Therapist Notes – Pain inside shoulder blade when slouching while seated

Pain between the shoulder blades is seldom rhomboids unless the client has trapped the rhomboid muscle against a hard surface or they have extremely imbalanced extrinsic back and extrinsic chest muscle. When the problem is postural, the shoulders and upper back are notably rounded or the upper back is very straight and shoulder blades are winged out.

First, know your shoulder patterns. If this is not rhomboid muscles, don’t waste your time diligently digging through the upper back, especially if they have rounded shoulders.

Rhomboids produce achy trigger points just along the border of the scapula. They are often too sensitive to get a good release without using ice, heat, MET or working the joints first.

This is one of those life lessons like the one that I talk about in The Godfather of Organized Pain. I’ve witnessed Dr. Pruitt, reach out and press those sensitive rhomboid trigger points, mobilize the upper thoracic vertebrae and then press on the same spots with little or no tenderness. Rhomboid muscles will not release with any lasting effect unless the facet joints and costovertebral joints along the upper thoracic vertebrae are addressed.


This NMT protocol is great for mobilizing vertebrae and melting down the lamina. It starts with the sub-occipital area, which helps with Forward-Head Posture.


If you are doing additional structural work to correct posture, do that before you treat the local area.


Next, treat the rhomboids with this protocol to get rid of local trigger points and further mobilize local joints.


Unless there is some acute injury to the rhomboids, lasting relief is all about rebalancing the shoulder girdle. Evaluate their posture, then use the wall push-ups, chest stretches and other techniques in this post.

The neck stretches for Forward Head Posture in this post are also very helpful.




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Is the pain from
degenerative discs or
trigger points in the muscle?

This post discusses the differences in pain from disc problems and pain from trigger points. Who should you see to help with your pain?

Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.

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