Biomechanical fault in rhomboid

Hi,

I could do with some advice regarding an injury/fault in the rhomboid area, on the right of my spine.

I've been swimming at a reasonably high level on and off for 16 years. When training a lot, I do 10 hours a week of swimming training, along with 3-4 hours of landwork, involving weights, complex movements etc. When training minimally, training can drop to as low as an average of 1-2 hours per week of swimming. I have periods where I stretch a lot, particularly after swim training but have neglected stretching somewhat over the past few years leading to some notably inflexible hamstrings (I mention this as somebody mentioned to me that hamstring flexibility can have a large impact on other areas, particularly in the back).

Anyway, approximately 10 months ago, I began to get pain in my rhomboid area during swimming sessions. The pain was generally sharp and seemed to be associated with certain movements (such as reaching upwards/forwards) but I wasn't always able to replicate this. When the pain was bad, it hurt to breathe, and move my neck. Resting eased the pain for a while, so I took three-ish months out of training before returning. The pain came back immediately.

I did several sessions of physio. The physiotherapist was able to work out that I have a biomechanical fault in my rhomboid. As I lift my arms up, my right shoulder blade moves too far away from the spine, causing pain to the muscle that's supposed to keep it close to the spine. To paraphrase my physio a little, 'my body has adapted to the high intensity exercise and taken shortcuts. Some muscles are 'turned on' and some are 'turned off'. This has led to some muscles not doing their job properly - hence the shoulder blade not being kept in place.'

The physio was able to prescribe me several exercises to help with this. I don't know how consistent the names of these are but they are:
1. Right sidelying supported hip lift
2. Right sidelying right apical expansion with left FA IR - this one was adjusted so I reach across my body with my right arm (rather than the left as the pictures suggest)
3. Standing supported left AF IR with right arm reach - this was adjusted to not use a support

For each of these exercises, I breathe deeply 5/6 times and rotate through them 3/4 times. When the pain in my shoulder is bad, I can feel it as I inhale and particularly when I exhale. However, these exercises do help a lot! I include them in all swimming sessions, and superset them with exercises when at the gym.

However, today I went to a proper swimming session for the first time in months. For the past few months I've been swimming on my own, at a rather slow, gentle pace relative to a normal training session. I thought that the problem was gone but about half an hour into today's session, the pain returned, immediately as bad as it had been many months ago.

As a student, I can't really afford any more physio sessions so I was wondering if anybody could point me in any direction for what to do next. The exercises I have are great for remedying the pain once I have it but it seems that they aren't really fixing the root cause of the issue. Happy to do any reading if somebody knows where I can start - I find it all quite interesting anyway!

Thanks for your help, it is much appreciated - I really don't want to end my swimming career just yet!