Rhomboid tear

[powersnatch]

Dr Lancaster,

I suffered a rhomboid tear in November and I am still not back to lifting heavy in the gym. I believe it was grade 2 (as I had no surgery) and believe the problem developed from poor posture (though I hurt it squatting). The issue is I seem to always re-injure (or tweak) it every three to fours weeks (e.g. last week when putting my bag in the car, a few weeks before I felt good and hurt it lifting something etc). Is this usual/will this eventually stop happening? It is happening less and less frequently but every time I feel like its a set back. I am thinking about going on cissus quadrangularis to help. I have been doing rehab work in the gym (postural stuff). But should I be trying to strengthen my scap retractors or should I benefit more by taking a few weeks off?

Thanks, any help is appreciated

[RhysI]

I'd be interested on this one as well. I hurt my upper back by sneezing believe it or not! It slowly improved but then whilst training I unracked my first warm up on front squats and felt it go again badly as I stepped away. Had MRI's as they thought I may have a prolapsed disc but apart from some minor bulges there was nothing there.

Since a physio has suggested I may have torn my rhomboid. It's better now but I still get pretty locked up every now and then and I have to get a lot of soft tissues work done to keep it in check! I definitely don't want to be in pain like that again!

Rhys

[drdiran]

Powersnatch,
I had to google cissus quadrangularis to find out what it was. If you take that along with ibuprofen it will probably work well. (that is a joke, just take the ibuprofen)

There is a trend in all aspects of physical medicine. Chiropractors, PT's, Ortho's will often upgrade a diagnosis to make the problem seem worse than it really is. For example, you have been told you have a "torn" rhomboid. I'm not suggesting you do not have an injury, but any tearing you may have is almost certainly microscopic in nature. From what you have posted you most likely have a mild to moderate strain of the rhomboid.

Most mild to moderate strains will resolve through a natural course of healing within 6 to 8 weeks in the absence of unusuall factors and or circumstances. When you lift and flare up the injured area, it is like knocking the scab off of a cut. The healing process has to start all over.

As a DC I would treat the injury with ice, interferential therapy, massage and adjustments. In fact I have developed a specific adjustment just for your type of injury that allows me to adjust under the scapula (shoulder blade). Yours is a common injury in rodeo cowboys, (I treat a lot of PRCA and PBR athletes) and we can usually have one of them back roping or riding in 7 to 10days.

Dr. Diran

[powersnatch]

Originally Posted by drdiran

Powersnatch,
I had to google cissus quadrangularis to find out what it was. If you take that along with ibuprofen it will probably work well. (that is a joke, just take the ibuprofen)

There is a trend in all aspects of physical medicine. Chiropractors, PT's, Ortho's will often upgrade a diagnosis to make the problem seem worse than it really is. For example, you have been told you have a "torn" rhomboid. I'm not suggesting you do not have an injury, but any tearing you may have is almost certainly microscopic in nature. From what you have posted you most likely have a mild to moderate strain of the rhomboid.

Most mild to moderate strains will resolve through a natural course of healing within 6 to 8 weeks in the absence of unusuall factors and or circumstances. When you lift and flare up the injured area, it is like knocking the scab off of a cut. The healing process has to start all over.

As a DC I would treat the injury with ice, interferential therapy, massage and adjustments. In fact I have developed a specific adjustment just for your type of injury that allows me to adjust under the scapula (shoulder blade). Yours is a common injury in rodeo cowboys, (I treat a lot of PRCA and PBR athletes) and we can usually have one of them back roping or riding in 7 to 10days.

Dr. Diran

Thanks, I recently took a week off, felt great so I upped it to two weeks, and from what you've said, i\Im gonna let this one recover fully. Its funny because my physio kept pushing me to do more rehab than I felt I could handle. You said "as a DC", may be a stupid thing to ask but what does DC mean? Its also funny you mention the scap, as Ive already noticed the craziest knots just under my scap, and if Active Release was easy to find in Australia, that'd be something I would already be doing. Why aren't there people like you in Australia? You are honestly the only professional that has not pissed me off completely by being ambiguous, dismissive or just a plain old idiot. Until you, I have not spoken to one doctor or physio that I felt knew what they were doing. Thank you, your reply is greatly appreciated, and its good to talk to somebody I really respect

[powersnatch]

sorry forgot to add, as the inflammation has gone down, is heat therapy beneficial? Thanks mate

[drdiran]

Powersnatch,
No worries. DC is Doctor of Chiropractic. Heat is OK before workout, but I would still use ice after workouts.

A little trick you might try is to get a physio-ball/exercise ball about 25cm to 35cm would be best. Sometimes they will call these pilates balls. You can buy them in the US at Wal-Mart for $12.00.

Anyway lay over the ball face up and roll back and forth, and side to side real slow. A lot of times there will be a rib head under the the scap that is rotated just enough by the muscle spasm to cause some irritation. Rolling on the ball with sometimes relax the muscle enough for the pressure to release on the rib head. The ball needs to be aired up pretty hard. A basketball might work.

Let me know how it goes.

Dr. Diran

[powersnatch]

Originally Posted by drdiran

Powersnatch,
No worries. DC is Doctor of Chiropractic. Heat is OK before workout, but I would still use ice after workouts.

A little trick you might try is to get a physio-ball/exercise ball about 25cm to 35cm would be best. Sometimes they will call these pilates balls. You can buy them in the US at Wal-Mart for $12.00.

Anyway lay over the ball face up and roll back and forth, and side to side real slow. A lot of times there will be a rib head under the the scap that is rotated just enough by the muscle spasm to cause some irritation. Rolling on the ball with sometimes relax the muscle enough for the pressure to release on the rib head. The ball needs to be aired up pretty hard. A basketball might work.

Let me know how it goes.

Dr. Diran

Cheers, I actually have a foam roller but I think that maybe your idea is better so I can get in deeper (thats what she said) Ill start on that asap and let you know, but how often should I do this kind of soft tissue work?

[drdiran]

Powersnatch,
Use the therapy as often as you like. You may sometimes feel a "pop" and other times not. If you use a foam roller put the roller across your spine for what we are trying to accomplish. The problem with the foam roller is that when you do run it across the spine it is usually too wide for the scapulas to rotate so they become fixated against the roller and you don't get the movement that we are shooting for.

http://www.walmart.com/ip/Danskin-No...-Ball/12167855

This link is the ball we use. It is 25cm and cost $8.00 Air it up to where it is very hard, little to no give when you lay across it.

Don't get a big exercise ball (45cm to 65cm). They are too big and pose the same problem, blocking the scapula, as the foam roller.

Dr. Diran

[powersnatch]

Ok so I have given it a shot up against a wall with a tennis ball. Felt good (though obviously tender) to do, and was quite sore the next day. Is this normal/should I continue?
I am just into my third week of no gym/exercises. Is there a particular point where I should start doing some exercises? I was thinking maybe after week 4 (about a month) I would start doing some thoracic extension stretches maybe.

Anyway speaking of rehab I will have a chat to my functional anatomy tutor, because as I asked my lecturer about muscular injury, which he touched on in the lecture, he told me my tutor is finishing up some research on hamstring tears. Really interesting information about how the force-length curve changes with an injured muscle, and the importance of eccentric (with full ROM) training in regards to correcting these changes. Anyway, my lecturer mentioned that they hypothesised that there are neuromuscular changes that never change back after a tear. It'll be hard to ask him tomorrow, because we have an exam lol, but maybe after I will have a chat to him, if not maybe next week.

[drdiran]

Not sure what you are doing with the tennis ball.

Return to activity should be based on decreased symptoms. If you are feeling better then you should start slowly back into activity. Stretches first followed by light lifting, making sure to ice after all activity regardless of how good it may feel.

Dr. Diran