When pain strikes the area between the shoulder blades, particularly when performing a simple movement like turning the head, it can be distracting. This discomfort is often described as a deep, aching sensation that intensifies with neck movement. Understanding the anatomy provides insight into why turning the head aggravates pain centered in the upper back. The pain may stem from local muscle issues or, more commonly, from referred problems originating in the neck.
Locating the Rhomboid Muscles and Their Role
The rhomboid muscles, named for their diamond-like shape, include the rhomboid major and the rhomboid minor. These muscles are situated in the upper back, lying underneath the larger trapezius muscle, and connect the spinal column to the medial border of the shoulder blade (scapula).
The primary function of the rhomboids is scapular retraction, pulling the shoulder blades toward the spine. They also stabilize the scapula against the rib cage, which is necessary for healthy shoulder and arm movement. When the head turns, these muscles adjust their tension to maintain stability, meaning pre-existing tightness or irritation can be provoked by cervical rotation.
Common Reasons for Pain When Turning the Head
The distinct connection between neck movement (cervical rotation) and upper back pain suggests the issue is often not purely a local muscle strain. One frequent mechanism is the referral of pain from the lower cervical spine. Dysfunction in the facet joints or intervertebral discs at the C6 or C7 levels can send pain signals directly to the area between the shoulder blades. This referred pain is typically a deep, diffuse ache, characteristic of pain originating from spinal structures. When the head turns, it causes slight movement and compression in these lower cervical structures, irritating the C6 or C7 nerve roots. The pain is then felt in the rhomboid area even though the source is in the neck.
Another common source of discomfort is the presence of myofascial trigger points, often called muscle knots, within the rhomboids or the nearby levator scapulae muscle. These hyperirritable spots become taut when stretched. Turning the head to the opposite side stretches these upper back muscles, which can aggravate the localized knots and cause sharp pain.
A simple muscle strain or overuse can also cause the rhomboids to become tender to the touch. Activities involving repetitive arm motions or holding a static, hunched posture can lead to micro-tears and inflammation. When the head rotates, the rhomboids are stretched and activated to stabilize the shoulder, causing the inflamed muscle to protest with a sharp increase in pain.
Immediate Strategies for Relief at Home
For acute muscle pain and spasms, applying heat is beneficial as it increases blood flow and helps relax tight muscles. A moist heat pack or warm shower applied for 15 to 20 minutes can ease muscle tension. Conversely, if the pain started suddenly and feels sharp, suggesting acute inflammation, applying ice for 10 to 15 minutes can help numb the area and reduce swelling.
Gentle, controlled movement can provide temporary relief by carefully stretching the affected muscles. A simple cross-body arm stretch, where the affected arm is pulled across the chest, can gently lengthen the rhomboids. Another effective stretch involves performing slow chin tucks, which help mobilize the lower cervical spine without excessive rotation. These movements should be performed slowly and stopped immediately if they intensify the pain.
Over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can help manage both the pain and underlying inflammation. Topical pain relief creams or gels can also be applied directly to the painful spot for localized relief. These strategies provide short-term comfort and should not be relied upon as a long-term solution for chronic or recurring pain.
When It Is Time to See a Specialist
While most acute rhomboid pain resolves with rest and home care within a week, certain signs indicate the need for professional evaluation. Pain that persists unchanged for more than seven to ten days, despite consistent application of heat, ice, and gentle stretching, requires a visit to a healthcare provider. If the pain is severe enough to limit your ability to perform daily tasks, a specialist can offer a more accurate diagnosis and treatment plan.
Several “red flag” symptoms warrant immediate medical attention, as they may suggest a more serious nerve issue originating from the spine:
- Numbness, persistent tingling, or noticeable weakness in the arm or hand accompanying the rhomboid pain.
- Pain that radiates down the arm.
- Fever or chills accompanying the pain.
A physical therapist can conduct a thorough assessment, including postural analysis and specific exercises, while a physician can evaluate for spinal involvement or prescribe further diagnostic tests.