It’s quite common to have patients in clinic with a nasty, nagging pain that presents between the spinal column and the medial border of the scapula.
There can be several reasons for this, meaning, it could be muscle tightness, muscle weakness, myofascial trigger point build up, nerve entrapments, etc. All these issues are manageable, given the right strategy. That being said, even though we get results within treatments, in many cases it’s only a matter of time before the same issue is back, and causing us the same nagging pain that stops us from performing well at the gym, at work, and just in life. So that leaves us wondering, are we treating the source of the problem, or just superficial symptoms?
To explain this further, we'd need to get into a bit of anatomy and physiology. The Rhomboid muscle is one of the many muscles in that area. It's main job is to stabilize the Scapula, and to foster a solid foundation for the arm to move and transfer energy. If the Scapula is stable, all goes well, and efficient pulling and pushing power is possible. iI the Scapula is unstable however, our shoulder muscles lose their delivery power and become stabilizers in an attempt to keep the shoulder joint safe. If this happens, we don’t only lose pushing and pulling power, but we lose tons of mobility, and the shoulder itself tends to become stiff. This is basically a safe-guarding strategy of the nervous system to avoid further injury, so that stiffness is actually a good thing because it’s telling you that something is wrong, and that the wrong thing isn’t necessarily at the shoulder, but generally somewhere else..
So, to put it simply, when the Rhomboids have been working too hard for too long, in trying to keep the Scapula stable, they tend to build trigger points which cause all of those nasty pain-like symptoms along the middle of the back on the same side of the issue.
So what now? Well, releasing a weak muscle may only make the entire situation worse as it would contribute to making this muscle even LESS capable of keeping the Scapula stable. (so basically, it is now weak AND unstable). In doing this, we would be forcing the Rhomboids to work even harder, therefore likely building more trigger points and creating more issues in the shoulder and everything around it, or that works along with it. Not good!
So now, this leaves us with the question: Why are the Rhomboids so tight? Why are trigger points being created? So glad you asked! To answer this, we'll first have to go into a little anatomy: The Rhomboids aren’t the only muscle that influence scapular stability. The middle fibers of the Trapezius muscles – or just the mid-traps – can also stabilize the Scapula medially. The Trapezius (or mid-traps) are more involved in actual movement of the Scapula as they help move the Scapula medially towards the center of the body (towards the spine). These muscles are commonly weak in people due to bad posture, too much chest exercises, too little posterior work, sedentarysm, etc. If they aren’t working enough, they tend to leave the Rhomboids working by themselves, causing dysfunctional patterns and muscle imbalances.
So no, you can’t just release the Rhomboids without activating the mid-traps; you need them working together; you need to down-regulate one, and immediately up-regulate the other. It’s all about balance and homeostasis. If you only massage the area, you’ll definitely get the mid-trap first since it’s more superficial. If you use a lacrosse ball or a foam roller, you still have to go through the mid-traps. If you just constantly rub the area, you might just irritate the whole area even more. Soft tissue release techniques such as Functional release or Active Release Technique (ART) are the only manual therapy that can affect deeper muscles without compromising the most superficial ones. How? It is all about movement, about the relative movement that is provided by both the therapist and the patient. ART uses highly skilled movement techniques that isolates and moves certain muscles while keeping others at rest. This technique applies to muscles, ligaments, tendons, fascia, nerves, and even vascular structures.
So how do we know if this particular case applies to you? Well, we don’t know. We must assess and go from there. Thats said, let us take you through the right assessment and we’ll determine the right technique, and the right rehab option for you. Even with all the information available on the internet, today.. there is sadly no "one size fits all" or fail proof recipe, when it comes to personalized treatment.