Understanding the Source of Rhomboid Pain
Many patients experience persistent pain between the shoulder blades, often referred to as “rhomboid pain.” When reviewing patient onboarding forms, this discomfort is described in various ways—upper back pain, thoracic pain, neck pain, shoulder pain, medial scapular pain, or even T-spine pain. This type of pain can feel like a dull ache or a sharp, stabbing sensation that disrupts sleep and daily activities.
So, what causes this nagging pain? Could it be related to cervical spine issues, thoracic spine dysfunction, poor posture, muscle imbalances, or latent trigger points? More often than not, it’s a combination of these factors. This article will explore how to identify the source of this pain and effective treatment approaches for resolving rhomboid qi stagnation.
Understanding Qi Stagnation & Referred Pain
What Is Somatic Referred Pain?
Pain between the shoulder blades often originates from another structure within the body, a concept known as somatic referred pain. Unlike radicular or neuropathic pain, which follows nerve pathways, somatic referred pain has a deep, aching, and expanding pressure-like sensation that can be challenging to pinpoint.
In contrast:
• Radicular pain is sharp, shooting, or burning and follows a dermatomal path.
• Neuropathic pain is burning and often accompanied by sensory abnormalities.
Since rhomboid pain is often somatic referred pain, identifying the source is crucial for effective treatment.
Cervical Spine & Rhomboid Pain
If rhomboid pain originates from the cervical spine (C5-C7), it is likely referred pain from disc pathology or facet joint dysfunction. Patients with cervical-generated rhomboid pain often experience:
• 
Diffuse, aching pain that is difficult to localize.
• Neck pain that intensifies as rhomboid pain worsens.
• Pain provoked by palpation of cervical joints.
Treatment Approach for Cervical-Related Rhomboid Pain
Electro-Acupuncture Considerations:
• Local points: BL10, GB20, GB12, LI18, GB21, GV13-14, SI14-16, and Huatuojiaji (C5-T1).
• Distal points: Luo Zhen, SI3, SJ3, LI4, LI10.
Manual Therapy Techniques:
• Cupping, guasha, traction, moxibustion, joint mobilization.
Home Exercises:
• Chin tucks, neck curls, self-mobilization, use of a lordotic neck bolster.
Thoracic Spine & Rhomboid Pain
The thoracic spine can also refer pain to the medial scapular area. Research has shown that dysfunction in the thoracic facet joints and costotransverse joints can create localized rhomboid pain that mimics a muscular issue.
Signs of thoracic-referred rhomboid pain:
• A history of thoracic pain that correlates with current symptoms.
• Palpation of thoracic segments reproduces the pain.
• Stiff or hypermobile thoracic joints detected through segmental motion palpation.
• Hyperkyphosis, or significant rounding of the mid-upper back, creating a long, weak, curved upper back
Treatment Approach for Thoracic-Related Rhomboid Pain
Electro-Acupuncture Considerations:
• Local points: BL and GV channel points, multifidi (T1-T7), Huatuojiaji.
• Distal points: LI, SI, SJ Jing-Well points, GB10, SJ3, LI4, LI10, SI3, BL60, GB41, SJ5.
Manual Therapy Techniques:
• Cupping, guasha, traction, moxibustion, thoracic mobilization.
Home Exercises:
• Foam rolling, windmills, prayer stretch, wall thoracic rotation, scapular retraction exercises.
Trigger Points & Local Muscle Pain
If neither the cervical nor thoracic spine is the root cause, rhomboid pain may be due to local soft tissue dysfunction such as:
• Trigger points (TrPs) causing referred pain.
• Muscle imbalances due to poor posture or overuse.
• Dehydration, electrolyte imbalance, or trauma.
Identifying Trigger Points
Trigger points in the rhomboids and levator scapulae are common, especially in individuals with Upper Crossed Syndrome (forward head posture, rounded shoulders). Muscle testing can reveal whether the rhomboids are short and overactive or weak and inhibited.
Manual Muscle Test for Rhomboids:
1. Have the patient lie prone and place their hand on the opposite back pocket.
2. Palpate the medial border of the scapula.
3. Ask the patient to lift their hand off their lower back.
4. If the rhomboid does not engage properly, this indicates weakness.
Treatment Approach for Trigger Point-Related Rhomboid Pain
Electro-Acupuncture Considerations:
• Local points: BL and GV channel points, ashi points, motor points, trigger point needling, Huatuojiaji.
• Distal points: Selected based on the patient’s pain pattern.
Manual Therapy Techniques:
• Cupping, guasha, traction, heat therapy, stretching, deep tissue massage.
Home Exercises:
• Self-myofascial release using a tennis ball (targeting tender points).
• Resistance exercises: rowing variations, band pull-aparts, dumbbell lateral raises.
Final Thoughts: Identifying the True Cause of Rhomboid Pain
Whether the pain is referred from the cervical or thoracic spine or caused by trigger points, proper assessment is key.
Key Takeaways:
✔ Cervical spine involvement produces a diffuse aching pain that spreads outward.
✔ Thoracic spine dysfunction can mimic muscular pain patterns due to facet joint referral.
✔ Trigger points in the rhomboids and levator scapulae create localized sharp pain.
A skilled practitioner will evaluate joint mobility, muscle imbalances, and soft tissue dysfunction to develop a personalized treatment plan. Electro-acupuncture, manual therapy, and corrective exercises work together to resolve qi stagnation and restore pain-free movement.
About the Author:
Dr Christopher “Chappy” Chapleau, DAc, LAc, Dipl Ac, AIT, IMT, MSHP, CES, HMS, is a practicing Sports Acupuncturist, Human Movement-Biomechanical Specialist, Integrative Manual Therapist, and Exercise Physiologist. Dr. Chappy has a doctorate in Acupuncture Medicine and has Degrees in Human Performance, Western Health Science, and Sports Acupuncture. He holds many certifications which include Selective Functional Movement Assessment (SFMA I & II), Human Movement Specialist (HMS), Integrative Manual Therapist (IMT), and Orthopedic & Sports Medicine Acupuncture/Needling and works with Boulder Therapeutics in Boulder and Superior, Colorado.
Specializing in acupuncture and exercise science, Chris seamlessly integrates acupuncture into musculoskeletal rehabilitation therapy for pain modulation, faster recovery, and peak athletic performance.