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Rhomboid Static Manual Release (Soft Tissue Mobilization)
Rhomboid Static Manual Release (Soft Tissue Mobilization) is a manual therapy technique used to reduce pain, improve motion, and increase mobility in the muscles and fascia of the rhomboid area. By targeting the muscles and fascia of the rhomboid region, this technique can help to reduce tension, promote healthy movement, and improve overall function. This mobilization technique may be used to address chronic pain, muscle strain, and other ailments related to the rhomboid area.
Transcript
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This is Brent of the Brookbush
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...blank
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Institute, and in this video we're bringing
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you another manual technique. Now if
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you're watching this video I'm assuming
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you're watching it for educational
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purposes, and that you are a licensed
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manual therapist following the laws
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regarding scope of practice in your
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state or region. That means athletic
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trainers, chiropractors, physical
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therapists, osteopaths, licensed massage
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therapists, you are likely in the clear
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to do these techniques, personal trainers
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this probably does not fall within your
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scope of practice; although you might be
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able to use the palpation portion of
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this video to aid in learning your
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functional anatomy, in an educational
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setting supervised by a licensed manual
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therapist. Now before we place our hands
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on a patient or client it is important
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that we assess and have a good rationale
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for doing so, and of course if we're
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going to assess then we should be
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reassessing to ensure that the manual
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technique we're using is effective, and
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we have a good rationale for continuing
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to use that technique. In this video
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we're going to go over static manual
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release of the rhomboids. I'm going to
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have my friend Melissa step out and help
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me demonstrate. Now this technique uses
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the same protocol we've used for all of
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our static manual release techniques,
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that basically comes down to palpate and
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compress, although we are going to get a
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little bit more detailed, talk about how
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to differentiate the rhomboids from the
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other tissues in the area. We're going to
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talk about where our common trigger
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points are, we're going to talk about
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what other tissues in the area maybe
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are contraindicated to press on, and then
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of course the last thing we're going to
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talk about is patient and client
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position and your position, so that you
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have great technique.
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Now the rhomboids are deceptively
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difficult to get a good release on. iIt's
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a fairly thin muscle, we don't have those
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big thick fibrous bands to find, that gives
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us really good indication of like a
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fiber direction; and there are a couple
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of other muscles in the area, not to
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mention the rib cage right underneath it.
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So let's talk about how to differentiate
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this tissue. The thing to start with
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would be your origins and insertions to
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set up some borders for the area that
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you should be in. The origin of your
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rhomboids major and minor goes from C7
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to T5, and then the insertion is the
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vertebral border of your scapula which
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is fairly easy to palpate there. So if
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you find these things
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roughly C7 to T5 to the vertebral border,
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and you draw a little box around that
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you get this little twisted square, also
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known as a rhomboid, which is where the
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rhomboid muscle gets its name from.
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We know that this is the area we
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should be palpating in, so what other
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tissues are there that maybe we need to
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differentiate? Well, I happen to know that
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our traps lie on top of our rhomboids, so
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our lower trap and middle traps
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specifically, we need to kind of figure
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out how are we going to differentiate
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between lower trap and rhomboid. Well
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being that my rhomboid goes in this
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direction we would expect more of a
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horizontal fiber direction. My lower trap
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goes from the spine of the scapula, the
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medial portion of the spine of my
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scapula, all the way down to T12. So we
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get this somewhat oblique but mostly
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vertical fiber direction, and what the
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lower traps actually feel like is a
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somewhat triangular shaped vertical
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column of muscle, being that those fibers
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are vertical it makes it very easy to
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differentiate that from what would be
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horizontal fibers of the rhomboids. Now
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the middle traps do have that horizontal
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fiber direction, but if we follow them
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they don't go into the vertebral border
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of the scapula they continue on to the
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spine of the scapula, not to mention the
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middle traps are much much thicker than
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the rhomboids. So after you've done this
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a few times you've learned how to
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identify the rhomboids, you know how to
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identify the mid traps, you're going to
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know when you're on the trapezius muscle
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in general just because it's a much much
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thicker muscle. Now the only other muscle
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that's in that area is the serratus
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posterior superior which is deep to the
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rhomboids, very thin, not generally
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something we think about palpating,
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something we think about having trigger
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points. I would imagine if we were trying
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to go after it, it would have something
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to do with CT junction dysfunction, maybe
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breathing dysfunction, maybe some
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sort of assessed dysfunction of the upper
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ribs. If we're trying to palpate the
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rhomboids, my guess is we had more of the
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thoracic or scapular dyskinesis
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that we're worried about. I think it's
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actually fairly uncommon for us to go
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after the rhomboids, when the serratus
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posterior superior was involved, or vice
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versa.
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I think that muscle for the most part is
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not something that we're going to have
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to worry about, and when we talk about
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step 2 - where are the common trigger points,
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we're going to find out that our hands
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are actually going to be even further
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from the serratus posterior superior. So
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the trigger points here, that's getting
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into step 2, are all along the vertebral
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border of the rhomboids. This is a really
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important fact because this is what's
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going to save us when we try to locate
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these hypertonic fascicles within the
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rhomboids, because if you try to
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feel here, like let's say you just start
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trying to feel in that rhomboid area for
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horizontal fibers, I don't think you're
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going to find much. There's like there's
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not these differentiated fascicles in
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here and unfortunately we have the
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ribcage which has these little bumps in
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it, which make it a little hard to figure
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out whether you're just feeling bumps on
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the ribcage, or you're actually feeling
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some fascicles on the rhomboid. You can
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even end up just feeling this flat mush
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over the ribcage until you get down into
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the vertebral border here, and at the
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vertebral border you can feel a little
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bit of thickness as the rhomboid turns
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into these tendinous fibers
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that invest into that vertebral border.
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In fact we're going to make this even
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easier for ourselves, we're going to go
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ahead and ask Melissa to put her hands
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up over her head. If she didn't have a
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face cut out in this table we could
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actually have her put her hands
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underneath her forehead which sometimes
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it's just more comfortable, now I've
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lengthened out these rhomboid fibers
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even further. That's going to add a
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little tension, maybe make it easier for
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me to feel the horizontally oriented
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fibers. It's also going to help me with
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that finger on a marble game right, we
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don't want to play that, we don't want to
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play that game where we keep trying to
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hit trigger points but they keep sliding
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out from underneath our fingers. We can
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use
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this increase in length, increase in
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tension on the rhomboids to help
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stabilize that trigger point. I think
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once you get somebody in this position
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and you start strumming perpendicular to
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those fibers right up against the
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vertebral border, now you start feeling
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some fascicles. But it's really not until
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we get into this position and feel very
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specific to about where these trigger
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points are along the vertebral border
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that we can feel anything, and I want you
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guys to experiment with this, experiment
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with hand down and then hand up and I
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think you'll see what I'm talking about.
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Now before we take this to the actual
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technique and getting a good release
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here, is there anything contraindicated,
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is there anything that I shouldn't put
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pressure on, is there anything that's
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sensitive in this area -the answer is no
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not really. You always run the risk of, or
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the chance of over stretching like a
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sensory nerve or something, like
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something that gives us some
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sensation in the skin and that would
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give us some sort of like sharp twinge
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of pain, like it's that burning searing
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pain I know we've all felt when somebody
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like stretches our skin the wrong way
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and you like it that little that little
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zap, but even that's fairly uncommon in
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this area. I don't think it's something
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that you're going to have to worry about.
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So this is probably the best position
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for the patient, before I go through this
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technique also notice that I am working
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on the rhomboid that's farthest from me,
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and they're the reason for that has to
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do with how we're going to pin the
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tissues. If I were to try to do the
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rhomboid closest to me I end up kind of
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like this trying to push down towards my
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thigh, which this type of force just
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isn't a real easy force to apply. I'd
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much rather be pushing across my body be
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able to walk out my arms and just lean.
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So this is the patient position I know
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it was a long explanation to try to get
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to where we're going to be, and the
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technique isn't that difficult. All I'm
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going to do is take a thumb, strum
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perpendicular to what would be the
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direction of the fibers at this point,
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which is going to be parallel to the
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vertebral border of my scapula. Once I
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find something that feels like an
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increase in tissue density, I'm then
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going to go a little bit along the
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length of the fiber and see if I can
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identify a nodule of tightness. Once
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again those nodules are going to be
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pretty close to the vertebral border. I
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don't know if you guys can see the X's
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where I actually marked off the trigger
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point parts, but when we get into the
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close-up recap I know you will.
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Once I've not only identified the tight
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fascicles but I've done my palpation
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along the length of those fascicles to
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find the tight nodule, now what I'm going
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to try to do to pin it -is actually push
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into the vertebral border of the scapula.
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I find that that is easiest and what
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I'll usually do is since I was just
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strumming this way, I'll use my thumb to
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kind of block this way and then I'll put
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my thumb right in between my thenar eminence
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there, just like so walk out my arms, and
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press in. How does that feel? Okay a
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little tender I'm sure, I'm sure this is
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just a little bit of tenderness here, and
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of course after I get one release let's
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say after 30 seconds to two minutes of
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holding, that's not a tremendous amount
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of pressure. I just have to press up to
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the point of the tissue giving me some
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resistance back, I don't have to like try
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to push my thumb all the way down
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underneath her scapula per se. I just
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wait for a release then I can do the
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same thing, perpendicular strums try to
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feel for an increase in tissue density,
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increase in tissue tightness, right about
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there I'm feeling some tight fascicles,
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and then I can move along the length of
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the fascicles
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to find a tight nodule, and then again
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I'm going to make sure I can get some
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pressure on that nodule and I find that
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going in kind of this direction rather
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than like let's say straight down, if
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you did go straight down it just hurts a
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little bit, you just end up pushing into
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the rib cage. So if I go this way a
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little bit -this direction, I can hold,
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get a good release,
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and on my bottom hand as soon as this
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hand puts pressure becomes the dummy
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thumb, I'm not using my hand strength I'm
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just using my bodyweight to get a good
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release. Now the only tricky point is
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this rhomboid minor trigger point in
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this position doesn't quite work, because
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unfortunately when we
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upwardly rotated the scapula
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the superior angle ends up
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retracting a little bit. So we need to
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lengthen out these rhomboid minor
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trigger points. I think the easiest way
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to do that is to actually have Melissa
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put her hands underneath her ASIS,
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alright so I know you guys have seen
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this position before and then I might
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even try to protract her a little bit
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further, abduct her scapula as far as I
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possibly can and then I'm just going to
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go ahead and palpate that superior
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portion of her rhomboids right up
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against the superior third of the
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vertebral border of her scapula.
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Doing my perpendicular strokes, now I'm
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doing my along the fiber to find the
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nodule, found it -make sure I can apply
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some pressure right without losing it,
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it's not trying to shoot out from under
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my finger. I'm going to use my hand
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here putting my thumb right in the
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middle of my palm and just leaning, and
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that's it. This is a real easy technique
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for me, for Melissa it might not
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feel that easy up front, we're going to
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get a little bit of tenderness at first,
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but then it's going to let go and of
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course for example if she had something
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like downwardly rotated scapula as part
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of like some upper-body dysfunction and
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shoulder impingement syndrome, hopefully
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this would give her better outcomes
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after we finished this technique. Stay
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tuned for the close-up recap. The
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close-up recap, step one we have to be
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able to palpate, differentiate this
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muscle from the other muscles in the
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area. I already have Melissa's arms up so
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we pulled the vertebral border of the
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scapula away from the other tissues we
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would be concerned about confusing
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ourselves with, being like the lower trap
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column over here, you know we have the
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mid traps that they're way up here,
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and then our serratus posterior superior
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would be somewhere in here. The vertebral
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border of the scapula is, I'm trying to
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palpate this for you guys and kind of
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show you, you see that crease I just
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created in our skin, that crease is the
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vertebral border of our scapula, and
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you'll notice that these are the common
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trigger point sites for the rhomboids
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which are all along that vertebral
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border. So well now all we have to do is
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do our strokes perpendicular to the
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fiber direction, all right so we're going
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to come through here like this, and not
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surprisingly as I do these perpendicular
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strokes, I'm finding that I have these
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dense fascicles, this increase in tissue
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density, this tightness occurring right
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around these X's, especially this X on
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her, maybe a little bit here too. So once
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I find that increase in tissue density
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then I'm going to search it this way
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right, make sure that I'm right on the
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tightest nodule and then I'm going to
00:14:3200:14:35
try to make sure I have that trigger
00:14:3500:14:38
point anchored, so that it's not moving
00:14:3800:14:40
out from under my thumb, and then once I
00:14:4000:14:42
have it nice and anchored I'm going to
00:14:4200:14:44
go ahead and put my palm over the top of
00:14:4400:14:49
that thumb, and I can do this with each
00:14:4900:14:52
of the dense fascicles, or each of the
00:14:5200:14:56
tight nodules in the rhomboids here, hold
00:14:5600:14:59
for 30 seconds to two minutes. The only
00:14:5900:15:00
one that's a little different is the
00:15:0000:15:01
rhomboid minor, i'm going to have
00:15:0100:15:04
Melissa move her arm down so she has
00:15:0400:15:08
her hands underneath her ASIS, and then
00:15:0800:15:09
I'm going to make sure she's abducted,
00:15:0900:15:11
her scapula is abducted as far as
00:15:1100:15:13
possible, she's protracted as far as
00:15:1300:15:13
possible,
00:15:1300:15:18
and then I'll look at the upper rhomboid
00:15:1800:15:20
fibers, and once again doing my
00:15:2000:15:22
perpendicular strokes once I find the
00:15:2200:15:23
tight fascicles,
00:15:2300:15:26
going along the length of the fiber and
00:15:2600:15:30
then anchoring that dense nodule, and
00:15:3000:15:32
putting my palm over the top of it;
00:15:3200:15:36
to apply that static pressure for 30
00:15:3600:15:39
seconds to two minutes. So there you have
00:15:3900:15:41
it, knowing your functional anatomy will
00:15:4100:15:43
definitely help your manual technique.
00:15:4300:15:45
It'll help you differentiate structure
00:15:4500:15:46
so that you can place your hands where
00:15:4600:15:48
they need to be, as well as make you
00:15:4800:15:50
aware of these sensitive structures
00:15:5000:15:52
around the tissue that you're trying to
00:15:5200:15:54
target. Things like nerves and lymph
00:15:5400:15:57
nodes, and arteries. Make sure that if
00:15:5700:15:58
you're going to place your hands on a
00:15:5800:15:59
patient that you have done an assessment
00:15:5900:16:02
and have a good rationale for placing
00:16:0200:16:03
your hands on that patient, and if you're
00:16:0300:16:05
going to assess, make sure you reassess
00:16:0500:16:07
to ensure that your technique was
00:16:0700:16:09
effective and you have a good rationale
00:16:0900:16:11
for using that technique again. Now with
00:16:1100:16:15
manual therapy, one-on-one live education
00:16:1500:16:18
is incredibly important. Please be
00:16:1800:16:21
looking for opportunities like workshops
00:16:2100:16:24
and mentorships, and maybe even classes
00:16:2400:16:26
at your local university that can get
00:16:2600:16:29
you some one-on-one individual
00:16:2900:16:31
instruction, or at least some live
00:16:3100:16:33
classroom instruction so you've had a
00:16:3300:16:38
chance to be critiqued and mentored by
00:16:3800:16:40
somebody senior to you with some
00:16:4000:16:42
experience in manual therapy techniques,
00:16:4200:16:45
and before you bring this stuff back to
00:16:4500:16:48
your rehab, fitness, or performance
00:16:4800:16:52
setting, please practice on colleagues.
00:16:5200:16:55
There is no substitute for practice and
00:16:5500:16:57
it is going to take a while to get
00:16:5700:17:00
accustomed to some of the techniques
00:17:0000:17:02
that we show in these manual technique
00:17:0200:17:04
videos. Don't expect to learn them in two
00:17:0400:17:07
or three or even five minutes. You want
00:17:0700:17:10
to have hours of experience under your
00:17:1000:17:12
belt working on various different body
00:17:1200:17:15
sizes and shapes. So that when you do get
00:17:1500:17:17
that first paying client, first paying
00:17:1700:17:19
customer, then you're really trying to
00:17:1900:17:22
make a good positive impact, really
00:17:2200:17:26
trying to promote better outcomes, you
00:17:2600:17:28
feel comfortable with that technique. I
00:17:2800:17:29
look forward to hearing about your
00:17:2900:17:32
outcomes and hearing your questions in
00:17:3200:17:34
the comments section of this video. I'll
00:17:3400:17:37
talk with you soon.
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