rhomboid muscle pain

Rhomboid Pain

If you are feeling pain at the back of your neck between your shoulder blades and your spine, you may be experiencing rhomboid muscle pain. Before we delve into the pain itself, let’s identify the rhomboid muscles.

Your Rhomboid Muscles

Your rhomboid muscles – both major and minor – are located in your upper back where they connect your shoulder blades to your spine. They are part of a group of muscles that form the shoulder girdle which holds your shoulder and shoulder blade stable. Thanks to your rhomboid muscles, you are able to lift and rotate your shoulder blades and pull them back. Rhomboid muscles also help you throw and pull, lift your arm overhead and rotate your torso.

rhomboid muscle knot

Causes of Rhomboid Pain

Rhomboid pain is generally not serious and can be treated easily with physiotherapy. It may be caused by postures that round your shoulders forward, such as hours spent sitting in front of a computer, or by poor posture. This tires the muscles and they become tight, forming a rhomboid muscle knot in the back. In addition, you may feel rhomboid pain from sleeping on your side, rowing, pushups, throwing motions, pulling motions, working out with weights and injury.

You may feel rhomboid pain after carrying heavy bags or backpacks. In addition, if you have problems with your shoulder joints due to arthritis or myositis, it may affect the surrounding muscles.

Symptoms of Rhomboid Pain

You generally feel rhomboid pain under the neck between the spine and shoulder blades. It may be referred to as shoulder blade pain. You may also feel it at the backs of the shoulders or in the mid-upper back. Additional symptoms can include:

  • loss of movement, or difficulty or pain when moving the muscle;
    pain when breathing;
  • a popping or grinding noise when you move the shoulder blade;
  • tightness, swelling, and muscle knots around the muscle; and/or
  • tenderness in the upper back area.

Treating Rhomboid Muscle Knots

If you are feeling rhomboid pain, begin by treating it as you would any other muscle injury – with RICE, or rest, ice, elevation and compression. Avoid activities that use these muscles; ice the area several times a day for 15 to 20 minutes; wrap the area with a compression bandage; and when lying down or sleeping, keep your chest and shoulders elevated with pillows. You can also use topical pain relievers, such as Voltaren, or essential oils to reduce pain.

After a few days of icing the area, you can apply heat with a warm compress or a heating pad for 15 to 20 minutes at a time; you may wish to alternate heat and ice.

If you’ve taken these steps and haven’t found relief, it’s time to see a physiotherapist. They can recommend a course of exercise that will help the injured area heal. These exercises may include stretching your chest to reduce the strain being placed on the muscles and those that strengthen your upper back.

rhomboid muscle pain

You can also try a self massage: Take a tennis ball and place it between your upper back and the wall. Lean into it until you find the sore spot; then, gently make small circles with the ball. You can also lie on the floor and roll your shoulders over a foam roller to loosen and massage the muscles. Your physiotherapist will suggest other exercises targeted to your injury, depending on its severity.

It will take a bit of time to recover from rhomboid muscle pain, depending on how severely you have strained the muscles. Mild strains generally heal within three weeks, while more severe strains may take several months to heal.

Preventing Rhomboid Pain

Once your rhomboid pain is going, going, gone, keep it at bay by using a number of preventive measures:

  • Always warm up before a workout and cool down afterward;
  • Avoid lifting heavy objects, and use proper form when you do;
  • Carry heavy backpacks on both shoulders, not one;
  • Exercise and stretch regularly to stay in shape;
  • Maintain a healthy weight;
  • Practise proper technique when playing sports;
  • Practise good posture while sitting, standing and walking;
  • Take a break from exercise and activities when you feel sore or tired;
  • Take frequent breaks to move around, walk, and stretch during periods of extended sitting; and
  • Use protective equipment for sports and work.

Once you’re back to your old self, you can also consider working with your physiotherapist on an exercise program to ensure that you avoid imbalances in your body.

Intramuscular Stimulation IMS

Intramuscular Stimulation (IMS)

If you’ve been experiencing chronic pain or tight muscles, intramuscular stimulation might offer relief. First, however, you might want to know a bit more about this technique, used by specially trained physiotherapists.


Intramuscular stimulation is actually a made-in-Canada solution to muscle tightness or pain. It was invented in the 1970s by Dr. Chan Gunn, a physician working for the BC Worker’s Compensation Board. Gunn was trained in Western medicine, but he was also adept at acupuncture, an ancient Chinese practice. He drew from both approaches to pain in creating IMS. It is based on the theory that much chronic pain results from the nerves overstimulating the muscles. IMS works to reset these nervous impulses as a way of reducing pain by using acupuncture needles to stimulate the affected muscles.

How Does IMS Work?

IMS releases or lengthens affected muscles so that they relax. Your IMS-certified practitioner will assess you to determine which, if any, muscles can be helped by this approach. They then sterilize the affected area and insert very fine needles – the same type of needles used for acupuncture – into a muscle and manipulate the depth and direction to stimulate healing. (The inserted needle targets a compressed nerve root.)

The needle causes the muscle to twitch or cramp in response, triggering a spinal cord reaction; once that occurs, the needle is removed. (If the muscle is functioning normally, it won’t twitch or cramp.) The muscle can then relax and begin to function normally. Dry needling, as it is called, also creates a tiny wound in the muscle that promotes blood flow to the area and stimulates healing by producing a healthy inflammatory response that removes toxins from the area.

intramuscular stimulation

How Does Intramuscular Stimulation Help?

Intramuscular Stimulation provides two major types of positive results: increased movement and significant pain reduction. As you progress through your treatment regimen, the tight bands of muscle will loosen and allow for increased joint mobility. In addition, as the muscle loosens, there will be less pressure and compression on your joints, nerves and ligaments, so your pain should subside.

Generally, depending on the duration of the pain, the tight or painful muscle will require a series of IMS treatments before the pain disappears or lessens to a great degree.

When Is IMS Appropriate?

IMS targets chronic musculoskeletal pain. It does not work for chronic inflammatory pain or other types of pain, such as pain from cancer, diabetes or degenerative neurological conditions such as Parkinson’s disease. IMS is usually not administered during pregnancy or to patients who have had surgery in the past 12 weeks. It has successfully been used to treat such issues as:

  • Achilles Tendonitis
  • Carpal Tunnel Syndrome
  • Chronic postural pain
  • Golfers and Tennis Elbow
  • Chronic Tendonitis or Bursitis
  • Headaches
  • Iliotibial Band Syndrome Jaw and TMJ Pain
  • Low Back Pain
  • Myofascial Pain Syndrome
  • Neck Pain
  • Patello-femoral Syndrome
  • Plantar Fasciitis
  • Piriformis Syndrome
  • Repetitive Strain Injuries
  • Sciatica
  • Shin Splints
  • Shoulder and Hip impingement syndromes
  • Spinal Disc Problems
  • Torticollis Trigger Finger

Will IMS Be Painful?

IMS is generally considered to be unpleasant, but not painful – especially given the results. Each needle is only inserted for a few seconds, but as the muscle is stimulated into relaxation, there may be a bit of discomfort before the pain dissipates. Pain relief may happen quickly or it may take a few days. In addition, patients generally have increased movement and muscle function as a result. The IMS-trained physiotherapist carefully identifies the points for needle insertion so that the affected muscles can react.

Afterward, you may experience some bruising and soreness in the area. Your physiotherapist may recommend that you avoid vigorous exercise or stress to your body so the treatment can take effect. Drinking a lot of water and applying heat to the area will flush the body and assist in healing.

Acupuncture Compared to IMS

Acupuncture and IMS both use the same needles and dry needling technique, but they are very different therapies.

Acupuncture is an ancient Chinese medicine technique that focuses on using needles to stimulate the body’s meridians of energy, specifically those related to a certain organ or muscle. A series of needles is inserted around a particular point and may be left there for 10 to 20 minutes to effect change.

IMS, a technique that is only about 50 years old, blends Western medicine with traditional Eastern medicine to impact chronic pain and muscle dysfunction. It is based on Western medicine’s understanding of the human body’s physiology and anatomy.

Acupuncture is relaxing, but IMS can often be intense. However, both strive to help the patient feel better.

posterior shin splints

Coping with Posterior Shin Splints

While you may think of splints as devices used to immobilize injured body parts, it’s a term that has another connotation in the medical world, one with which many runners are all too familiar. Shin splints is a term used to describe pain in the lower leg; it refers to the inflammation of one of the muscles that runs along the tibia or shin bone, the tibialis posterior. The tibialis posterior runs along the inside rear of the tibia bone. Posterior shin splints are the most common cause of painful shin bones.

The Mechanics Behind The Pain

Your tibialis posterior muscle controls a portion of the foot’s arch when it is doing weight-bearing exercise. It helps to produce the motion that allows your foot to lift off the ground when you are running or walking, necessary to keeping the foot and ankle stable; this is called supination. The tibialis posterior muscle also helps to apply the brakes to the flattening of the arch when you are in motion.

tibialis posterior

What Causes Shin Splints?

Posterior shin splints can be result from various causes, including:

  • Flat feet – Flat feet can put too much stress on the tibialis posterior muscle and tendon by causing the muscle to be lengthened. If the foot’s core muscles aren’t strengthened, the foot may be subject to over-pronate and there may be an inward knee collapse, which aggravates shin splints.
  • Overuse or overtraining – If you increase your mileage on the roads, you are landing on your foot more often, which increases the force on your arches. If you run faster, you increase the force with which you strike the ground, which can also have a negative impact on your tibialis posterior muscle.
  • Tight calf muscles – If your calves are tight, your ankle’s range of motion becomes limited, causing pronation that causes your tibialis posterior to work too hard.
  • Weak hip and core muscles –
    These muscles help control the leg’s inward rotation, and if the pronation becomes more extreme, it can aggravate your tibialis posterior muscle.
  • Worn out footwear – Walking or running shoes help support the feet and ankles, so if a shoe begins to break down, the foot may pronate more and require the tibialis posterior to work harder, which can lead to inflammation.

Symptoms of Posterior Shin Splints

Are you wondering if your shin pain is due to shin splints? If so, look for these potential symptoms:

  • Dull, aching pain in the inside-rear front of the lower leg;
  • Shin pain along the side of the tibia bone or within associated muscles; or
  • An area that is tender to the touch.

However, you should talk to a registered physiotherapist or a physician before proceeding with specific treatment options. A physiotherapist will base the treatment on the severity of the injury.

With stage one shin splints, your pain disappears during warm up exercise, so you may be allowed to continue exercising unless the injury worsens. A stage two injury means the pain may reappear at the end of a workout, so your physiotherapist may recommend modified workouts while you are treated.

If shin pain worsens during a workout, this means that it’s time to suspend activity before the tibia suffers stress fractures. This is a stage three injury. If you have pain and discomfort all the time, your injury has progressed to stage four and it’s time to stop all activity. You may need crutches or an air cast to take pressure off the area while it heals.

It’s important to address shin splints even though the recovery isn’t quick; it usually takes at least two months. However, depending on the severity of the injury, you may be able to continue with modified exercise.

posterior shin splints

Diagnosis and Treatment

As with most injuries, it’s useful to start with the RICE method of treatment: rest, ice, compression and elevation. Apply ice every two to four hours for 20 to 30 minutes. Avoid anti-inflammatory drugs for the first 48 to 72 hours. See your physiotherapist as soon as possible to obtain a diagnosis so that you can begin to rehabilitate your injury. Initially, your physiotherapist may do some supportive taping to help support the injured soft tissue and offer your tibia some stress reduction.

Next, your physiotherapist will work with you to help you regain your full range of motion without pain. This often involves remoulding scar tissue so it doesn’t tear easily in the future by lengthening and orienting it through stretching, massage and targeted exercises. Your physiotherapist will also evaluate your gait to determine what corrections need to be made so that you can prevent a recurrence of your shin splints. You may need to wear corrective orthotics to give your foot some assistance.

Restoring strength to your muscles is also critical, so your physiotherapist will help you create a realistic exercise plan that will restore weakened calf, shin, quadriceps, gluteal and other lower limb muscles to their appropriate strength. Once you’ve reached this point, it’s time to return to your usual activities – but you’ll want to work with your physiotherapist to create a workable re-entry plan.

So, if you’re feeling pain in the area near your tibia, don’t hesitate to have it diagnosed. As they say, shin up – or do I mean chin up?!

pulled butt muscle

Pulled Butt Muscle | Gluteal Pain

The phrase “Pain in the Butt” is a slang reference to someone who is annoying, but it derives from a real medical problem: a pulled or torn muscle in the buttocks that can, indeed, be painful.

What Causes Pain in the Gluteal Muscles?

One of the major causes of buttocks pain is a strain – a tear to one of the gluteal muscles. This type of injury is often called a pulled butt muscle. A strain happens when the load placed on the muscle exceeds its normal boundaries. It can result when there is too much force or repetitive force during the muscle’s contraction. They are most likely to occur during exercise, especially sports that involve running or jumping.

A strain, or tear, to a gluteal muscle, may result in sudden pain after a fall or an exercise session. Chronic wear and tear can also lead to a strain in the glutes. Your muscles may experience fatigue if you aren’t properly conditioned to handle a specific exercise or motion or a strain may result if you don’t warm up adequately before exercise. In addition, poor technique can lead to gluteus strains.

The Gluteus Muscles Explained

Your buttocks are medically referred to as your gluteus and each buttock comprises three separate muscles: gluteus maximums, gluteus medius and gluteus minimus – along with fat. These muscles run diagonally from the pelvic rim toward the femur, or thigh bone. They exist in layers with the gluteus minimus being the smallest and deepest; the gluteus medius in the middle and the gluteus maximus the most superficial. The three muscles work together to stabilize the pelvis and allow for hip motion by contracting or shortening.

gluteus muscle anatomy
  • The gluteus maximus is one of the body’s strongest muscles and is responsible for a leg extending backward. In one’s gait, it is crucial to pushing off and it is the muscle that allows you to straighten your hips when rising from a chair or ascending a flight of stairs.
  • The gluteus medius muscle is responsible for the sideways movement of the leg (abduction) and in keeping your hips level when you move from side to side. It also helps steady your thigh bone when you run, jump or walk.
  • The gluteus minimus muscle assists in sideways motion and internal rotation of the leg and helps the gluteus medius in stabilizing the hip and pelvis when one leg is lifted.

Symptoms of Buttock Pain

If the injury results from trauma, you may feel a sharp, sudden pain when it occurs. However, it will be most noticeable when you undertake activities that rely on the use of the affected gluteal muscle. Depending on the severity of the tear, your symptoms may include:

  • A deep ache in your hip or buttock;
  • Severe pain in the buttock;
  • Difficulty climbing stairs;
  • Unstable feeling in hips;
  • Tingling and numbness in your buttock;
  • Swelling or bruising in the hip and buttock area; and/or
  • Sharp pain when squeezing your buttocks together.

Diagnosis and Treatment

If you experience gluteal pain and can pinpoint the time of an injury, be cautious for the first 48 to 72 hours. Rest is important. You may also want to ice the affected area using a bag of frozen peas or crushed ice wrapped in a damp towel. Apply the ice for 15 to 20 minutes each hour or two.

Until you receive treatment, it is important to proceed cautiously so the injury doesn’t worsen; avoid the temptation to stretch and exercise through the pain. This means avoiding certain motions and activities, such as sitting cross-legged or with your thigh crossed over; sitting in a deep chair; climbing stairs; and, of course, running or cycling.

You will also want to contact a licensed physiotherapist to assess your injury. A physiotherapist will stress and stretch your soft tissues, exploring the muscle strength, lengths, range of motion, flexibility and stability to determine the extent of the strain. They may ask for a diagnostic ultrasound, since this test shows soft tissues and tendons.

Your physiotherapist will start rehabilitation with movements involving the specific muscle before moving on to resisted movements, followed by activities that involve the muscle, such as climbing stairs. Then, you can transition to running and jumping activities. Exercises will focus on strength and range of motion.

It is important to treat a gluteal strain or pulled butt muscle, because if it doesn’t heal properly, it can recur and become a chronic problem. Generally, for a moderate tear, you can expect healing to take place within six to eight weeks. If the strain is a recurring one, it will take longer.

Take heart! With determination and treatment, you will no longer be the butt of jokes about your gluteal strain.

shoulder pain after sleeping

Shoulder Pain After Sleeping

There are multiple reasons why many people don’t get enough sleep at night. One of the main reasons is physical discomfort, which can be due to inadequate neck support or a room temperature that’s too warm or too cold. Often, the cause of lack of sleep due to physical discomfort is shoulder pain.

There are several conditions that can cause shoulder pain during and after sleeping. One common cause is an injury to the rotator cuff. The rotator cuff is a group of muscles and tendons that are attached to the bones of the shoulder joint. These muscles and tendons allow you to move your shoulder while at the same time keeping it stable. An injury to the rotator cuff can be caused by tendonitis, strains, or partial or complete tears.

Can Sleeping On Your Side Cause Shoulder Pain?

Tendonitis occurs when muscles in the shoulder are injured or overused, causing inflammation. An inflamed shoulder is painful. The pain can be felt during the day, at night, or both. Tendonitis is caused by keeping the arm in the same position for long periods of time, such as sitting at a computer all day. Another cause is sleeping on your side at night, which can cause your arm to fall asleep. Other causes of tendonitis are sports injuries, poor posture, tears, and aging.

Rotator Cuff Tears

Rotator cuff tears can be caused by a single event or by repeated motion over time that eventually results in a small tear that can grow bigger over time – think of baseball pitchers and their repetitive arm motion. Besides rotator cuff injuries, other conditions that cause shoulder pain are osteoarthritis, bursitis, and shoulder impingement:


In this condition, the cartilage — the material that provides cushioning to the ends of bones — degrades. Degradation of cartilage in the shoulder joint causes shoulder pain over time. Osteoarthritis occurs with age as well as from trauma and injury. Symptoms include a decreased range of motion in the shoulder joint and stiffness and pain with movement. You may also hear clicking or grinding sounds in your shoulder when you move it.


Bursae are fluid-filled sacs that cushion tissues around joints. Shoulder bursitis occurs when the bursae around the shoulder joint become inflamed or irritated. Symptoms include redness and stiffness in the shoulder, local tenderness, and increased pain from movement or pressure.

Shoulder Impingement

Shoulder impingement occurs when the tissues that surround the rotator cuff grind or rub against adjacent bones and tissues. This rubbing can eventually lead to bursitis, tendonitis, or bone spurs. This condition is characterized by weakness in the shoulder and pain at the top or outer part of the shoulder.

Prevention and Treatment of Nighttime Shoulder Pain

The duration of your shoulder pain from sleeping depends on your sleeping posture, as well as on your underlying medical conditions. Here are some things you can do to prevent waking up with a sore shoulder:

  • Avoid applying direct pressure on your shoulder while sleeping. Sleeping on your side, sleeping with your arm under your pillow, or sleeping with your elbow above your head can irritate the rotator cuff and cause discomfort during sleep, especially if you sleep on the same side every night. You can wake up with a dull pain or ache in the shoulder and have a reduced range of motion due to stiffness.
  • If you sleep on the shoulder that hurts when you wake up, try switching sides when you sleep to give your sore shoulder a break while your opposite shoulder supports your body during sleep. You can also sleep on your back so that your body weight is more evenly distributed and you’re not putting any stress on your shoulders.
  • Regular exercise strengthens the muscles and tendons in your shoulders, neck, and spine by helping to increase range of motion and strengthen your upper body, including the rotator cuff. A physiotherapist can help prescribe appropriate exercises for you.
  • Add or remove pillows to support your body and shoulders.

How To Relieve Shoulder Pain After Sleeping

Applying heat and cold is a natural way to relieve pain in your shoulder after sleep.

  • If you have osteoarthritis, apply moist heat to the shoulder joint to ease stiffness and relax muscles.
  • For a strained shoulder, first apply ice to reduce inflammation and pain, then apply heat to reduce stiffness.
  • If you have tendonitis in your shoulder, apply ice to reduce inflammation and pain.
  • If heat and cold don’t relieve your shoulder pain, you can consider taking non-steroidal anti-inflammatory drugs for temporary pain relief, such as acetaminophen, NSAIDs, or Naproxen.

When to See a Doctor

For most people, shoulder pain after sleeping resolves within 48 hours. For some people, however, the pain becomes persistent. If self-help measures don’t work, it’s time to see a physiotherapist.

If your shoulder hurts longer than a few weeks, if you have additional pain or limited movement, and if you regularly wake up at night because of your shoulder pain, it’s time to consult your doctor.

Other signs that indicate a need for medical attention are grinding, snapping, clicking, or popping noises in your shoulder; visible growths or masses in your shoulder; and an inability to perform your regular tasks of daily living.