T Nation

Rhomboid Injury


#1

Hi all

I have been suffering from a recurring rhomboid injury for about 8-10 months. It first arose after a session of squats and has since reoccurred after many different types of movements, including upright rows, overhead presses and, more recently, dips.

I can generally tell when I have hurt the muscle, so cease training and employ the RICE method. The rhomboid area will later develop a sharp pain that I can feel whenever I twist my torso or look down.

I have been to various GPs and physios. They generally tell me that I have strained the muscle, recommend I take a couple of weeks off the gym, take Celebrex, have it massaged and apply heat. I do this and the pain goes away usually in less than a week.

My concern is that the injury continues to come back, and over the last few months it has been re-occurring much more frequently. My physio thinks the root of the problem is my office and the fact that I have spent a lot of time looking down to read (I was a student and am now a lawyer). My office has for the last few weeks been much improved and I have equipment which will limit the amount of time I spend looking down (although it won't eliminate it).

My last injury was 1.5 weeks ago. The pain has gone, but I am taking a further week or so off before I start training again. When I re-commence training, I plan to do the following:

  • warm up on a cardio machine which involves your arms for 5-10 mins;
  • complete 2-3 sets of an exercise for rhomboids (probably lie face down on a bench and row light dumbbells to armpits)
  • stretch rhomboids at the end of every workout
  • ice rhomboids at the end of every workout

My question relates to whether you guys have any comments or feedback in relation to:
1. whether any of these strategies are good or bad; and
2. whether there is anything more I can do to prevent the injury from re-occurring.

Thanks in advance for any help.


#2

I had problems with rhomboids when I was heavier doing pullups, try doing scapular pulldowns,on lat pulldown machine, also if you can get stim treatment from physio/ chiro will help. You can try standing in corner of a room and put hands in push up position on each wall and lean into wall stretching scapular/ rhomboid region. hope this helps


#3

You could try myofascial release with a tennis ball.

Lean against wall with the ball sandwiched between your upper back and the wall.

Do it everyday.


#4

Thanks for the advice. Wouldn't doing what you have suggested stretch the pecs though?


#5

Good idea. I have been foam rolling, but it really doesn't work well on the rhomboids.

I bought a hard ball and have been using that the last 2 days. It seems a lot more effective than using the foam roller.


#6

In addition to the tennis ball you can also try a lacrosse ball.

There is a product called the Thera Cane that will allow the user to actively pinpoint the adhesions.

Obviously, a visit to a skilled therapist is the most effective solution. Perhaps a weekly (or every two weeks) visit and doing the thera cane (or something similar) EVERY day might be worth a shot.

I also believe that you need to have your sitting position in the office analyzed and take the appropriate measures in adjusting desk height, type of chair, etc. Also, it certainly won't kill you to stand up every 15 minutes or so to stretch and change body position.

In addition to working on the adhesions and stretching on a regular basis, you may want to consider strengthening the subscapularis and serratus anterior (if you are not already doing so) as these muscles act to protract the scaps. You may be the rare lifter who isn't overactive in that regard (most guys who bench too much need work that REtracts and depress the scaps).

The rest of this post is optional, however, I prefer you take the time to read it.

I strongly suggest you stop the upright rows. There is a test orthos and PTs do called the Hawkins test. In that test, the examiner purposely elevates the upper arm to 90 degrees of abduction and internally rotates to create an impingement at the shoulder. If you google this test, it looks very similar to the upright row. To add resistance (loaded barbell) and perform this motion is asking for trouble.

The way in which most people perform the movement involves some activation of the upper traps. The upper traps elevate the scaps. Rhomboids (along with mid traps) retract the scaps.

Now, I don't know if the upright row is also causing your rhomboid issues. You said yourself you hurt it squatting. Logically, one would surmise that over-activity in scapular elevators has nothing to do with chronic pain in scapular retractors. However, we know the body doesn't always respond in a logical manner. Since my job as a personal trainer is to explore all possible causes of a client's issue, I don't think you should rule out the possibility that overactive upper traps may have some negative effect in your rhomboids. Regardless, if you continue with the upright rows, you may end up with impingement issues on top of (no pun intended) the rhomboid issue.


#7

Thanks for your suggestions.

The Thera Cane looks good! Do you think it is much more effective than using a hard ball?

I don't do upright rows anymore for the reasons you mention. Even when I was doing them, it was only occasionally.


#8

OP, have you considered that there may be an underlying issue with your ribs? I had a similar situation in which I was told the muscle strain or muscle tear was the most likely culprit (I too was hurt during squats). However, 4-5 months later I still had this recurring issue. Through my studies (exercise science/nutrition and dietetics) I have a pretty good knowledge of anatomy and physiology etc so I knew that they something was defiantly wrong, but it doesn't take a genius to realise that muscle should not take this long to recover.

I finally spoke to a very good chiropractor over the US (I'm in Australia) who said this sounds like a common injury with bull riders and is commonly dismissed by others as muscle strain. What can actually happen is that ribs can become subluxed and the pain is felt n that rhomboid area. So my best advice would be to see if you can see a good chiropractor. I don't know if your issue was as bad as mine, but it takes time, and it sucks, but don't get discouraged.

Its been about 8 months for me since the initial injury and I've just started making steady progress (only been w/ chiro for 2-3 months). I read your post and could not believe you were dealing with what sounds like the exact same thing, so I had to become a member (I've been on this site for a while though) to let you know. Im pretty good with injuries of the shoulder complex (through my studies, which I seem remember very well due to experience haha) but at the same time I'm still an undergrad so I'm no expert.

I need to focus on uni so you probably won't see me posting on this site too much, but if you (or anyone else I guess) have anymore issues or questions then just let me know, I'm happy to help since it helps me learn/remember stuff. Good luck man, sincerely, I know how much it sucks to be out of the gym this long.


#9

Re: Thera Cane

It's more precise than the tennis ball/lacrosse ball method. That's a huge plus, in my book. Another advantage is that you can perform the SMR while sitting upright; so you can do this in your office or at home while watching tv.


#10

Thanks for signing up to reply to my post!

I decided to see a chiro last Friday. I don't think I have subluxed ribs, but the chiro thinks the underlying cause of my rhomboid strains is a strucutral problem which is affecting my ribs.

In short, my right shoulder is lower than my left, and this is creating torque on the ribs. The chiro said he will be able to tell me exactly what's involved in correcting it when I go back in a week. Until then, I just have some exercises to do at home.


#11

Nice. Keep me updated man. It'd be nice to know what exercises he has you doing because my right shoulder is lower than my left too (due to a shoulder dislocation ages ago) but my chrio never actually mentioned it. In fact, as far as exercises are concerned, a physio has been of much more help. My chiro pretty much kept trying to unlock me spine and did little else (apart from prescribing vague scapula exercises I was not really ready for).

I've been doing some lower trap and serratus activation work as well as some RC stuff (internal and externals rotations). Then we progress the difficulty each week e.g. go from supported external rotations to unsupported. How about you, what kind of exercises are on atm?


#12

This is interesting. Out of all the reading I've done on this issue I think you're the first that has mentioned overactive upper traps as a possible cause for this type of shoulder issue. I've always had (until recently) really big upper traps- in fact I considered them my most impressive muscle group (disproportionately large) and sure enough I have the "lower right shoulder" /rolled forward symptom. I pretty much stopped all shrug movements months ago and have only recently begun to add them back in at a much lighter weight. I make sure to stretch my pecs out and do my foam rolling, in conjunction witch face pulls and some other work but it hasn't seemed to help a lot over the last 8 months or so. Prone trap raises in particular seem to actually cause more pain than alleviate. I've started doing prone scap raises and more back work, but I'm still incredibly disheartened by it all.


#13

If the prone scap raises causes more pain, then stop and re-evaluate.

If you're doing to prone trap raises (I presume what some call Y's) the old fashioned way, with the head unsupported, it could be possible that your upper traps (which are "disproportionately large" as you describe it) is taking over the movement.

Try the following protocol:

1) smr if possible (this may not be pragmatic to do on your own at the gym) the upper traps

2) static stretch for a minimum of 30 seconds. This will activate the golgi tendon organ and down regulate the upper traps

3) perform a variation of the Y in which you rest your non-working arm on a stable surface, rest your head on the non-working arm (so the upper traps do not have to support the weight of your head), perform half a Y with the working arm (thumbs up to minimize internal rotation) and DO NOT elevate the working arm so high that you aggravate an impingement at the shoulder

Steps 1 and 2 can also precede work such as face pulls (the angle of the cable in relation to your torso needs to be 45 or steeper to target the proper area). There is also a great exercise in which you do a modified lat pull down: elbows bent, hands about shoulder width, elbows in about 30 degrees (scapular plane plus or minus a few degrees) and squeeze your lower traps (think pressing the scaps towards your hips). If you do this right, the bar will only move a few inches. You can bring more mid traps and rhomboid major/minor into play by leaning back with the torso. Obviously, there will be a certain learning curve.

A lot of guys really pride themselves on huge upper traps. However, as you described them, yours are "disproportionately large." This most likely means that - aesthetically at least - you may want to focus on other things; a lot of men don't realize that when the upper traps are dominant, they actually acquire an 'A' shape to their torso when seen from the front. This, as any physique athlete will tell you, is not nearly as aesthetically pleasing as the broad shoulder (with proportionate upper traps) tapering down to a narrow waist.

As far as functionality goes, you're experiencing first hand the effects of having an over active body part.

Are you "incredibly disheartened by it all" because the pain is still there or because you can't hit the upper traps as hard as you used to? Eight months is a long time to live with this (or any other) issue.

As I stated in my previous post, it may not be the upper traps for either the OP or for you. I just mentioned it to examine a variables.

Based on the limited information I have, it appears your pec minor/major are tight and your scapular retractors and possibly external rotators need work.

If you're game, feel free to post some pics and page LevelHeaded and BBB. They both have well educated set of eyes and can offer some insight. I will then be happy to examine your past and current training routine and offer some suggestions on cleaning things up.


#14

Step 3 makes a lot of sense- and yes, I had been doing "Y's" the traditional way with my head unsupported. I have been doing external rotator work and have strengthened them, but that didn't really solve a lot. I've been disheartened because it seems like no matter what I do the situation doesn't get any better. I saw a 'physio'/doctor over a year ago after leaving the gym on the verge of tears after 3 sets of bench and my shoulder being in so much pain that I couldn't even lift my gym bag. He took x-rays and said everything looked fine and there was no built up scar tissue. His solution was to take 6-8 weeks off all heavy lifts- I think we all know that's not a solution. I told him that and he had nothing else to offer. Ever since then I've completely stopped flat-benching (decline only now), can't do dips, and had to stop doing squats- so now I'm relatively pain free. I'm incredibly unbalanced now when comparing my left and right sides and I know it all stems back to my shoulder. It looks like it's hanging down and doesn't stick out as wide as the other. My left and right lats look like they belong on two different people even though they are equal in strength. I'm sending you a PM about pics, not sure if you want specific shots that would make it easier to see what's going on.


#15

^^^Well, the pics should be posted on this thread. Or feel free to start a new one. Hopefully, LevelHeaded and BBB will be able to look at them and offer some insight.

My skill set centers around designing training programs so that people are able to train AROUND their injuries and not through it (which, we should all know by now, is playing with a loaded gun).

I think stretching the upper traps for at least 30 seconds to activate the golgi tendon organ is an important part of doing exercises such as Y's. Yes, performing SMR before each set can be unrealistic in a commercial gym setting. However, the static stretching can and should be performed for people who need to down regulate a certain body part so it doesn't conflict with the exercise.

At this point (and I'll repeat this at the end of this post), I strongly encourage you to research other specialists in your area (as well as post pics here). It sounds to me like the first doc you saw is either incompetent or didn't really care.

As for the exercises you described, here are some possible variations:

db press (if you can use a slight incline, that might work best - avoid flat bench)

push ups using perfect push ups, blast strap, or something similar (add external load using weight vest, bands, chains, or even McGyver a cable station).

split squats

one legged squats off box. don't laugh at these - they are surprisingly effective with a 3-4 second eccentric. also, if you have access to bands, use them to sit back and make the move more hip dominant vis a vis vertical tibia when in the hole. once you get over the learning curve and any preconceived notions, you will be AMAZED at how hard you can load the legs while sparing the spine.

For example, I am currently experimenting with a protocol in which my lower body work consists primarily of RDLs (uni and bi) and one legged squats. For speed (because strength without speed makes for poor athletes), I rely on power cleans and some med ball work (the light weight of a med ball addresses the absolute speed end of the strength-speed contiuum). The RDLs and power cleans taxes my spine and CNS pretty damn well. So, in order to get in sufficient volume, I took out the traditional squat and front squat and replaced them with the one legged box squat. I perform this with a 5 second eccentric, 1 sec pause in the hole (below parallel but NOT sitting on my calf) and concentric as explosively as possible with out losing form. I work up to max triple, then do more rep work using bands. The bands really allow you to sit back (which the free form version doesn't allow). This is important because, although quad dominant squats (tibia past vertical in the hole) is an important part of athletic movement people need to spend time in hip dominant squat patterns as well (tibia vertical when in the hole). This will minimize the possibility of any future knee issues AND help to teach proper glute activation.

In fact, I start off all my beginning or rehabbing clients with hip dominant squat patterns (unless they have specific contraindications) and integrate quad dominant squat patterns as they advance. Show me a trainer or coach who has beginners do walking lunges from the get go and I'll show you an idiot.

This is an example how proper programming can allow continual improvement WITHOUT aggravating past injuries or creating new ones. It can be done IF you are willing to flush preconceived notions regarding what is and what is not weight training.

I see all these threads in this or other forums about how people drink the 'bench, squat, dead' kool-aid without a proper understanding of the fundamentals. (Sadly, many of the writers on this site do not help matters because they themselves preach it.) Well, guess what...many of those people either end up posting on the Injured forums or lurking. That should speak volumes.

I'll repeat my advice to post pics on this thread or to start your own and to start a search for a specialist in your area. Your case most likely involves more than over active upper traps (although that certainly appears to be a contributing factor).


#16

@Toby_Queef I know this is an old post but I have been going through the EXACT problems you described in this post and been to different CHIRO’s and PT’s and they cant solve it…what did you end up doing or finding out???