippincott Williams & Wilkins, 2005.

 

Sources   [ + ]

1. Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 425-430.
2. Ferguson, Lucy Whyte., and Robert Gerwin. Clinical Mastery in the Treatment of Myofascial Pain. Philadelphia: Lippincott Williams & Wilkins, 2005. 213-217.
3. Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004.
4. Hertling, Darlene, and Randolph M. Kessler. Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. Philadelphia: J.B. Lippincott, 1996.
5. Sahrmann, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, 2002.
6. Kendall, Florence Peterson, and Florence Peterson Kendall. Muscles: Testing and Function with Posture and Pain. Baltimore, MD: Lippincott Williams & Wilkins, 2005.