Rhomboid Major and Minor Trigger Points

Introduction

The rhomboid major and minor are key upper back muscles responsible for scapular retraction, posture support, and shoulder stability. When trigger points develop in these muscles, they can cause upper back pain, shoulder blade tightness, and postural discomfort, often mimicking trapezius strain, rotator cuff dysfunction, or cervical spine issues.

Name and Area

  • Name: Rhomboid Major and Rhomboid Minor

  • Area: Located in the upper back, running from the thoracic vertebrae (T2–T5) and cervical vertebrae (C7–T1) to the medial border of the scapula.

Indications

Rhomboid trigger points may contribute to:

  • Pain Between the Shoulder Blades (Mistaken for Trapezius Strain or Thoracic Spine Dysfunction)

  • Tightness in the Upper Back That Feels Like a "Knot" (Can Mimic Muscle Spasms or Postural Strain)

  • Pain That Radiates to the Shoulder or Upper Arm (Can Resemble Rotator Cuff Dysfunction or Nerve Irritation)

  • Pain or Stiffness That Worsens with Slouching or Forward Shoulder Posture

  • Discomfort When Lifting or Reaching (Common in Weightlifters, Climbers, and Swimmers)

  • Pain That Increases After Carrying a Heavy Backpack or Holding a Shoulder Bag

Pain from this muscle is often mistaken for trapezius overuse, cervical spine dysfunction, or rotator cuff injuries.

Muscle Action

  • Retracts the Scapula: Pulls the shoulder blades toward the spine, essential for posture and shoulder stability.

  • Elevates the Scapula: Assists in lifting the shoulder blade.

  • Stabilizes the Shoulder Blade: Works with other scapular muscles to support upper body movements.

The rhomboids are crucial for postural support, scapular mechanics, and upper back function.

Signs and Symptoms

Individuals with rhomboid trigger points often report:

  • Deep, Aching Pain Between the Shoulder Blades That Feels Like a Constant "Knot"

  • Tightness That Worsens with Poor Posture or Prolonged Desk Work

  • Pain or Weakness When Pulling Movements (Rowing, Climbing, or Lifting Weights)

  • Pain That Extends to the Shoulder or Upper Arm (Can Mimic Rotator Cuff Dysfunction or Nerve Pain)

  • Discomfort That Worsens After Carrying a Backpack, Shoulder Bag, or Heavy Objects

  • Clicking or Popping in the Shoulder Blade When Moving the Arm

Pain worsens with prolonged slouching, carrying loads on one shoulder, or excessive pulling exercises.

Perpetuating Factors

Common causes of rhomboid trigger points include:

  • Forward Shoulder Posture (Common in Desk Workers, Gamers, and Cyclists)

  • Repetitive Overuse from Pulling Movements (Rowing, Rock Climbing, Weightlifting, Swimming)

  • Carrying a Heavy Backpack or Shoulder Bag (Can Overload One Side and Cause Muscle Imbalances)

  • Sleeping in a Poor Position (Can Cause Chronic Upper Back Tightness and Shoulder Imbalance)

  • Emotional Stress and Tension (Can Increase Upper Back and Shoulder Tightness)

Trigger Point Referral Pattern

Trigger points in the rhomboids refer pain to:

  • The space between the shoulder blades (Can Mimic Trapezius Strain or Upper Back Tightness)

  • The upper shoulder and medial arm (Mistaken for Rotator Cuff or Shoulder Dysfunction)

  • The thoracic spine (Can Resemble Poor Posture-Related Pain or Rib Dysfunction)

Pain from this muscle is often confused with cervical radiculopathy, upper trapezius strain, or thoracic outlet syndrome.

Differential Diagnosis

Rhomboid trigger points may be mistaken for:

  • Trapezius Strain (Upper Back and Shoulder Pain That Worsens with Postural Fatigue)

  • Cervical Spine Dysfunction (Neck Pain That Can Radiate to the Shoulder and Upper Back)

  • Rotator Cuff Dysfunction (Pain in the Shoulder Blade and Weakness in Overhead Movements)

  • Thoracic Outlet Syndrome (Pain, Numbness, or Tingling Down the Arm Due to Nerve Compression)

  • Scapular Dyskinesis (Abnormal Shoulder Blade Movement, Often Due to Muscle Imbalances or Poor Posture)

A thorough upper back, cervical spine, and scapular movement examination is necessary to rule out these conditions.

Associated Trigger Points

Rhomboid trigger points often co-exist with:

  • Trapezius (Upper Back and Shoulder Pain, Common in Postural Strain and Stress-Related Tension)

  • Serratus Anterior (Pain in the Ribs and Shoulder, Affects Deep Breathing and Scapular Stability)

  • Latissimus Dorsi (Thoracic and Shoulder Pain, Common in Overhead Movements and Pulling Exercises)

  • Pectoralis Minor (Anterior Shoulder and Chest Tightness, Contributes to Forward Shoulder Posture)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Rhomboid Major Spinous processes of T2–T5 Medial border of the scapula Dorsal scapular nerve (C4–C5)
Rhomboid Minor Spinous processes of C7–T1 Medial border of the scapula (superior to rhomboid major) Dorsal scapular nerve (C4–C5)

The rhomboids are innervated by the dorsal scapular nerve (C4–C5), which also controls scapular movement and upper back stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the upper back and medial scapular border.

  • Resisted Scapular Retraction Testing: Assess pain and weakness when pulling the shoulder blades together against resistance.

  • Postural Analysis: Look for forward shoulders, rounded upper back, or excessive thoracic kyphosis.

  • Scapular Mobility Testing: Rule out scapular winging or movement dysfunction.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the rhomboids, reducing upper back tightness and improving scapular mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots along the medial scapular border.

  • Massage Therapy: Helps improve circulation and reduce upper back muscle tension.

Stretching

  • Cross-Body Shoulder Stretch: Helps release tension in the rhomboids and upper back.

  • Foam Roller Thoracic Stretch: Improves thoracic spine mobility and scapular alignment.

Strengthening Exercises

  • Scapular Retraction Drills (Band Pull-Aparts): Strengthens the rhomboids and improves shoulder posture.

  • Face Pulls: Encourages proper scapular control and prevents excessive forward shoulder posture.

  • Wall Angels: Improves thoracic mobility and postural stability.

Postural and Movement Adjustments

  • Avoid Slouching or Prolonged Forward Shoulder Posture (Maintain a Neutral Spine and Open Chest Position)

  • Ensure Proper Form During Pulling Exercises (Engage the Scapular Muscles and Avoid Overuse of the Traps)

  • Practice Breathing Techniques for Shoulder Relaxation (Encourages Better Rib Expansion and Scapular Mobility)

Conclusion

The rhomboids play a crucial role in scapular stability, posture, and upper back function, but trigger points in these muscles can cause significant shoulder blade, upper back, and postural pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic postural dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.