Rhomboid Pain: Why the Muscle Between Your Shoulder Blade and Spine Hurts and How to Relieve It

01Anatomy

Where the rhomboids are and what they do

There are two rhomboid muscles on each side: the rhomboid minor, higher up, and the larger rhomboid major below it. They run from the spinous processes of the lower neck and upper back (roughly C7 to T5) to the inner border of the shoulder blade. They lie under the trapezius, so you cannot see them directly.

Their job is to pull the shoulder blade towards the spine (retraction), help rotate it downwards and hold it flat against the rib cage. They work hard when you row, pull, carry and when you hold your arms in front of you for long periods, as at a keyboard.

02Causes

Common causes of rhomboid pain

• Sustained posture: sitting with the shoulders rounded and the head forward keeps the rhomboids in a lengthened, constantly working position; see forward head posture.
• Overuse: rowing, climbing, pull-ups, throwing, painting a ceiling or carrying a heavy bag on one shoulder.
• Strain: a sudden reach or lift can overstretch the muscle and cause a sharp pain that then turns into an ache.
• Trigger points: sensitive knots in the rhomboids and middle trapezius that refer pain locally; see muscle knots.
• Sleeping position: sleeping on the side with the top arm across the body can overstretch the muscle.
• Stress: muscle tension in the upper back often increases with stress and poor sleep.

03Other causes

Pain in the same area that is not the rhomboid

• Neck problems: a trapped nerve or irritated joint in the lower neck can refer pain to the area between the shoulder blades, sometimes with arm pain or tingling; see pinched nerve in the shoulder.
• Rib and spinal joints: pain that is sharper with deep breathing, twisting or coughing can come from the joints between the ribs and the spine; see back rib pain and back pain when breathing.
• Shoulder blade muscle strain: other muscles around the shoulder blade, such as the levator scapulae, cause similar pain; see shoulder blade muscle strain.
• Internal organs: heart problems, gallbladder disease and, rarely, lung or aortic conditions can cause pain between the shoulder blades. These are usually not affected by moving the arm or pressing on the muscle.

For a broader overview, see pain between the shoulder blades.

04Self-check

Signs that the pain is muscular

• You can press on a tender spot that reproduces the pain.
• It is worse with certain movements, such as pulling the shoulder blades together or reaching across your body.
• It eases with heat, movement or massage.
• It changes with posture and is worse after long periods at a desk.
• There are no breathing problems, fever or chest symptoms.

05Relief

How to relieve rhomboid pain

• Move little and often: get up every 30 to 45 minutes; roll the shoulders and gently squeeze and release the shoulder blades.
• Heat: a warm pack for 15 to 20 minutes relaxes the muscle; ice can help in the first day after a sudden strain.
• Self-massage: lean against a wall with a tennis or massage ball between the spine and shoulder blade and roll slowly for one to two minutes.
• Adjust your workstation: screen at eye level, keyboard close, elbows by your sides and feet flat.
• Change how you carry: use both shoulder straps or a wheeled bag.
• Painkillers: paracetamol or an anti-inflammatory gel or tablet if suitable for you.

06Exercises

Stretches and strengthening exercises

• Upper back stretch: clasp your hands in front, round your upper back and push your hands away to spread the shoulder blades. Hold 20 to 30 seconds.
• Thread the needle: on hands and knees, slide one arm under the body and rotate the upper back, then open the arm towards the ceiling. Repeat 8 times each side.
• Thoracic extension over a towel or foam roller: lie with a rolled towel across the upper back and gently extend over it.
• Rows with a band: pull a band towards your lower ribs, squeeze the shoulder blades gently together and down, and return slowly. 2 to 3 sets of 12.
• Prone Y and T raises: lying face down, lift the arms in a Y or T shape with thumbs up, holding two seconds.
• External rotation with a band: see shoulder external rotation.

Strengthening is as important as stretching: a rhomboid that is weak and constantly overstretched by posture tends to keep hurting. Combine these with the posture exercises guide.

07Physiotherapy

How a physiotherapist can help

If the pain lasts more than two to three weeks or keeps coming back, a physiotherapist can check the neck, upper back, ribs and shoulder blade movement to find the true source. Treatment may include soft tissue techniques, trigger point therapy, joint mobilisation of the upper back and ribs, and a progressive strengthening programme with workstation and sport advice. Most people improve within a few weeks.

09Summary

Key points to remember

• The rhomboids hold the shoulder blade towards the spine and are often overloaded by posture and pulling.
• Muscular rhomboid pain is tender to touch and changes with movement.
• Heat, posture breaks, self-massage and shoulder blade strengthening help most people.
• Pain with chest or breathing symptoms needs medical assessment.