Tricky trigger point in Rhomboids!

[PollyLove]

hello!! I'm new to the board, so Hi to all!! I have a client {i work for a chiropractor} that i've been working with for a few weeks. She has Large TP's in her rhomboids that for some reason I cannot get to release. I've tried using vibration,elbows, muscle stripping, pinching, knuckles....Everywhere else that has been troubling her is doing much better, but this one area is giving us a tough time...any suggestions????
thanks so much!!!

 

[delphispolaris]

how are her pecs, as far as tissue quality is concerned?

are you sure what you are pushing on is a "trigger point"?

patrick

 

[Cheese is good.]

Yeah i'm sure they are a tp, also, one day she has referred pain from them and the next it's not there..back and forth..actually the client is a massage therapist as well lol. Her pecs are tight...but getting better..we've been working on them to try to help with the release...At this point, both of us are totally stumped!!

 

[bearsma90]

My suggestion would also be to work on the pecs (major and minor) and all those "little" muscles that go in and around the front of the shoulder. Subscapularis is also important. Also, remember when you work one side of the scapula you also need to address the other 2 sides.

Angie

 

[Pompal 09.]

Infraspinatus and Teres M and m are also important, I've found, as well as trapizius (all of it) and levator, esp. the attachment to the scapula. I know that's all the obvious stuff, but thought I'd mention it anyway.

My rule is to work the entire surrounding area, and then go to the problem area. Then work the other side. Then come back and work the problem area.

Occipital stuff could be nice to release also.

Ah! Since you work for a chiropractor, I just had an idea. What about giving her a good 'ole relaxation massage with some really basic (deep but not too deep) kneading of the upper back and shoulders. I find that sometimes when I give a client too much or just a lot of therapeutic, deep tissue, physical therapy type techniques what they are missing is basic relaxation massage. TPs in that area are frequently related to stress and even with every perfect technique you have, sometimes you just gotta do relaxation and stress relief.

Also, have her do some yoga, and take a hot bath, and look at her massage schedule!!

 

[max g]

I'm just curious, but I was taught in school that the rhomboids very rarely got trigger points!! Is this not the case, or would you say this is a rare occasion? Sorry for hijacking the thread.

 

[H.E DUBBLE HOCKEY STICKS]

i would say this is a special case....thanks everyone for all the imput...I feel like we've tried all of this but we will give it another go today!!!! I have a couple of new tricks up my sleeves for the occiput and scalens/SCM...so we shall see!!!

 

[Bubbl3z]

Have you tried any positional release techniques? I have found strain counterstrain and several other positional release methods to be very effective in relieving TPs in that area. Since those muscles tend to be weak/lengthened, stripping or otherwise attempting to further lengthen the tissues is often ineffective or only temporarily helpful. Repositioning the scapulae to place the rhomboids in a shortened, "crowded" state may help "reset" the muscle spindles and provide greater relief.

 

[houseboy]

JasonE can you elaborate on the positional release techniques you would use to release TrPs in the rhomboids?
I too have a client with chronic rhomboid TrPs. I have addressed the pecs, supra and infraspinatus, levator scap, Subscap, Teres major and minor, as well as the Traps. I've used Stripping, compression, vibration, and of course TrP release.
She gets temporary relief from the work.
She has a scoliosis in the thorasic that she is seeing the chrio for, so I am assuming that is one of the major causes. That and she is a teacher. :shock:

So any info you have about positional release would be apreciated.

Also, anyone have any suggestions on MFR for this ailment?
THanks!

 

[vine]

Are the clients doing any self-care (stretches) to maintain the release you facilitate in their pecs, etc?

 

[JosephWard]

JasonE can you elaborate on the positional release techniques you would use to release TrPs in the rhomboids?
I too have a client with chronic rhomboid TrPs. I have addressed the pecs, supra and infraspinatus, levator scap, Subscap, Teres major and minor, as well as the Traps. I've used Stripping, compression, vibration, and of course TrP release.
She gets temporary relief from the work.
She has a scoliosis in the thorasic that she is seeing the chrio for, so I am assuming that is one of the major causes. That and she is a teacher. :shock:

So any info you have about positional release would be apreciated.

Also, anyone have any suggestions on MFR for this ailment?
THanks!

My best suggestion regarding learning about Positional Release Techniques is to get direct instruction. That said, I highly recommend Leon Chaitow's text on Positional Release Technique; it's excellent, and includes a nice DVD-ROM. Lawrence Jones' book on Strain Counterstrain is good too, though somewhat less user-friendly.

Hard to properly describe a PRT without pics, but I'll try. For the rhomboids, I'd seek to shift one or both scapulae medially. The client would be completely passive, so that the rhoms wouldn't be actively assisting or resisting the movement. This may be done with the client supine, prone, or sidelying. One way to test whether the positioning has been successful: locate a tender point in the area of concern, reposition the scapula, then retest the tender point. If the pain hasn't decreased by 70% or more, you may need to adjust the position. If you are palpating the rhoms during the positioning, you may feel them soften as they are brought into a position of ease. Hold the position of ease for 90 seconds or more, then return to the starting position. Retest the tender point, and it should be significantly less painful. At this point, other types of direct work are more likely to be successful - I usually use NMT-style trigger point and cross fiber friction, and have had good success.

I would definitely release the pecs prior to performing the above technique. MFR for the upper chest can be very helpful, but don't neglect to directly address pec minor - it's almost always tight and short, placing a great deal of stress upon the rhomboids. Release the pecs and you'll find it easier to bring the scapulae back to ease the traps, rhoms, etc.

For self-care, I have taught many clients AIS stretches for the pecs, biceps, etc. The client needs to get their scapulae back in place and keep them there. I don't have them do any stretches for their traps or rhoms, as these are already chronically overstretched.

 

[lotpot]

Thanks JasonE. You pretty much said exactly what I though you would say. I just needed you to say it! LOL!

 

[Stan P]

I'm just curious, but I was taught in school that the rhomboids very rarely got trigger points!! Is this not the case, or would you say this is a rare occasion? Sorry for hijacking the thread.

I would tend to agree with this... also, in the last class I took, James Waslaski said there is research indicating that trigger points simply don't form in the rhomboids.

I don't know if this is a case of "and bumble bees can't fly", or not... but there you have it.

 

[pink smiling]

Trigger points can form in weak and overstretched muscles. It is possible, although not as common for rhomboids to develop TrP's. Sometimes a muscle will develop a TrP in order to help it function better, so if the rhomboids are overstretched there may be a TrP to hold it in a contracted state for better functioning. If you can get the aneforum.xxxonists to open up the TrP should go away. Also, rhomboid TrP's can be there because of a TrP in the sup traps, if you find one there and release it first and the other may disappear. If you are definitely positive the TrP is in fact in the rhomboids.

If your client can do pec stretches, that will be very helpful. A lumbar support is great especially in her car and desk.

I'm sure you know what you are doing but I just wanted to add that often they are actually in the spinae group which lies underneath or in the traps which are over them. I can't tell you how many therapists I have gone to who have tried to release my rhomboids when I can feel the TrP is in the spinae.

 

[Wish I was boredDude]

hey everyone..thanks for all of the suggestions...we had a bit more luck this week and she is starting to slowly feel better.....i've been giving her pec stretches since day 1, although i'm not sure how much they are being done!!! working subscap seems to help a bit... i appreciate all the feedback and will def use all of the information!!