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Rhomboids Audio

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

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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

 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

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

Attachment & Innervation: Rhomboids

Where are the Rhomboids Located?

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

Palpating the Rhomboids

Introduction to the Rhomboids

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

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

Fascial Integration

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

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