Yoga, Injury and Safety Q+A / Survey Answer #3: Pain under the Shoulderblade

I may have incurred the same injury multiple times in my yoga classes (Anusara and Vinyasa). How might I be able to continue in my practice while allowing the muscle to heal?

The muscle felt like it was under my shoulder blade and fanned out to connect to an imaginary line following my spinal cord. Perhaps it is the Rhomboideus Major muscle? The pain was dull and sustained but once in class it would become even more irritated in poses like downward dog (and other weight bearing poses with hands over head). When the pain would intensify I would try to better square my shoulders and “drop my shoulder blades” (a regular cue given by my Anusara instructor). This would be much more comfortable, but during dynamic movements I could not always protect the muscle (or at least I didn’t know how to).

Each time I injured myself the healing time was more than a couple months. During this time I did nothing to treat it except for adjusting held postures during my daily practice. In fact, after a year long break from yoga I still feel a very dull pain (and moderate pain when I clasp my hands over head and bend over).

I’d be curious to know how to avoid straining this muscle again and if there are modifications for poses and movements that would enable me to continue practicing while healing from the injury.

First, I’m so sorry you have been in pain. Chronic low-level pain often is more disruptive of activity than sharp pain that quickly leaves.

It sounds as though the pain you are feeling is indeed in the area of your rhomboids (great sleuthing!), and could be a tendonopathy (like tendonitis) or bursitis, or a variety of other dysfunctional parts and patterns. The muscle layer more superficial to the rhomboids is trapezius (middle fibers) and beneath the rhomboids are intercostals (between ribs). In addition, there are joints where your ribs meet your vertebrae.

This pain has gone on for a long time, and you are unable to participate in something that previously gave you joy. Get evaluated by a medical specialist to figure out the exact cause and eliminate it. For musculoskeletal expertise, see a physical therapist (PT). You may or may not need a prescription for PT from a medical doctor depending on the state where you live and your health insurance policies.

To find a great PT, try asking friends for recommendations, consider seek out “manual therapists” who have some extra training, and, check here to see if there’s a “certified manual functional therapist” – CMFT –  near you: http://www.instituteofphysicalart.com/ipa/referral/list, and for someone skilled in Intramuscular Dry Needling.

In my clinical experience, it’s rare that a long-term shoulder problem has a single origin. There is a strong relationship between scapular strength, thoracic spine/rib mobility, core strength, neck position, rotator cuff capacity for stabilization and even TMJ issues like teeth clenching. Seek out a PT who can spend 45 minutes to an hour with you in order to complete a thorough examination. If they know about yoga, even better. If not, during the evaluation, demonstrate the moves that irritate you.

In addition, not as an alternative, consider the possible contribution of asymmetrical movements in your life: slinging a bag on a single shoulder, carrying your bike down the stairs daily on your right side (example from my life!), habitually sleeping on one side only. Sleep on your back, evenly distribute backpack weight, switch off auto-pilot.

Massage can be a phenomenal compliment to musculoskeletal healing and physical therapy, as well.

Although I’m obviously a fan of yoga, instruction for core strengthening (NOT CRUNCHES!) is frequently a weak point during group yoga classes, and / or too abstract for students to grasp. Instability in the core often leads to strain elsewhere. Although no system is perfect, a few pilates classes may offer great cross-training with less likelihood of re-irritating the area.

If you don’t have other health concerns, while you wait for your first physical therapy appointment, start with two foam roller exercises. Foam rollers are available at gyms, sports stores and on amazon:

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Lay face up with a foam roller horizontally placed under your shoulderblades. Bend your knees and place your feet flat. With your hands cradling the weight of your head, lean back until you feel a stretch in your chest and concentrated pressure at a point in your upper back.

Foam Roll Thoracic Extension Exercise

Curl up to return to a neutral long spine, lift your hips and reposition yourself so the foam roller is about one inch up or down. Lower your hips, lean back again. To shift the location of the muscular stretch, point your elbows up to the ceiling versus out to the side.

Foam Rolling for Thoracic Extension and Lats Stretch

This exercise can be intense. It is a form of self-mobilizing one vertebra over another. If you have a “stuck” feeling spot, or a location that brings up concentrated pain, you may be closer to working out the root cause.

Secondly, lie on your side with the foam roller under your armpit. With knees bent you can shift your body weight up/down or roll forward/back. This area (lats, teres major, teres minor, infraspinatus) is remarkably tender to pressure for many people who don’t otherwise have pain there.

Latissimus Dorsi Roll-out with Foam Roller

If these suggestions relieve your symptoms, fantastic. I still highly recommend seeing a physical therapist to help you figure out the cause and contributions.

Let me know how it goes in the comments below or at facebook.com/SacredSourceYoga