It's not all about cosmetics, it's truly about health. Your body changes in response to exercise in ways that improve anxiety/depression, balance hormones, increase brain function and memory, reduce inflammation, keep you from getting sick, and also the extra benefit of being able to keep doing stuff when you get older. Like not falling over. Additionally, these effects of exercising regularly are still there even if you are overweight. (Yes, really.) Today's post is on the many amazing benefits of that thing that most of us totally hate... Exercise!
Fundamentals of Health: Sleep, Exercise, Diet
The first post will attempt to persuade you to the idea that exercise is a fundamental part of the puzzle of health and well-being. The second post will go into a small sample of the vast amount of research and data-driven analysis on the many ways that exercise benefits us.
As a massage therapist, I encounter all sorts of imbalances in a persons body. As much as we want to blame it on having bones out of place, blame it on genetics, or posture, or just blame it on atmospheric pressure... many minor imbalances can be corrected with exercise. As much as I love my clients coming to me for repeat treatment for problems that pop up over and over again, I really do want people to be healthy and have the tools to take care of themselves.
There are two main points I want to make in this post.
About 3 times a week for 30 minutes is all that many of us need for many of the benefits associated with exercise. After that much time, the benefits start to plateau, so unless you are looking to compete in a sport, your general maintenance can be done in as little as 30 minutes 3 times a week if you are able to do a vigorous workout for 30 minutes, or 5 times a week for moderate intensity. (1) The benefits do continue as you add more time exercising (up to a point) but this number (3x30) is a really good starting goal, especially for those with a sedentary lifestyle.
Types of exercise
As for the different types of exercise, there are some simple categories: endurance training, strength training, and stretching. Endurance training helps your heart health, immune system, and brain function, strength training (when done correctly) helps keep you upright and balanced, strong, and is good for your immune system and your brain/memory too. Endurance refers to high repetition (doing the same movement over and over again), and your muscles adapt by using oxygen more efficiently. Strength training refers to lower repetitions with higher weight (8 to 10 repetitions). This can be done by lifting weights, using a resistance band, or your own body weight. Each type give different benefits, so it is recommended to include some of each in a weekly routine (2).
Invest in your health
"I can exercise on my own, why would I need to employ someone to help me exercise?" To learn the things you don't know that you don't know. In other words, to help become well balanced, invest in a few training sessions with someone who can help customize a well-balanced routine for your specific body type. For example, you may not know that "the rhomboids retracts the scapula and rotates it to depress the glenoid cavity, functions to stabilize the scapula against the thoracic wall, is antagonized by the serratus anerior, and can be effectively targeted to help upper-crossed syndrome and neck pain" but you don't have to know what all that means if you have a trainer who instead says "Ok we're going to pull your arm backward for this exercise and it's going to help your back and neck". Let someone else do all the research and then boil it down for you. Invest in the person who is willing to do that, because it's saving you a ton of time and will leave you more well-rounded as a result.
Maybe you are clued into the idea of "buy local" ... it helps support your local vendors, you can feel all warm and fuzzy about buying from a local source and helping your home town economy. You can do this by finding a local personal trainer as well. Just like any other business, there will be good and bad representatives of the field. My best recommendation is to actively look for a class you can take (such as yoga, pilates, zumba) for the community exercise aspect (especially if you are very introverted) and a 1-on-1 trainer such as a personal trainer, who has proper certification, and expertise in working with people like yourself.
Things to look for: You want your trainer to be knowledgeable, especially if you have any chronic conditions that need to be taken into account. A good trainer will know that you need to be pushed in order to grow, but will know how to do it in a way that will avoid injury. The risk of injury can be minimized, but not completely avoided. The second part of the equation is that you need to communicate with your trainer.
You don't have to see your trainer 3 days a week for 30 minutes, you could see them once a week, or twice a week. Or see them once a month for a 'check up' depending on whether you are a self-motivated person. My recommendation would be to see someone twice a week for a month, then scale back to check-ups. I feel like this is a great way to get comfortable with their routine, see the progress you get in a month, then evaluate. Just remember, if your goal is muscle growth, you need to expect several months to see real progress. For those who have a sedentary lifestyle, you will see a lot of progress in your first couple months, though.
The second post (Coming Soon™) will start getting into the hard-hitting research on things like the benefits of exercise on chronic inflammation, depression, anxiety, oxygen usage in tissues, immune function, memory and brain function, adaptations to bones, muscles, nerves, hormones, and all the other stuff that you just can't wait to hear about! So stay tuned!
This post is intended for those who have irritation or discomfort near the shoulder blade without a clear cause (such as posture from being sedentary). If there has been trauma to the back or shoulder, or very sharp pain, I highly recommend contacting a professional. This post will have a few tips for things you can do for self-maintenance at home, from quick pain relief to more long-term techniques to keep the discomfort at bay. I must add extra stress on the long term techniques, especially for those who often are at the computer or looking down at their phone a lot. This pain pattern might also be explained by something called Upper Crossed Syndrome if you are interested in more information.
To see what may be causing the pain at the shoulder blades, I recommend looking over my first post on the topic.
This post is in no way meant to replace professional advice, and please be very mindful that you do not have other conditions going on (such as osteoporosis) before following any of this advice, and for heck's sake get an actual evaluation from a Physiotherapist if the pain is really bothering you. With that being said, here are some things you can do at home to help with mild discomfort of the inner shoulder blade.
1. Topical Analgesics
One of the easiest ways to deal with aching muscle pain is to just cover it up for a little bit. Of course this won't help in the long run but if it's driving you crazy, or just needs some time to heal, topical analgesics can help.
Some common recommendations:
and a host of others. Some people find pain relief from simple peppermint essential oil. Try one or two out, and see how you respond.
2. Hot/cold pack
The next simple thing to do is add some heat and cold to the back.
Prepare an ice pack in the freezer (or a bag of iced peas) and use a dry towel so the ice does not make direct contact with the skin (and also to hold it in place easier).
For heat, soak a towel in hot water, wring it out, and toss it in the microwave for a minute or until hot.
To alternate heat/cold, simply leave the cold on for 3 minutes, then put the heat on for 3 minutes, and repeat alternating a few times.
The idea behind this: heat causes expansion of blood vessels, cold causes contraction of blood vessels. By alternating them you are expanding and shrinking the blood vessels, and for some this can create a relief from pain.
3. Self-massage and Stretch
You can work on your own back and shoulder blade using a tool such a tennis ball. I have also used a theracane, a curved tool that you hold onto, with good results.
The Painotopia website has as great guide on how to locate the muscles you want to massage.
First you can try some trigger point therapy on yourself. This may provide temporary pain relief but I caution against using this method long term. Since the rhomboids are already elongated, you are effectively making a long muscle even longer. Actually, for most people, the better, longer lasting treatment (that nobody wants to hear), is building the strength of the muscle. (ref: J Phys Ther Sci. 2016 May; 28(5): 1636–1639) Which we will get to later.
Place a tennis ball on the wall and lean your back against it to hold the ball on the wall. Adjust the location of the ball so that it is right at the shoulder blade where the rhomboids attach (as shown in the picture), and check for any tender spots. When you locate the tender spot, lean into the ball to create a deep pressure and hold that pressure for 30 seconds. You want to feel a deep radiating 'ache' but it should not really be painful (if it is, stop). You need to make the distinction between good ache versus burning stabbing pain, the latter meaning you should stop immediately.
Now do the same thing for the spot at the infraspinatus, moving the ball onto the shoulder blade. This one can take your breath away, trust me I know. It can also really help to release this trigger point for a number of issues. You'll look for a really sensitive spot and lean into it for 15 to 30 seconds. The possible locations are marked as X's on the image below.
Next, do the same for the teres major/minor muscles (you'll be hitting part of the latissimus dorsi muscle as well). For this one place the ball on the wall and lift your arm overhead. The ball will almost be in your armpit but don't let it go in the actual pit, keep it on that muscle that makes the back border of the armpit. You might have to roll up and down the muscle slowly til you find that tender spot, then press and hold on it.
Next we will work the front of the shoulder. Go to a wall corner or door frame, place the ball on the upper pectoral near the shoulder, and lean forward. Let your arm hang next to you so that you're not activating or straining it, just relax into the pressure (the area marked by the X below). The reason we use a wall corner here is so you can lean past the wall. This works well in a door frame, so your torso leans forward while your shoulder stays on the frame. Next, remove the ball and position your arm fingers pointing up on the door frame, and lean forward slowly to stretch the pec muscle.
Lastly you can try a self massage for the scalenes. In order to do this safely, start with very light pressure, and if you don't know how to apply a lot of pressure with the finger tips, you will simply use friction (moving the fingers back and forth over the muscle) to help loosen up the area. I highly recommend finding a professional massage therapist or physiotherapist to work on this area for you.
Using the opposite hand, put the fingers on your collar bone (right hand if touching your left collar bone) and move back just a bit so your fingers sink into the groove. Press down slightly, then move your finger tips left to right (not too rapidly) for about 30 seconds. Tilt your head back, your chin going in the opposite direction from your collar bone, to stretch the scalene muscles.
You can also add a passive stretch by simply laying back with something under your back. Use a foam roller or thick pillow, lay flat on the floor with the pillow under your mid-back parallel with your spine, and allow your shoulders to fall back, and lay in this position for 10 minutes or so.
4. Exercise for the shoulder
Using exercise for shoulder mobility is going to be the best way to stabilize the shoulder, keep it toned, and keep it from aching from posture. In my experience, the mid back pain most often comes from being immobile or sedentary.
In this section I will recommend a couple different types of exercise, one of which is resistance exercise. The reason this is important is that it helps to cue the muscles to contract against some kind of resistance, which will be important for it to hold that shoulder in place without pain down the road.
What a lot of people don't realize is that you can use a personal trainer for a sort of check-up, like you would a dentist. It is really helpful to have someone there to make sure you're doing the movements correctly, that your mind-to-muscle connection is happening, and that you're using the right progression in exercise. So I recommend finding a good personal trainer who knows the importance of these things to do a session or two with, even if you are a self-motivated person.
These exercises will target the muscles around the shoulder blade using body weight or resistance. There are all sorts of machines you can use for adding resistance, and if those interest you I recommend hiring a personal trainer for a session or two to learn how to use the machines properly, or ensure that you are targeting the correct muscles. For home use, I recommend dumbbells or a resistance band. Either way, start off light and gradually increase the resistance you are using.
Rows are any movement that pull your shoulder blades back together. You can use a resistance band around your feet, you can put the resistance band in the door, or you can lean forward and use a dumbbell. You can adjust your arms to change which muscles you are targeting. For this particular target, keep your arms about shoulder height and pull the elbows back, focusing on pinching the shoulder blades together. It may help to have someone behind you touching your rhomboids- this will help your brain to make sure you feel the contraction occurring in the rhomboids and not just the rotator cuff. It is a common mistake to only rotate the arms instead of pulling the shoulder blades back (the latter is our goal here). While this will target the rhomboids and part of the trapezius muscle, other shoulder stabilization exercises that you might learn from a person trainer will benefit you in many ways to have a well-rounded and stable shoulder.
2. Super man
Lying on the floor, lift your arms up and pinch the shoulder blades together, hold for two seconds, then return to the floor. Don't let your head come back, focus on just pulling your shoulder blades together. Repeat 8 to 12 times and rest.
3. Scapula Push-up
This one is a fantastic shoulder isolation exercise. I have found it to be very useful, just follow the video.
These are just 3 ideas for waking up the rhomboids and trapezius in your back, and if that is the source of your pain, the exercises will really help more than anything in reducing your pain, and helping you to feel like your shoulders and back are more supported.
For more exercise ideas, have a look at a few of these links:
Upper back pain, the pain between the shoulder blades, is one of the most common complaints I hear as a massage therapist. For some it is a persistent and debilitating problem, for others it is an annoyance that disappears on its own after a few days. There are several ways to address upper back pain, such as seeking out a massage therapist, physiatrist, personal trainer, physical therapist, or chiropractor, but in today's post we will be focusing on ways to manage self-care, and so we will be focusing on the muscles that cause or assist with this problem.
To see what to do to help fix it, visit my second post in the series.
Usually posture is given the blame for the pain one gets in the upper back, but for most people "sitting up straight" is not a fix for this problem. Generally instead of referring to correct posture, I will instead refer to staying in one position for a long period of time. In the first part of this post we will get into some of the muscles of this group, theories for why this pain occurs, and the second part we will cover some ways to manage or fix the problem. Knowing why/how it occurs is useful for correcting the problem, so we will cover that first.
The muscles of the upper back and shoulder attachments are going to be our focus here for one simple reason: they are what you can control and work on yourself at home, or with limited assistance. Some of this pain may be explained by something called the Upper Crossed Syndrome which I encourage you to click and take a look at.
Yes, I want you to really look at the picture of the muscles here, to get some insight into what's going on in the back. Also, because how the muscles lay and how they work is really really cool. First, look at the direction of the lines. This is showing the direction the muscles will contract (I covered this topic in my muscle function post for more information). The mid back pain you feel is probably somewhere around the rhomboids muscles (major and minor, but I will simply call them rhomboids), so find that in the picture and take note that the fibers run from the shoulder blade to the spine. This means the rhomboids pull the shoulder blade toward the spine, that's their job. More importantly you should note that this also means that the lines of the fibers do not pull the shoulder in any other direction. Notice also that the Trapezius muscle has a similar fiber direction, so it also pulls the shoulder blade toward the spine. Take note of the muscles of the rotator cuff (which I have written a separate post about if you want to review it). You'll recognize them when we get to 'fixes' in the second post on this topic.
The antagonist of the rhomboids is the serratus anterior. Just stick that in the back of your mind for now, we will visit it again in the second post.
Now the front side of the shoulder blade is going to be noteworthy as well. One of the main reasons that 'posture' is blamed on upper back pain is because when the shoulders round forward on the front of the body, the back of the body becomes elongated. Essentially, that means your rhomboids have to maintain constant tension, which may be one of the reasons they start to get sore.
The powerful pectoralis major muscle of the chest (your 'pecs') pull strongly on the shoulder in the forward motion, and the rhomboids must oppose this action to keep the shoulder blade in place.
Also remember that sometimes the problem is not necessarily where you feel the pain. For a review on that topic, read my post on "What are Trigger Points?"
The second post will cover tips on how to help relieve some of the discomfort.
What's going on with me, research articles, interesting little blurbs. This blog is an attempt to consolidate research into an easily digestible format.
Alex Moon has been a Licensed Massage Therapist since 2012, did his undergraduate studies at Utah State, and is currently working on his Doctorate in Physical Therapy.