American College of Sports Medicine

National Academy of Sports Medicine

PTA Global

Canadian Fitness Professionals

Athletics and Fitness Association of America

Provider #1315 Home Study and Credits: {{ncbtmbCredits}}

National Certification Board for Therapeutic Massage & Bodywork

ACE Course ID: {{aceId}} and Credits: {{aceCredits}}

American Council on Exercise

The Brookbush Institute (BOC AP# P10038) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of {{credits}} hours/ Category A CEUs. ATs should claim only those hours actually spent in the educational program.

Board Of Certification

International Sports Sciences Association

Providers of Approved Continuing Education

REPs Ireland

World Instructor Training Schools

Completion of this course will earn you {{credits}} non-contact hours of continuing education in "Anatomy and Physiology" with Yoga Alliance

Yoga Alliance

Australia Physiotherapists

This activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider 2309052TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas.

Texas Physical Therapy Association

New York Physical Therapist just a disclaimer The Brookbush Institute (B2C Fitness) is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education.

New York State Education Department's State Board for Physical Therapy

CIMSPA course ID: {{cimspaId}} and Credits: {{cimspaCredits}}

Chartered Institute for Management in Sport and Physical Activity

The Brookbush Institute is an AOTA Approved Provider of professional development. PD activity approval ID# {{aotaCourseApprovalNumber}}. This distance learning-independent activity is offered at {{aotaCredits}} CEUs {{aotaLevel}} {{aotaCategory}}.  AOTA does not endorse specific course content, products, or clinical procedures.

American Occupational Therapy Association

Integrated functional anatomy of the rhomboids. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Examples of common strengthening exercises, foam rolling, mobility, and stretches for the rhomboids/mid-back muscles.

Rhomboids

Access to all courses with monthly membership

Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

Home

Courses

This course describes the anatomy and integrated function of the rhomboids (a.k.a. the rhomboid muscle, upper back, shoulder blade muscle). The rhomboid major originates on the spinous processes of thoracic vertebrae 2-5, and the rhomboid minor originates on the spinous processes of the cervical vertebrae 7, and thoracic vertebrae 1. The rhomboid major and minor insert on the medial border of the scapula (shoulder blade). The rhomboids are innervated by the dorsal scapular nerve and are composed of slightly more type II muscle fibers than type I muscle fibers. The rhomboid muscle crosses the scapulothoracic joint (scapula), influencing motion of the acromioclavicular joint (AC joint) and sternoclavicular joint (SC joint) during motion of the shoulder girdle. The rhomboids contribute to scapular retraction and downward rotation (functional antagonist to the serratus anterior). This course also describes the role of the rhomboid muscles in scapulothoracic arthrokinematics, fascial integration, postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the rhomboids for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. rhomboid muscle pain, upper back pain, serratus anterior inhibition, dorsal scapular nerve palsy, posture issues), the effect the rhomboids have on scapular kinematics (e.g. downward rotation in synergy with the levator scapulae and upper trapezius muscles), and rhomboid specific exercises and techniques (e.g. rhomboid muscle self-administered and static manual release techniques).

Brookbush Institute’s most recommended techniques for the Rhomboids (see videos below):

Upper Trapezius, Levator Scapulae, Splenii, and Rhomboid Release

Rhomboid major and rhomboid minor muscles attaching on the scapula and spine

 Course Description: Rhomboids

Introduction

 1560s, from Middle French rhomboide or directly from Late Latin rhomboides, from Greek rhomboeides "rhomboidal; a rhomboid;" see 

Rhombus - 1560s, from Late Latin rhombus, from Greek rhombos "rhombus, rhomb, lozenge; spinning top, magic wheel used by sorcerers; a spinning motion," from rhembesthai "to spin, whirl," from PIE *wrembh-, from *werbh- "to turn, twist, bend" (

"- oid" - word-forming element meaning "like, like that of, thing like a ______," from Latinized form of Greek -oeides, from eidos "form." The -o- is connective or a stem vowel from the previous element. (

Like the shape of a rhomboid (bent square)

The muscles on the posterior side of the upper body, including the rhomboids, lats, and posterior deltoid

Transverse Section - Rhomboids highlighted http://denversom.wikispaces.com/file/view

Attachment and Innervation

The attachment of the rhomboids on the thoracic spine and vertebral (medial) border of the scapula

Attachment & Innervation: Rhomboids

Relative Location

Where are the Rhomboids Located?

Palpation

The fascial attachment of the rhomboids to the spinous process and continuation of the ligamentum nuchae

Palpating the Rhomboids

Introduction to the Rhomboids

Actions

Scapular retraction, elevation, and downward rotation (8, 11, 17).

The medial border of the scapula highlighted as the insertion of the rhomboids

 Stabilization of the scapula (20) (acromioclavicular and sternoclavicular joints respectively) and potentially the upper thoracic and lower cervical spine.

 Protraction, upward rotation, and depression.

The rhomboids work synergistically with the upper trapezius and levator scapulae during elevation.

The rhomboids assist in retraction along with the lower trapezius.

The rhomboids act as downward rotators along with the levator scapulae and 

 in acromioclavicular external rotation (flattening of the scapula against the ribs).

Arthrokinematics

Rhomboid Muscle Actions

Fascial Integration

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

Thoracocervical Fascia: Certainly more research is needed, investigating the complex relationship between the fascia and investing musculature at the cervicothoracic junction. The rhomboids share some common fascial tissue at their origin on the spinous process and ligamentum nuchae with the lower and middle trapezius muscles and potentially the splenius capitis and cervicis; but, what about the deeper erectors? Could there be layers of fascial tissue, enveloping columns of muscle that provide support to the upper thoracic and lower cervical spine that increase tension, rigidity, and stability of the vertebral column and upper ribcage? As this segment of the spine and the associated ribs have a complex role to play relative to the optimal motion of the scapula and shoulder, there could be a functional purpose for complex synergies. Could there be synergistic subsystems analogous to those found crossing the lumbar spine and investing in the thoracolumbar fascia?

Serratus Anterior and Rhomboids: The serratus anterior and rhomboids share a thin piece of fascia deep to the medial border of the scapula and look to have a nearly continuous fiber orientation. Two relationships have been cited by various clinicians. One, these muscles act as functional antagonists, implying balanced activity is imperative to optimal scapular mechanics. Tom Myers refers to the "rhombo-serratus" muscle in his "spiral line" and notes that these muscles often become locked in opposition (one locked long, the other locked short - see "Behavior in Postural Dysfunction" below) (6). Two of these muscles are both capable of internal rotation at the AC joint and play a pivotal role in stabilization by maintaining the scapula flat on the thoracic spine. In this scenario these muscles are synergists that prevent anterior tipping and internal rotation, a.k.a scapular winging.

Image of the adaptive kyphotic positioning from sitting at a desk

Behavior in Postural Dysfunction

Although this muscle is often considered to be long and under-active (1, 6), I believe this muscle has a tendency toward 

 I am not alone in this hypothesis, Sahrmann pairs the rhomboids with the often short/over-active levator scapulae (7).

the rhomboids are often trigger point laden. Although trigger points may develop in long musculature, long musculature is generally inhibited and less active (via altered reciprocal inhibition). Generally, this results in less demand on tissues and fewer trigger points relative to those muscles that are short and over-active. Although the traditional model of Upper Cross Syndrome (1) describes common upper body dysfunction as relative elevation and protraction of the scapula and the rhomboids as long, the Brookbush Institute describes 

 as relative downward rotation and anterior tipping of the scapula, placing the rhomboids on the "short/over-active" list. It is my hypothesis, that the rhomboids (along with the 

) contribute to relative downward rotation via elevation of the superior angle of the scapula around a fixed glenoid fossa - these muscles may be acting as over-active synergists for an inhibited 

. Both Kendall and Travel & Simons note that optimizing rhomboid activity is dependent on correcting poor upper body posture (8, 11).

The seemingly paradoxical over-activity of the rhomboids was noted in an older study by Scovazzo et. al. (1991) (mentioned in Travel and Simons) - the study examined swimmers with painful and asymptomatic shoulders and the difference in rhomboid activity. Although the rhomboids were activated later in the stroke, EMG activity was 4 times greater in those with a painful shoulder than those without painful shoulders (8, 15)

Every joint motion is relative. That is one bone moves relative to the other.

How does downward rotation of the scapula occur when I clearly see the scapula elevate during the assessment?

It’s an optical illusion, kind of… What you see is the superior angle (superior/medial corner) of the scapula elevate, but the glenoid fossa remains fixed. That is to say, downward rotation of the scapula can occur as it is traditionally taught – glenoid fossa moving inferiorly, or as elevation of the superior angle of the scapula around a fixed glenoid fossa.

The diagram below depicts a posterior view of the right scapula and humerus. The image on the left depicts downward rotation as it is “traditionally” taught, while the diagram on the right depicts relative downward rotation around a fixed glenoid fossa (downward rotation masquerading as elevation).

Note: scapular downward rotation around a fixed humerus is relative humeral abduction indicating a decrease in length of the 

An image of downward and upward rotation of the scapula

In a similar fashion to the example above, the forward motion often noted as protraction may be viewed as anterior tipping.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

, the rhomboids plan no significant role.

, the rhomboids have a propensity toward 

 and may be acting as over-active synergists for an inhibited 

 muscle. This may imply that interventions for the rhomboids should include release and stretching techniques and that some benefit may be gained from thoracic mobilization (see videos below).

Signs of Altered Length/Tension and Tone:

Goniometric assessment of the scapula is not reliable; however, visual observation of gross deviation, asymmetry, and range that replicates symptoms may be valuable clinically.

Palpation results in tenderness and may result in radiating symptoms.

Comparison of Upper Trapezius, Levator Scapulae and Rhomboid trigger points (listed from superior to inferior) with posterior deltoid trigger point marked on male subject:

Postural Dysfunction and the Rhomboids

Techniques and Ending Info

Open Books - Active Thoracic Spine Mobilization:

Rotational mobilization for thoracic spine mobilization, stabilization, and strengthening:

Rhomboid (Self-Administered) Static Release

Latissimus Dorsi and Rhomboids Static Stretch (Child’s Pose)

Latissimus Dorsi and Rhomboids Active Stretch (Child’s Pose)

Self-administered Thoracic Spine Mobilization: Posterior to Anterior with Extension

Self-administered Spine Mobilization: Rotation (Open Books)

Self-administered Thoracic Spine Mobilization: Rotation

Exercises and Techniques for the Rhomboids 

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

Scovazzo ML, Browne A, Pink M, et. al.: The Painful shoulder during freestyle swimming. Am J Sports Med 19(6):577-582, 1991

Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. 

Journal of Orthopaedic & Sports Physical Therapy

Oladipo GS, Aigbogun Jr EO, Akani GL. (2015). Angle at the medial border: the spinovertebral angle and its significance. 

Crowe MM, Elhassan BT. (2015). Scapular and shoulder girdle muscular anatomy: its role in periscapular tendon transfers. 

Nasu H, Yamaguchi K, Nimura A, Akita K. (2012). An anatomic study of structure and innervation of the serratus anterior muscle. 

Reed D, Cathers I, Halaki M, Ginn KA. (2015). Does load influence shoulder muscle recruitment patterns during scapular plane abduction? 

Sultan HE, Younis El-Tantawi GA. (2013). Role of dorsal scapular nerve entrapment in unilateral interscapular pain. 

Archives of Physical Medicine and Rehabilitation

Bibliography

Questions, comments, and criticisms are welcome and encouraged.

Rhomboids

Related Courses:

Course Description: Rhomboids

Introduction to the Rhomboids
3 Sub Sections

Rhomboid Muscle Actions
1 Sub Section

Fascial Integration

Postural Dysfunction and the Rhomboids

Exercises and Techniques for the Rhomboids
6 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Rhomboids

Related Courses:

Course Description: Rhomboids

Introduction to the Rhomboids3 Sub Sections

Rhomboid Muscle Actions1 Sub Section

Fascial Integration

Postural Dysfunction and the Rhomboids

Exercises and Techniques for the Rhomboids 6 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the Rhomboids
3 Sub Sections

Rhomboid Muscle Actions
1 Sub Section

Exercises and Techniques for the Rhomboids
6 Sub Sections