Rhomboids Static Manual Release (Soft Tissue Mobilization)

Rhomboids Static Manual Release (Soft Tissue Mobilization)

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

7 thoughts on “Rhomboids Static Manual Release (Soft Tissue Mobilization)”

  1. Hey Brent, 2 things, what does a trigger point say about a muscle and 2 have you looked into active manual release, great stuff keep it up

  2. Since the romboids are usually fixed long, how about doing this in a sitting position, so that the musscle is able to shorten once the release is achieved?

  3. Could someone use one of those "vibrating massage appliance" devices, or, a sturdy "J-hook"-massage-tool", to help "release" and sooth these regions of tension, if they do not have someone to help them get this done, by the assistant, as demonstrated?…

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