Ep 167 – The Rhomboids: Spread Too Thin: “The Rebel MT” with Allison Denney

0:00:00.0 Speaker 1: Anatomy Trains is delighted to announce a brand new Dissection Livestream Specialty Class on September 18th, Lumbopelvic stability, a one-day layer dissection with Anatomy Trains author Tom Myers and master dissector Todd Garcia. The early bird price of $150 is held until September 10th. After September 10th, the price is $250. Come see the body's actual core for yourself. This course will be provided over Zoom webinar with multiple camera views, live chat and Q and A. Visit anatomytrains.com to sign up.

0:00:34.7 Speaker 2: This episode is brought to you by the Massage Mentor Institute. Dayan Matkowski, also known as the Massage Mentor, and Allison Denney also known as Rebel Massage, have teamed up to bring you the Massage Mentor Institute. MMI is a collection of teachings and education opportunities from industry leaders around the world, because your continuing education experience should be whatever you want it to be. They are building community one body part at a time, and they want you to be a part of it, head over to the massagementorinstitute.com today to see more, learn more, and do more.

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0:01:20.9 Allison Denney: Hi, my name is Allison Denney and this is the Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow, but the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peak at what's under the surface.

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0:02:08.8 AD: Let's talk about the rhomboids for a minute. Muscles that are named for a geometric shape are bound to have issues. I mean, I guess if you think about it, all muscles have issues, but the rhomboids seem to excel in this area. Their intimate relationship with the trapezius over top, and the layers of muscle underneath creates quite the kerfuffle and the grip they have on the scapula definitely throws a wrench into things. But let's back track a little first and talk about their namesake.

0:02:38.9 AD: A rhomboid in geometry is defined as a parallelogram with oblique angles and only the opposite sides are equal, so like a diamond. In these muscles, the sides that are equal are the two that attach to the spine and the scapula, and then the two that are more free-floating on the top and the bottom. The fibers, in this instance, run parallel to the lines of the free-floating borders, so that when they contract, they grab onto the spine and the scapula, and because the scapula has way more freedom of movement, it's the scapula that gets manipulated. Their technical action that they are responsible for is retraction, elevation, and downward rotation of the scapula. What this means is that when all of these fibers contract in unison, they create the first two actions. They pull the scapula toward the spine, known as retraction or sometimes adduction, and then they lift the scapula up toward the ear, also known as elevation.

0:03:37.7 AD: But when they decide to go rogue and the lower fibers take over, they pull the inferior angle of the scapula in toward the spine, creating a "downward rotation", or to get really specific what your scapula is doing as your arm does the second half of a jumping jack. All three of these actions are pretty much the only thing the rhomboids want to do, like a bee that wants to pollinate flowers or a guitar that wants to be played, or a parachute that wants to prevent someone from falling to the Earth too fast. In a normal world where everything operates without distraction or drama, these prime actions would happen, things would move smoothly and everyone would live happily ever after. But we know this rarely happens if ever. Like I mentioned before, muscles have issues, a lot of issues, and for these little guys, I'm not talking about tension or spasms, I'm talking about sacrifice, self-sacrifice to be specific. In all of their hopes and dreams of moving the scapula, they will put other muscles actions first and squash their own sense of purpose to make this happen. The rhomboids for all intents and purposes, have epitomized what it means to be a people pleaser.

0:04:55.8 AD: We all know a people pleaser in our lives. That person who bends over backwards to make others happy. They will frequently sacrifice their own time or energy to ensure that those around them get what they want. They will very often go so far out of their way to be certain others get what they need, that they themselves will become sick or weak or stretched thin. You might see where I'm going with this. The rhomboids have a clear purpose. They have actions that they are supposed to do, but what happens to them is what happens all too often in life, other things pop up, asking that we help out here, or offer assistance there. Obstacles arise that sidetrack us from doing whatever it is we were going to do, and then before we know it, the day is over and we have no time to get our own stuff done. In this case, the rhomboids wake up with dreams of retraction, but then we do the dishes, and we clean the house, and we sit at computers and we lift groceries, and the rhomboids then let go of doing what they want to do, and instead scramble to make sure other muscles are getting to do what they think is so important.

0:06:07.9 AD: All of these important things that never seem to stop coming, pull the scapula so far away from the spine that the rhomboids spend all of their time just trying to get it back to neutral. Let's take, for example, what it looks like under the skin when we do the dishes. Standing at the sink, our chin drops down to our chest, our shoulders round forward and we slightly lean over the sink, creating a favorable advantage for gravity. The entire upper half of our bodies are falling forward, and all of those muscles from the back running from the base of the skull to the top of the hips are fighting to keep us from a face full of bubbles.

0:06:46.7 AD: Clearly, this affects more than just the rhomboids, but if we stay focused on these muscles, they are not pulling the scapula back to the spine like they might have wanted to back when they woke up in the morning, instead they are reining in the scapula in hopes that they don't fall completely off the ribcage. Technically, we refer to this as an eccentric contraction. Commonly, when a muscle contracts, it gets shorter, bringing two bones closer together, this is called a concentric contraction. But in this case, the rhomboids are contracting and getting longer. They're working hard and going nowhere, they are spinning their wheels in the mud, so to speak. Don't get me wrong, there are instances where we want this kind of contraction, like when you lower those huge dumbbells down away from your shoulder in the gym in weight training. If this is intentional and you're trying to get big biceps, yep, we want that kind of contraction. But when the muscles in your back are clinging on for dear life in an effort to get the dishes done, there is only so far that they will go before they snap and snap, they will. What happens when a rhomboid snaps, you ask? Good question. Like many people, pleaser that have been pushed to the brink, the snap isn't literally a breaking in half, the snap is a reaction.

0:08:10.8 AD: It is the moment they've had enough and hit the proverbial wall. The snap is an announcement that they are officially done. We feel this as a pain response, of course. The trigger point that sends reverberations into the shoulder or down the arm, or the domino effect of guarding up the neck that begets headaches. The problem is this, how does a massage therapist help a muscle that is only wanting to help other muscles. We are used to the greedy ones, the muscles that take and take and seize up because they get too anxious about all the taking they want to do. But how do we approach a muscle that is elongated and doesn't want to necessarily be any longer? How do we work with a rhomboid that is stretched thin and doesn't want to be stretched any thinner? The answer lies, as most things do in the biology of being human. If we revisit that people pleaser that you may know in your life, perhaps you are familiar with this interaction. Let's say you're talking to a colleague and she clearly has too much on her plate. She has kids, a full-time job, is a member of the PTA, helps out with the neighborhood committee, offers to host book clubs, volunteers for food drives.

0:09:25.6 AD: You know who I'm talking about. You notice that she is spread thin and you being the kind soul that you are, bring her a muffin for breakfast the next day at work. She then turns around and brings you a homemade pie the next day, not because it's a competition, but because when someone does something nice for her, she feels a complicated mix of thankful and guilty and humble, and wants to show her gratitude in return. The ability for her to receive anything, a gift, a compliment, anything cannot just stop there. It is literally uncomfortable for her to be in the spotlight, so she flips the switch. This is similar to how the rhomboids are operating. They give and give, and when it is finally their turn to receive, they find it extremely uncomfortable. They literally do not like it, when we pull the scapula away and ask them to take a deep breath and let go. So what do we do? We ask them to give a little more, only this time it's our turn to flip the switch. Instead of asking them to give the scapula more mobility or give the spine some space, we ask them to give us a little energy. Try this, before getting your client on the table, have them stand in front of you.

0:10:44.5 AD: This can be done from a seated position as well, but I find that standing engages them more both physically and psychologically. You can have them grab a towel that you are holding on to as well, or clasp your arms so that you are both holding on to each other's wrists. Then lean back, pull their arms toward you. You want them to hold their stance and resist falling forward, and at the same time, you want them to retract their scapula. A good way to make this happen is to tell them to get their shoulder blades to touch. You can even before you start, hold your hand against their spine at about T3 or T4, and ask them to pull their shoulders back until their scapula touch your fingers. This gives them a kinesthetic feel for what they should be aiming to do. This exercise asks the rhomboids to engage in one of their prime actions, retraction of the scapula. You are literally giving them the opportunity to do what they most want to do. You are offering them a moment to actually fulfill their purpose, and it may be a little difficult at first, change is usually uncomfortable, but it is what they want to do on some deep level, even if it has gotten lost at the bottom of the list of things that need to get done.

0:12:01.8 AD: Repeat this a handful of times, ensure that your client understands what you are working towards and continue to engage this activity until those rhomboids begin to feel a little tired. They are actually actualizing, and that is exactly what we want. Once you have the client on the table, your goal should then be to open all the muscles that are antagonists to retraction of the scapula. Those muscles in this case are the serratus anterior and the pectoralis minor, both serving as protractor of the scapula. Some would also throw the pec major in there, and I say why not, as the pec major doesn't officially bring the scapula away from the spine, it does horizontally adduct the arm, which is a fancy way of saying that it helps out with those dishes. It could use a reminder to stop being so demanding. With your client supine offer a rolled towel or a soft bolster under their spine laying along the length of the spine. This softens the rhomboids by nature and allows the chest to open up and the arms to fall into a slight extension. Some nice myofascial work away from the sternum, a little drag into the pec major and minor, and a few compressions into the serratus anterior, and you are on your way to returning balance to an unbalanced human.

0:13:19.8 AD: And that's what it's all about, after all. As body workers, we are quite good at bringing homeostasis back to the forefront of what is important for physical health. We just have to compensate for those over-active greedy muscles so often that our go-to modality is to lengthen and relax. But every once in a while, the people pleaser of the muscles need something different. They need to do what they were born to do. They need to find their way back to their purpose. We can help make that happen. And here we are, the end of the episode, thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately into my brain via my eye balls from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutations.

0:14:20.6 AD: Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other rebel massage dabblings.

0:14:41.5 S2: Members are loving ABMP five minute muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP five-minute muscles delivers muscle-specific palpation and technique videos plus origins, insertions, and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology created in conjunction with Ruth Werner puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members log in at abmp.com and look for the links in the featured benefits section of your member home page. Not a member? Learn about these exciting member benefits at abmp.com/more.