Persistent pain between the shoulder pains, or interscapular pain, may arise from a number of varying causes. The scapula is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone) on either side of the body. The intrinsic muscles of the scapula include the subscapularis, teres minor, supraspinatus, and infraspinatus, all of which make up the rotator cuff. The major muscles surrounding the scapula that make up the interscapular region include the rhomboids, trapezius, and levator scapulae.
The rhomboids are two quadrate-shaped muscles that originate from the lower cervical vertebrae and upper thoracic vertebrae and attach to the medial border of the scapula. The rhomboids work to retract and rotate the scapula downwards. The trapezius muscle extend from the occipital bone of the skull to the lower thoracic vertebrae and attach to the scapular spine. Its action is to elevate and rotate the scapula upwards. Likewise, the levator scapulae run from the upper cervical vertebrae to the superior portion of the medial border of the scapula and works to elevate the shoulder blades.
One of the common causes of interscapular pain may be due to a muscle strain of one of the muscles described above from poor posture, lifting, or twisting motions from activities such as golf or tennis. Other causes may include trauma such as dislocations or rotator cuff tears, cervical or thoracic herniation, arthritis, heart conditions, cancer, gallbladder disease, scoliosis, or gastroesophageal acid reflux.
Treatment begins by identifying possible underlying causes contributing to the pain between the shoulder blades. Poor posture occurs when the head is forward and shoulders are rounded. This stretches the rhomboid muscles excessively and causes the muscle to weaken. Correcting poor posture by taking frequent breaks from sitting, bringing your shoulders down and away from the ears, as well as evenly distributing your body weight to all sides may help relieve upper back soreness.
Active release, moist heat therapy, and intramuscular stimulation with a physiotherapist are effective ways to release tension in the back muscles.
Consult a physician or specialist to assess for gastrointestinal, pulmonary, and cardiac-related conditions as they may cause referred pain in the upper back region.
Watch the following videos below on how to stretch and strengthen key muscles in the shoulder region:
Many gastrointestinal (GI) problems can occur even if one trys to avoid eating before or during exercise. Studies suggest that approximately 30-50% of athletes experience some type of gastrointestinal issue that can impair performance and delay recovery.
The three main causes of GI problems:
During intense exercise, especially when dehydrated, blood flow to the intestines is reduced. This is believed to be one of the main factors leading to the development of GI symptoms.
other abdominal symptoms (from mild discomfort to sever ischemic colitis)
Classification of Symptoms:
1) Lower GI Tract
2) Upper GI Tract
Runners tend to experience lower GI tract symptoms such as flatulence (excessive gas), diarrhea, or urgency due to the repetitive impact and reduced blood flow to the gut. On the other hand, cyclists may experience upper GI tract symptomsdue to the increased pressure on their abdomen while in an “aero” or crunched position of the body. These mechanical effects may be minimized with training.
Tips for Athletes:
1) Avoid high fiber foods in the day and several days before competition
2) During training, diet with adequate fiber will keep the bowel regular
3) Avoid aspiring and non-steroidal anti-inflammatory drugs (NSAIDs)
4) Use of NSAIDs prior to a race is strongly discouraged, especially for athletes with a history of GI problems
5) Avoid high-fructose foods (especially drinks that exclusively contain fructose)
6) Avoid dehydration as it can excaerbate symptoms and start races well hydrated
7) Ingest carbohydrates with sufficient water or drinks with lower carbohydrate concentration to prevent very high concentrations and osmolalities in the stomach
8) Practise new nutrition strategies and make sure to experiment with pre-race and race-day nutrition plan many times before the race day to reduce the chance of GI symptoms from occurring
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