Today, we will talk about exercises for rhomboid pain and upper back pain. We will also cover some common root causes. Then we’ll go through four unique exercises that will help you eliminate pain by addressing the root causes.
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Root Causes of Upper Back Pain
What causes rhomboid pain?
Number one, the levator scapulae muscle runs from the back of the skull right down into the scapula. As the same implies, it elevates the scapula. The root of the pain starts when the muscle becomes short and tight, often from poor posture. It becomes weak, stiff, and restricted.
When the levator scapula stops working properly, the rhomboid jumps in to compensate.
There’s a recent study that illustrated this well. The study was titled “Levator Scapula and Rhomboid Minor are United.” It was published in 2022 in the Journal Annals of Anatomy.
In this study, the researchers dissected cadavers (dead bodies) and found that the rhomboid minor and levator scapulae muscles are interconnected – enclosed by connective tissue like fascia. 
As you can see here, with both muscles having a similar line of action and inserting into the scapula, if one of those muscles isn’t working (in this case, the levator scapulae), the rhomboid is in the best position to compensate. That results in overuse of the rhomboid causing pain and trigger points, aka muscle knots.
The second common cause comes from the serratus anterior. People often refer to it as the “boxer’s muscle” because it controls the protraction of the scapula. One function, perhaps more critical than protraction and often implicated in shoulder pain, is posterior tilt of the scapula.
Imagine you have a cup of water sitting on your shoulder. Scapular posterior tilt would spill the water behind you. Anterior tilt dumps the water in front of you.
Posterior tilt of the scapula provides scapular stability whenever you’re doing any arm movements like lifting something overhead or doing a tennis serve. Whatever you’re doing with your arms and shoulders, the serratus anterior muscle must function properly to keep good alignment with the scapula. Good alignment allows the head of the humerus (upper arm bone) to move around freely in the socket without pinching anything.
If the serratus anterior isn’t working well, the rhomboid can again (just like with the levator scap) try to compensate for it.
Finally, number three comes from stiffness in the thoracic spine. If you’re stuck in really poor posture and can’t get out of it because those deep muscles aren’t working, that can also create upper back pain.
You will probably get trigger points in those muscles because the rhomboids will lengthen over time. As the rhomboids get stretched out, they’ll get weak – too weak to do what you need them to do.
It’s like if you do 1,000 bicep curls, you’ll get sore. If you’re constantly in poor posture, you’re essentially doing those thousand bicep curls all day, every day. The rhomboids will get tired and tense. You’ll get trigger points, and they will feel all stiff and nasty.
Making sure that the thoracic spine has good mobility and functions correctly will potentially clear up a whole host of back and shoulder problems. It’s well worth your time to correct it.
Here’s another study titled “The Effects of Thoracic Spine Manipulation” that illustrates this point well. 
Thoracic spine manipulation is pushing on the thoracic spine in order to improve its mobility, specifically into extension. It can cause pressure, pain, and sensitivity because thoracic extension pushes into the rhomboid muscles, activating any trigger points.
The researchers conducted the study as a randomized controlled trial with two groups. One received just physio. The other received thoracic spine manipulation and physio.
The results came back showing that the thoracic spine manipulation group showed a greater decrease in pain in the rhomboids and a higher level of pressure that could be tolerated when poking into the muscle.
This just goes to show how vital thoracic spinal mobility is to decreasing pain in the rhomboids.
Those are the three common root causes in our society these days contributing to rhomboid and upper back pain.
So what do we do about it? We dive into four great exercises for rhomboid pain, including one to settle down the pain fast.
Quick Relief: Rhomboid Row ISO
The first thing most people do when they’re feeling stiff in the rhomboids is static stretching. But that’s something to only do very, very sparingly. Instead, and this might feel counterintuitive, activate the rhomboids.
Really fire up those muscles. What you find when you do is that the tension just releases. It feels better. Your body knows that the muscle is working and just releases the tension.
A good way to do that is with a bent-over rhomboid row. It’s just an isometric movement.
- Hinge over at the hips.
- Retract the scapula, then pinch your shoulder blades together. Really pinch them hard.
- While keeping them pinched, do a row-style movement, driving the elbow up towards the ceiling
- Pretend you’re holding a bar and remain in that position (big, deep breaths) for 10 seconds
- Keep pinching your shoulder blades as you release your elbows, lowering your arms back down to the floor
Repeat that for 3-6 reps, holding for ~10 seconds.
That isometric activation alone could help to dissipate some of that rhomboid pain, but this is like taking ibuprofen. It’s just a symptom we’re masking with the isometrics by playing with some neural mechanisms. Good stuff, but it doesn’t solve the underlying problem.
Segmental Thoracic Mobilization
The first technique is segmental thoracic mobilization.
Now, this isn’t just a passive extension over a foam roller. We have some active components in it that will help get those muscles firing, mobilizing your thoracic spine into extension. It will help mobilize your spine into extension and activate some of those deep muscles.
For this technique, you’ll need a foam roller or yoga block. Pay attention to your motions so that you’re not moving too fast. Don’t use any momentum, just move under control. Keep your lower back (lumbar spine) stationary.
- Start by placing the roller at your lower thoracic spine
- Flex and extend over the block under control three times
- Side to side bend three times
- Move the roller up to another segment, repeat
As you’re doing this, make sure you’re relaxing your neck and chest muscles as much as possible. Keep moving the roller or block until you’ve mobilized your whole thoracic spine. It takes 4-5 different areas for most people.
Wall Side Bend
Next up, a technique that helps throughout the day when you’re feeling a little stressed, or you have deadlines looming.
- Get your back to a wall, touching your butt, shoulder blades, and your head
- Move your ear toward your shoulder as you exhale
- Hold for 2 seconds
- Return to neutral as you inhale
- Move your ear toward your other shoulder as you exhale
- Hold for two seconds
Do 5 reps per side.
The key to getting the most out of this exercise is to match the movement to your breathing.
This technique is great because it lengthens all of the lateral neck muscles, including the levator scap. It’s also strengthening the levator scap, and that’s how you get started on the path to correcting any dysfunction in that muscle.
Keep performing this exercise, and you’ll be on your way to fixing the root cause of your rhomboid pain.
DIS: Shoulder Extension / Anterior Scap Tilt
This last technique is called the Dissociation Technique for Shoulder Extension Dissociating from Anterior Scapular Tilt. It’s quite the mouthful, but really, it’s just a very specific nomenclature that you’ll see quite a bit in the ROM Coach app (free on the Apple and Google stores.)
This technique breaks the subconscious association (dissociates) between shoulder extension and anterior scapular tilt.
Oftentimes, whenever people extend their shoulders, the common habitually associated movement pattern is to tilt the scapula anteriorly. We will break this pattern by firing up the serratus anterior muscle, which controls posterior scapular tilt.
Start off with really bad posture.
- Round your shoulders, tilt the scapular anteriorly, jut your head forward
- Extend the shoulders keeping that bad posture
- Keep extending your shoulders, lifting your arms while straightening your posture and posteriorly tilting the scapula – extending the shoulder up, trying to touch the hands together behind your back
- Keep sucking in the bottom of your shoulder blades
- Slowly return to neutral, then gradually let go keeping control through the full range of motion
Do 5 reps with a 10-second hold.
These are unique exercises for rhomboid pain for breaking habitually associated movement patterns and activating muscles. We need to activate different muscles to replace these dysfunctional movement patterns most of us fall into over time.
We have several other videos on the levator scapulae, rhomboids, and back pain. Head over to our YouTube channel to check them out.
You can also find several of these exercises on our free ROM Coach app.
But to really correct shoulder dysfunctions, check out Shoulder Pain Solution. It teaches you how to fix rhomboid pain like this and targets so many more areas. No matter what the underlying cause is, Shoulder Pain Solution guides you toward your specific goals, whether it’s solving acute pain or preventing future damage.