Rhomboid Muscle Pain (Causes,Symptoms,Treatment-Relief,Exercises,Prevention)

The rhomboid muscles are the upper-back muscles that sit between your shoulder blades and your spine. More specifically, the rhomboid muscles include the rhomboideus minor and the rhomboideus major, and their job is to help pull the shoulder blades together and keep them stable.

In plain English, they are part of the reason you can sit upright, pull your shoulders back and move your arms without your shoulder blades floating around like they missed the memo.

A rhomboid muscle strain happens when these muscle fibers are overstretched or slightly torn, often from overuse, poor posture or a sudden movement. As noted in older patient-education resources on rhomboid muscle pain, this can lead to pain, tightness, spasms or that annoying “knot” feeling between the shoulder blade and the spine.

Rhomboid muscle pain can be frustrating because it tends to show up during everyday things: sitting at a desk, carrying a bag, reaching overhead or even taking a deep breath. The good news is that most mild rhomboid strains improve with conservative care, patience and a little less “I’ll just push through it.”

The Causes

In most cases, rhomboid pain is related to overuse of the shoulder and upper back, especially when the same movement is repeated again and again. Trigger point and rehab-focused sources, including Trigger Point Therapist and HelpYourBack.org, commonly describe this pain as a problem that develops between the shoulder blades after stress, strain or poor mechanics.

Some of the activities and habits that may contribute to rhomboid muscle strain include:

• Poor posture, especially sitting at a computer for long periods of time.

• Rounded shoulders or constantly looking down at a phone, tablet or laptop.

• Overhead activities, such as reaching up to high shelves, painting, swimming or repeatedly serving tennis balls.

• Carrying a very heavy backpack, especially on just one shoulder.

• Rowing or pulling exercises done with poor form.

• Sleeping in an awkward position that leaves the upper back stiff the next morning.

• A sudden pull, fall or lifting something heavier than your body was prepared for.

Desk work deserves its own little mention here because, honestly, it is sneaky. You may not think sitting still can irritate a muscle, but hours of rounded shoulders can keep the rhomboids stretched and stressed, and eventually those muscles may decide they are done being polite.

Symptoms

Rhomboid muscle pain is usually felt in the upper back, between the spine and the inside edge of the shoulder blade. It may be sharp with movement or dull and achy after sitting, lifting or using the arm.

Common symptoms can include:

• Muscle pain between the spine and shoulder blade.

• Tightness, knots or spasms in the upper back.

• Pain that gets worse when moving the shoulder, arm or upper back.

• Tenderness when pressing on the area.

• Discomfort when taking a deep breath, coughing or twisting.

• A feeling that the shoulder blade area is “stuck” or tight.

Important to note, pain between the shoulder blades is not always a rhomboid strain. The Cleveland Clinic notes that upper back pain can come from muscle strain, posture, injury, spine issues or other medical conditions, so it is worth paying attention to the full picture.

Get medical care right away if upper back or shoulder blade pain comes with chest pain, shortness of breath, dizziness, sweating, pain spreading to the jaw or arm, fever, unexplained weight loss, numbness, weakness or pain after a major injury. Not to be dramatic, but this is one of those times where “wait and see” is not always the best plan.

Diagnosing Rhomboid Muscle Strain

To diagnose a rhomboid strain, a doctor or physical therapist will usually begin with a medical history. They may ask when the pain started, what you were doing when it began, whether you felt a pull or pop and which movements make the pain better or worse.

Your provider may also ask about past neck, shoulder or back injuries, your work setup, your exercise routine and the sports you play. Yes, the way your desk chair is set up may suddenly become part of your medical history.

During the physical exam, the provider will usually check the upper back, shoulder blades, neck and shoulders for tenderness, tightness and range of motion. You may be asked to move your arms in different directions, squeeze your shoulder blades together or resist gentle pressure so your provider can see which movements reproduce the pain.

Most mild rhomboid strains can be diagnosed based on symptoms and a physical exam. Imaging, such as X-rays or an MRI, is not typically needed unless there are red flags, symptoms suggest another problem or the pain is not improving as expected.

After reviewing your symptoms, health history and exam findings, a professional should be able to tell whether you are most likely dealing with a rhomboid strain or whether something else, such as a neck issue, shoulder injury or nerve irritation, may be involved.

Treatment and Relief

Rhomboid muscle pain is usually treated conservatively, which means rest, symptom relief, gentle movement and gradually rebuilding strength. A patient handout from North Dakota Orthopaedic Associates includes many of the usual recommendations, including rest, stretching and strengthening once pain allows.

Here are the most common treatment options:

» Resting – In the first few days, you may need to limit the activities that make the pain worse. That does not necessarily mean lying perfectly still, because the upper back usually prefers gentle movement over becoming a statue.

Activities such as rowing, tennis, heavy lifting, overhead work or intense pulling exercises may need to be paused for a short time. The goal is to avoid repeatedly irritating the muscle while it is trying to calm down.

» Icing the Affected Area – Applying ice may help reduce pain and inflammation in the early stage of a strain. A cold pack can be used for about 15-20 minutes at a time, with a cloth between the ice and your skin.

One easy way to reach the rhomboid area is to place an ice pack on the floor or bed and lie with the painful upper-back area over it. Is it glamorous? Not even a little, but it can be effective.

» Heat – After the first couple of days, heat may feel better than ice, especially if the main issue is stiffness or muscle spasm. Warm showers, heating pads or warm compresses can help relax tight muscles before gentle stretching.

» Medications – Over-the-counter pain relievers may help in the short term. Options may include acetaminophen or non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, but these are not right for everyone.

As the MedlinePlus guide to back pain medicines explains, NSAIDs can have side effects and may not be safe for people with certain health conditions, including kidney disease, stomach ulcers, bleeding risks or some heart conditions. When in doubt, ask your doctor or pharmacist instead of guessing in the medicine aisle.

» Massage and Physical Therapy – Massage may help relax tight muscles and temporarily reduce discomfort. Physical therapy may be even more useful if the pain keeps coming back, because a therapist can look at posture, shoulder blade control, neck mobility and exercise form.

This matters because the sore spot is not always the whole story. Sometimes the rhomboids are complaining because nearby muscles are not doing their share of the work.

» Self-Massage – A tennis ball, lacrosse ball or foam roller can be used for gentle self-massage. Place the ball between your upper back and a wall, then slowly move until you find the tight area.

Keep the pressure comfortable and avoid rolling directly over the spine. More pressure is not always better, despite what the “no pain, no gain” crowd may have told us.

Once you can move your shoulder and arm without pain, normal activities are usually added back gradually. Minor strains may improve within a couple of weeks, while more stubborn or more severe strains can take six weeks or longer.

The faster you stop aggravating the area and start the right type of gentle care, the better your chances of a smoother recovery. But if pain is severe, worsening or not improving after a week or two, it is time to get it checked.

Helpful Exercises

Exercises can help improve flexibility, posture and strength around the shoulder blades, which may reduce the chance of rhomboid pain returning. Older exercise roundups, including guidance from ePainAssist, commonly include rows, rhomboid stretches, neck stretches and gentle upper-back mobility work.

Before starting, the usual common-sense rule applies: these exercises should feel like a stretch or mild effort, not sharp pain. If pain increases, stop and check with a health care provider.

» Resistance Row Exercise – Place an exercise band around a solid object at about waist height. Stand facing the object, hold one end of the band in each hand and step back until there is light tension.

Slowly pull the band back while squeezing the shoulder blades together, keeping the elbows close to your sides. Return to the starting position with control and repeat 10 times.

» Rhomboid Stretch – Stretch your arms in front of you and place one hand over the other. Reach forward slowly until you feel a gentle stretch between the shoulder blades.

Once you feel the stretch, slowly lower your head slightly and hold for 15-30 seconds. Repeat three times, and please do not yank your head down like you are trying to win a stretching contest.

 

 

» Neck Rotation – With your chin level, slowly turn your head to one side as far as you comfortably can. Hold for 15-30 seconds, then turn to the other side and hold again.

Repeat three times on each side. Keep the movement slow and smooth, not forced.

» Neck Stretch – While sitting or standing, look straight ahead. Let your head tip to one side, bringing the ear toward the shoulder while keeping both shoulders relaxed and down.

Hold for 15-30 seconds, then return to the starting position and repeat on the other side. Do this three times on each side.

» Fixed Bar Stretch – Hold onto a fixed bar attached to a wall or another sturdy object. Stand about an arm’s length away, then gently shift your hips backward while keeping your arms and spine long.

You should feel a stretch through the upper back and around the shoulder blades. Keep your knees slightly soft if needed.

» Rhomboid Twisting Stretch – Sit on the floor with your legs straight out in front of you. Cross your right leg over your left leg, keeping the left leg extended.

Place your left hand on the floor behind you and gently rotate your upper body to the left. Repeat on the other side, moving slowly and staying within a comfortable range.

» Bent Arm Stretch – Sit or stand tall and bend your left elbow, reaching the arm across your body. Use the right arm to gently pull the left arm closer to your chest.

Hold for 15-30 seconds, then repeat on the other side. This should be felt around the back of the shoulder and upper back, not as pinching in the joint.

» Straight Arm Stretch – Sit comfortably in a chair or on the floor with your spine tall. Reach your left arm straight across your chest.

Use your right hand to gently pull the left arm closer to your chest, keeping the shoulder relaxed. Repeat on the other side.

 

 

Preventing Rhomboid Muscle Strain

While there are several ways to treat rhomboid muscle pain, preventing it in the first place is obviously the better deal. Fewer ice packs, fewer awkward self-massage sessions with a tennis ball, and fewer moments wondering how sitting at a desk somehow became an extreme sport.

One of the best ways to prevent a rhomboid strain is to warm up before activities that use the upper back and shoulders, such as rowing, tennis, swimming, strength training or heavy lifting. Dynamic warmups, light rows and controlled shoulder blade movements can help prepare the area before harder work.

Posture also matters, but not in the “sit perfectly straight all day and never move” kind of way. The Mayo Clinic’s office ergonomics guidance highlights the importance of chair height, monitor position, keyboard placement and keeping commonly used items within easy reach.

For desk work, try taking short movement breaks throughout the day. Stand up, roll the shoulders gently, stretch the chest and upper back, and change positions before the muscles start sending rude messages.

Other prevention tips include:

• Carry backpacks evenly on both shoulders instead of one.

• Keep bags lighter when possible.

• Strengthen the upper back, shoulders and core gradually.

• Avoid sudden increases in exercise volume or weight.

• Use good form during rows, pull-downs and other pulling exercises.

• Sleep with your neck and upper back supported in a comfortable position.

When to See a Doctor

Most mild rhomboid strains improve with home care, but not every pain between the shoulder blades should be ignored. See a doctor or physical therapist if pain is severe, lasts longer than one to two weeks, keeps coming back, limits daily activities or follows a fall, accident or sports injury.

You should also seek care if you notice numbness, tingling, weakness, pain traveling down the arm, neck pain that is getting worse or symptoms that do not match a simple muscle strain. Bodies are complicated, and sometimes the rhomboids are just the area where the pain shows up, not the original source of the problem.

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