Rhomboid Static Manual Release (Soft Tissue Mobilization)

Differentiation

1. The rhomboids lie deep to the lower trapezius .
2. Outline the area of the rhomboids by visualizing a box that extends from the muscles origin on the C7 - T5 spinous processes, to the muscle's insertion along the vertebral border of the scapula.
3. Both the rhomboids and the lower trapezius are relatively flat muscles, but the rhomboids have a nearly horizontal fiber direction and the lower trapezius a nearly vertical fiber direction.
4. Since the rhomboids lie deep to the lower trapezius , it implies deeper palpation will be necessary to "feel" the horizontal fibers of the rhomboids .
5. In the "area" of the rhomboids , gently press into the tissues until obstructed by the solid surface of the ribs. Using superior to inferior or inferior to superior strokes, try to feel the near-horizontal fibers of the rhomboids . Note, the fibers of the rhomboids have a slight obliquity from superomedial to inferolateral.
   • Tip: It may be easier to feel the ropiness of individual fibers by starting your palpation close to the insertion of the rhomboids on the vertebral border of the scapula

Potentially Sensitive Tissues

• As mentioned above, there may be some reason to consider the potential of abrading the dorsal scapular nerve while dry needling the rhomboids (137, 138); however, it seems highly unlikely that manual compression could cause any such damage.

Trigger Points

• The most common rhomboid trigger points are near the insertion along the vertebral border of the scapula. Most often trigger points exist close to the superior and inferior angle, and one or two additional trigger points closer to the center of the vertebral border of the scapula.

Release Technique

1. Although this technique can be performed in sitting with the practitioner behind the patient, it is most comfortable with the patient lying in prone.
2. Asking the patient to place their hands underneath their forehead is a comfortable position for the patient, the position lengthens the rhomboids and moves common trigger points out from under the more superficial lower trapezius .
3. The practitioner can use one thumb to strum the fibers of the rhomboids . Generally, it is easiest to start at the insertion, using strokes parallel to the vertebral border of the scapula.
4. Once a taut band is located, the length of the band may be explored for a dense nodule.
5. The direction of force may be adjusted to aid in pinning and compressing a dense/sensitive nodule. Generally, pressing into the nodule, toward the vertebral border, is effective.
6. Using the palpating thumb as a "dummy thumb", the palpation hand is relaxed, and the interthenar crease of the other is placed over the palpating thumb. The arms are straightened and pressure is applied using the practitioner's body weight.
7. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).