Understanding Pain Between the Shoulder Blades: Anatomy, Causes and Treatment Strategies

Experiencing pain between the shoulder blades?

Pain between the shoulder blades, also known as interscapular pain is a common issue that can significantly affect daily life. This discomfort often arises from strains in the muscles around and between the shoulder blades and poor posture, but can also indicate underlying issues such as rib dysfunction or can even be a sign that may indicate more serious issues. For many people, this type of pain can become a persistent nuisance, and can impact their ability to work, sleep and perform everyday activities. Discomfort in the shoulder blades can limit mobility, reduce quality of life and make routine tasks more challenging, resulting in decreased productivity and increased stress. Addressing the pain promptly is essential to improve well-being and prevent further complications.

Brief anatomy of the upper back and shoulder blade

The shoulder blade or scapula is a flat, triangular shaped bone located in the upper thoracic region, and sits on top of the back side of our ribcage. It connects with the clavicle to form the Acromioclavicular joint (AC joint) and humerus at the glenohumeral joint and together they come together to form the shoulder joint. The scapula is a very important bone in the function of the shoulder joint and is involved in many different movements including protraction, retraction, elevation, depression, upwards rotation and downwards rotation.

The shoulder blade is also the site of many different muscle attachments and origins as shown in the pictures above. The rotator cuff muscles which includes the supraspinatus, infraspinatus, subscapularis and teres minor all originate from the scapula and are critical in helping to stabilize the shoulder by compressing the head of the humerus (long arm bone) into the glenoid (socket). These muscles are also in charge of the rotational movements of the shoulder and when torn, can cause significant weakness/instability and pain into the shoulder joint. 3 other large, powerful muscles that attach onto the scapula include the deltoid, latissimus dorsi and the trapezius. Together, these muscles are in charge of movements like lifting your arm above, to the side and backwards, as well as shrugging your shoulders.

The scapula is an integral part of the anatomy of the upper back and plays an integral role in proper function of the shoulder and upper extremity. When there are problems with the muscles, ligaments and other structures on and around the scapula, it can cause significant issues with our shoulder function and may cause upper back pain and pain to the muscles between the shoulder blades.

Muscular causes of pain between the shoulder blades

There are many different reasons why someone might experience interscapular pain, fortunately, most of the time, the causes of pain between your shoulder blades are musculoskeletal in nature and are not serious medical conditions.

One of the most common causes of pain in the upper back and shoulder blade area is a muscle strain in the area. Muscle strains or “pulled” muscles occur when a muscle is stretched beyond its typical capacity and a tear occurs. Muscle strains are one of the possible causes of upper back pain, and often present as sharp and acute pain between and around the shoulder blades. This can cause sharp pain between the shoulder blades. Often times, this can occur from sort sort of impact injury, or quick/jerking movements that result in the muscles in the upper back to be overstretched.

Overuse injuries can also cause pain between the shoulders. An overuse injury is when we put too much stress into an area of our body over time which can result in pain. One example of an overuse injury that can result in back pain between the shoulder blades is a poor posture. Having poor posture where your upper back and shoulder blades are rounded forward and your chin is poked outwards can lead to pain in your upper back as this posture puts more stress on certain muscles, in particular muscles in your upper back as they become overstretched. Having bad posture does not always mean you will have pain, but can be one of the reasons for pain near the shoulder blade.

Other causes of shoulder blade pain

Shoulder blade pain is usually because of injury or overstress to the muscles around the shoulder blade but there are other reasons for why you may be experiencing pain and discomfort in the area.

Sometimes, we can have what is known as referred pain, which is pain that presents itself in one area (upper back pain between shoulder) but the actual source of the pain is from an issue somewhere else, such as your neck.  Radiculopathy or a pinched nerve in the neck may cause pain in the shoulder blade area. Pain associated with a pinched nerve is usually described as an “electric” feeling, often the pain is severe and it may be difficult to find activities that relieve the pain. This referred pain can range from being intermittent in nature to being a more constant type of pain. Upper back pain may also come from issues in the spine, ribs, or even your heart.

Upper back pain may indicate a herniated disc or slipped disc in the thoracic spine. Often times, a herniated disc in this area is asymptomatic. However, it may sometimes cause severe pain into other areas of the body. It can cause upper back pain, chest pain, low back pain, pain in the lower extremities and other symptoms.

Rib issues can include issues such as cartilage inflammation or intercostal (between the ribs) muscle strains. These can also cause upper back pain and pain the middle back. Other symptoms that can be caused by rib issues can include difficulty taking deep breaths, pain when rotating your spine, tenderness to touch around the areas of your chest and ribs.

Shoulder blade pain can sometimes be an indicator of a heart issue. Heart conditions such as angina or a heart attack might present with pain that radiates to the area between the shoulder blades. This referred pain may be misattributed to a musculoskeletal issue, but is usually also accompanied by other symptoms such as chest pain, shortness of breath, nausea of sweating. If shoulder pain is sudden, severe, not worsened by movement and presents with any of these other symptoms, seek out immediate medical attention to rule out any potential cardiac cause for pain.

Effective treatments for shoulder blade pain

How we might treat pain located between the shoulder blades in the clinic depends on what the causes for pain are. Our goal as physiotherapists is to find the underlying cause of your pain and help to address these issues and provide pain relief. Based on the results of our assessment, which includes an extensive subjective history and a physical evaluation of range of motion, strength, special tests, sensation tests, and potential pain-provoking movements, we can help you create a treatment plan. This plan will be tailored to address your specific problems and pain.

Here at Rep Physio in Edmonton, we have a strong focus on an active approach to rehabilitation. Two key elements of this are the importance of education as well as providing exercises that address the key problems that we find during our assessments.

For example, if a client presents with pain in between their shoulder blades due to a muscle strain or a pinched nerve, the treatment plan may present very differently for what may seem like a similar issue.

The exercises we prescribe and the reasoning behind why we prescribe them will be different based off of what the problem is. To address a strained muscle, we might give an exercise with the goal of initially working through range of motion with limited spikes in pain, then progress the exercise once tolerable to strengthen that weakened muscle. For a pinched nerve, we might give exercises that help to glide the nerve to help stretch the nerve to reduce your symptoms of pain. We may provide a stretch if we feel that tightness in certain areas are restricting your ability to move properly which may contribute to your pain.

Our primary goal is to empower patients and at REP Physio we have a strong emphasis on an active recovery, but we may also prescribe certain pain modulators such as manual therapy techniques and dry needling to help relieve pain. This can help to augment the main treatment of therapeutic exercises to hopefully help you reduce your pain and return to your daily activities and achieving your goals.

Finding pain relief for shoulder blade pain: tips and exercises

Pain in between your shoulder blades can be be very debilitating. Here are some things you can do to help reduce pain between the shoulder blades.

1) Managing stress levels

• Relaxation techniques such as deep breathing can be helpful. With increased stress, people sometimes feel extra tension in their upper back which can contribute to pain in the upper back and between the shoulder blades
• Ensuring you are sleeping well, this will include making sure you are sleeping an adequate amount, for most people this will mean making sure you’re sleeping more than 7 hours a night. Paying attention to things like sleep hygiene as well as keeping a consistent bed time will help with this

2) Regular physical activity

• Regular physical activity is important in a variety of ways. Exercise can stimulate endorphin release which is the body’s natural painkiller, which in turn can help with the perception of pain.
• Regular physical activity can help to improve muscle strength as well as flexibility which can help you become more bulletproof and resilient, decreasing the risk of future injuries.
• It can help with improving posture as well enhance sleep quality

3) Being aware of posture

• Frequent changes in posture can be helpful with shoulder blade pain. Making sure to be mindful if you are spending lots of time hunched over to adjust your posture frequently. This will help to put less stress on the muscles on the upper back.
• Improving the ergonomics of your work or computer set up to promote a neutral and comfortable position.
• Direct exercises that strengthen the muscles of the upper back and around the shoulder blades as well as stretching the muscles on the front can help with shoulder blade pain if posture is one of the reasons for your pain.

Conclusion

Pain in between the shoulder blades can have a very negative impact on your quality of life. Discomfort between the shoulder blades is common and many people don’t know what strategies to use to relieve their symptoms. Come see us at REP Physio, we are experienced in treating pain in the shoulders and upper back. We use an active, multidisciplinary approach to our treatments, and our goal is to help you better understand your shoulder problems and improve your pain.