The rhomboid muscle group, consisting of the rhomboid major and minor, is fundamental to scapulothoracic articulation and upper extremity motion dynamics. This discussion synthesizes their anatomical and biomechanical relevance with a focus on their integration within the Motion Specific Release (MSR) framework.
We will analyze the rhomboids' role in scapular stabilization, retraction, and rotation, in concert with numerous other structures. The implications for posture, scapular motion, and potential pathologies like scapular winging or dyskinesis will be discussed. Additionally, MSR methodologies pertinent to enhancing rhomboid function will be presented, targeting practitioners managing shoulder girdle dysfunctions and aiming to refine upper body mechanics.
Article Index:
Anatomy & Biomechanics
The rhomboid muscle group, critical for upper limb stability and movement, consists of two muscles: the rhomboid major and the rhomboid minor. Together, they play a key role in the orientation and movement of the scapula against the thoracic wall.
Origin and Insertion:
The rhomboid major arises from the spinous processes of the T2 to T5 vertebrae and attaches to the medial border of the scapula, below the spine.
The rhomboid minor, typically smaller, originates from the nuchal ligaments and the spinous processes of the C7 and T1 vertebrae, inserting above the spine of the scapula at its medial border.
Innervation and Vascular Supply:
Both muscles receive their innervation from the dorsal scapular nerve (C4-C5), which emerges from the brachial plexus. This innervation is crucial for the coordinated action required for scapular stability and control.
Vascular supply to the rhomboids is primarily through the dorsal scapular artery, a branch of the subclavian artery, providing the necessary oxygen and nutrients for their function.
Biomechanical Functionality:
Biomechanically, the rhomboids facilitate scapular retraction and downward rotation, countering the upward rotation by the trapezius. They are integral during activities requiring adduction and internal rotation of the shoulder. When the rhomboids contract, they bring the scapula towards the vertebral column, essential for movements like rowing or pulling.
Kinetic Interactions:
The rhomboids function synergistically with other periscapular muscles to maintain scapular positioning that is vital for proper glenohumeral mechanics. The balance between scapular protractors and retractors, including the rhomboids, is vital for dynamic shoulder stability, especially during overhead movements.
MSR Implications:
In the context of Motion Specific Release, the rhomboid muscles are pivotal in addressing thoracic and scapular dysfunctions. MSR interventions may focus on improving the flexibility and strength of the rhomboids to correct scapular winging and enhance scapular stability.
Motion Specific Release (MSR) Treatment
Initial Setup:
Patient Position: For optimal engagement of the rhomboid muscles, the patient will either be in a seated or prone position depending on the technique being used. This allows the practitioner full access to the upper back.
Practitioner Stance: The practitioner stands with a stable base, facilitating controlled application of pressure and movement, crucial for the specificity of MSR techniques.
Basic Technique:
Treatment: The MSR procedure commences with the localization of the rhomboid muscles' anatomical landmarks. The practitioner identifies the vertebral prominence and the medial border of the scapula to align the treatment with the rhomboids’ origins and insertions.
Support Hand: Utilizing the support hand to stabilize the patient's shoulder, the practitioner guides the scapula through its range, assisting in the mobilization of the rhomboid muscles.
Synchronization: Hand movements are harmonized with the patient's respiration and the passive movement of the arm to facilitate an effective MSR release, enhancing neuromuscular responsiveness. (See demonstration video)
Pressure Application: The practitioner employs a gradual, responsive pressure via a thumb (backed up with the other hand), flat hand or forearm to engage the rhomboid muscles, avoiding the use of the elbow for comfort.
Technique:
Contact: Broad contact is maintained with the flat hand or forearm to address the rhomboid fibers comprehensively, allowing for a multi-directional approach to the release.
Combined Actions: The patient's arm is maneuvered, incorporating patient circumduction to facilitate a deeper release of the rhomboids.
Rhomboid Muscle Release - MSR Procedures
In this video, Dr. Abelson demonstrates Motion Specific Release (MSR) procedures for releasing the Rhomboid Major & Minor Muscles.
Best Practices:
A bilateral approach is essential, recognizing the need to address both rhomboids to alleviate unilateral compensations and ensure musculoskeletal balance.
An understanding of the rhomboids’ influence on scapular and shoulder mechanics informs the MSR treatment strategy, acknowledging their role in the broader kinetic chain.
Precautions:
The practitioner prioritizes safety, mindful of contraindications, and ensures informed consent. The pressure and technique are adjusted based on patient feedback, ensuring a tailored and safe MSR experience.
Functional Kinetic Chains
The rhomboids, comprising the rhomboid major and minor, serve as key mediators in the scapulothoracic kinetic chain. Their anatomical positioning and biomechanical functions underscore their role in upper limb and spinal mechanics.
Direct Myofascial Connections:
Thoracolumbar Fascia: The rhomboids are enmeshed within this resilient fascial structure, which integrates their mechanical actions with the movements of the thoracic spine and rib cage.
Scapular Mechanics: Myofascial attachments of the rhomboids on the medial border of the scapula are instrumental in modulating scapular retraction and downward rotation, vital for arm kinematics.
Synergists:
Trapezius Partnership: The lower and middle fibers of the trapezius coalesce with the rhomboids, forming a synergistic mechanism for scapular control during arm elevation and abduction.
Levator Scapulae Interplay: This muscle synergizes with the rhomboids in regulating scapular elevation and stability, particularly during neck and head movements.
Stabilizers:
Rotator Cuff Collaboration: Through concerted action with the rotator cuff, the rhomboids contribute to glenohumeral joint stability, a prerequisite for precise upper limb movements.
Serratus Anterior Balance: The protraction and upward rotation imparted by the serratus anterior provide a counterforce to the rhomboids, facilitating a balanced scapular motion.
Antagonists:
Pectoralis Minor Opposition: It acts in opposition to the rhomboids' retraction, maintaining scapulothoracic equilibrium during anterior-directed upper limb activities.
Latissimus Dorsi Counteraction: As an antagonist, the latissimus dorsi contrasts the rhomboids by promoting scapular depression and aiding in adduction and internal rotation of the arm.
MSR Perspective:
In MSR application, the rhomboids are recognized for their integral role in upper body kinetics. Interventions focus on:
Myofascial Release: Techniques are employed to alleviate fascial constraints, enhancing the rhomboids' functional capacity within the scapulothoracic domain.
Neuromuscular Synchronization: MSR aims to refine the neuromuscular control of the rhomboids in coordination with their synergistic and antagonistic counterparts.
Kinetic Chain Enhancement: The rhomboids are treated as a central link within the kinetic chain, with MSR protocols designed to augment the congruence of scapulothoracic and cervicothoracic motions.
Exercise
Optimal conditioning of the rhomboids through targeted is critical for optimal function. Flexibility exercises help to not only increase range of motion but help to mitigate potential injuries. Strength protocols are indispensable for reinforcing pelvic and lumbar stability, directly influencing athletic and functional task execution. Additionally, balance-focused regimens are crucial for cultivating proprioceptive acuity and neuromuscular synchronization, integral to dynamic stability and movement efficacy. Below are some example of exercise that could be prescribed depending on the particular case.
Rhomboid Muscle Release
Welcome to our video where we'll be discussing the benefits of using a lacrosse ball for effective rhomboid muscle release. Whether you're experiencing upper back tension or suffering from a shoulder injury, understanding the anatomy and biomechanics of this technique can help you release rhomboid muscle restrictions and experience relief.
10 Minute Arm Routine - Dynamic and Isometric
This routine is designed to enhance upper body strength and power by incorporating a combination of dynamic and isometric exercises. These exercises are rooted in anatomy and biomechanics and have been proven to be highly effective.
4 Cardinal Planes - Shoulder Stabilization Exercise
The 4 Cardinal Planes shoulder stabilization exercise works on proprioception, balance, and coordination for your shoulder and its surrounding muscles as it moves through various ranges of motion.
Conclusion
The exploration of the rhomboid muscles in this article underscores their crucial role in scapular mechanics and overall upper body function. Through the lens of the Motion Specific Release (MSR) approach, we've detailed how targeted interventions can enhance the performance and coordination of these muscles, addressing common musculoskeletal issues. Emphasizing practical application, the article has presented protocols that align with the functional kinetic chains associated with the rhomboids.
DR. BRIAN ABELSON, DC. - The Author
Dr. Abelson's approach to musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the Motion Specific Release (MSR) Treatment Systems developer, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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ReferencesÂ
Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioner's Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.
Clark, J. M., & Lucett, S. C. (Eds.). (2018). NASM Essentials of Corrective Exercise Training. 2nd ed. Burlington: Jones & Bartlett Learning.
Cook, C. E. (2010). Orthopedic Manual Therapy: An Evidence-Based Approach. Upper Saddle River: Prentice Hall.
Hammer, W. I. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods. 3rd ed. Sudbury: Jones & Bartlett Learning.
Hertling, D., & Kessler, R. M. (2006). Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. 4th ed. Philadelphia: Lippincott Williams & Wilkins.
Jull, G., Moore, A., Falla, D., Lewis, J., McCarthy, C., & Sterling, M. (2013). Grieve's Modern Musculoskeletal Physiotherapy. 4th ed. Edinburgh: Elsevier Health Sciences.
Myers, T. W. (2014). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 3rd ed. Edinburgh: Churchill Livingstone.
Neumann, D. A. (2016). Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 3rd ed. St. Louis: Mosby.
Sahrmann, S. (2010). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby.
Vleeming, A., Mooney, V., Stoeckart, R., & Snijders, C. J. (2007). Movement, Stability & Lumbopelvic Pain: Integration of Research and Therapy. 2nd ed. Edinburgh: Churchill Livingstone.
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