Where pain between the shoulder blades comes from
The thoracic spine is by nature stiffer than the neck and the lower back, because the ribs attach to it. During hours of sitting bent over it loses even more mobility, and the muscles around the shoulder blades work in one position for hours without a moment’s break. The result can be a dull, diffuse ache at the end of the day, or a pinpoint “stab” next to the spine after a sudden twist, a sneeze or a night in an awkward position.
The source of the symptoms can be the costovertebral joints, the muscles and fascia, but also the cervical spine – irritation in the neck can cause pain felt right next to the shoulder blade. Hence the frequent link with neck pain. Thoracic disc herniations that actually cause symptoms are rare. Degenerative changes, on the other hand, often appear in scan reports and on their own do not explain the pain – we write more about this under spinal osteoarthritis.
First we rule out causes outside the spine
This is an area where pain can also come from the heart, the aorta, the lungs, the oesophagus, the gallbladder or the pancreas. That is why the history matters especially here. We ask whether the pain depends on movement and position, whether it comes on with exertion, whether it changes with breathing or after meals, and whether it comes with breathlessness, fever or weight loss. In people with osteoporosis we consider a vertebral compression fracture, which can happen even after a minor injury. A burning, one-sided pain along a rib with oversensitive skin, in turn, can be the first sign of shingles, before the rash appears.
Pain of musculoskeletal origin can usually be reproduced in the examination – by pressing on a specific joint, by rotating the trunk, or by taking a deep breath in a particular position. If the picture does not fit a problem like that, we do not start treatment – we refer you to a doctor instead.
What treatment looks like
At the start we reduce the pain and restore movement: we mobilise the thoracic spine and ribs, work on the soft tissues around the shoulder blades, and for stubborn trigger points we use dry needling. Relief can be felt quickly, sometimes after the first visit, but without exercise it usually does not last.
That is why, in parallel, we teach trunk extension and rotation exercises, breathing exercises and exercises that strengthen the muscles positioning the shoulder blade. With a recent overload, a clear improvement usually comes within a few weeks. Symptoms that have been there for years need longer, regular work, mostly through exercises done at home.
With a stiff thoracic spine we also work on breathing. Under stress and during long periods of sitting, breathing often becomes shallow and the ribs move very little. Breathing exercises combined with movement of the rib cage reduce the feeling of stiffness and tension in some people.
Your back in training and at work
In people who train, pain between the shoulder blades often appears after an increase in the volume of rowing, pull-ups or swimming, or after a return to sports with trunk rotation. There is usually no need to stop training – it is enough to change the choice of exercises, the range of motion and the rate at which loads go up for a while, and then to refine your technique.
With office work we do not look for one “correct” posture, but for a way to change position more often and take short movement breaks during the day – a few trunk twists and extensions every hour, a walk during your break, the stairs instead of the lift. We sort out the details at the visit.