Pain Between Shoulder Blades?
Introduction
Ever felt that nagging pain between your shoulder blades that just won't go away? You're not alone. This type of discomfort is common (very common!), and while it's easy to assume that the pain is due to a muscle strain or bad posture, the real causes can be as unique as you are. As a Clinical Exercise Physiologist, I've seen that the most effective way to address this pain isn’t by focusing solely on the sore spot. Too many times have I seen people go get the sore spot massaged and get better, for the pain to come back the next week. Instead, it should be about looking at the big picture—how you use (or don’t use) your entire body. This blog will dive into an movement-based approach to understanding and treating muscular pain between the shoulder blades, emphasising the importance of mobility, stability, and whole-body movement.
Why Focusing on Just the Pain Isn’t Enough
Ah! I’ve found the spot!
Have you ever tried to pinpoint the exact spot of your pain, hoping that if you just find the right muscle or joint to stretch, it’ll go away? It’s a common instinct and human nature to look for one easy fix, but rarely is anything that simple (definitely not impossible though). Think of your body as an interconnected system. When one part isn’t functioning well, it can throw everything else out of balance. Pain between the shoulder blades might be the result of issues in your neck, thoracic spine, or even your lower back. So, instead of getting bogged down by one sore spot, consider how your entire body moves—or doesn't move.
Acute Pain vs. Chronic Pain: Understanding the Difference (quite important….)
It's essential to understand the difference between acute pain and chronic pain when addressing shoulder blade discomfort. Acute pain typically arises suddenly, often due to injury or strain, and usually resolves once the underlying cause is treated. In contrast, chronic pain persists for months or even longer and might be due to ongoing issues like repetitive strain or even emotional stress. Identifying whether your pain is acute or chronic can guide your approach to treatment, ensuring that you address the root cause rather than just the symptoms (Treede et al., 2015). For more information about acute vs chronic pain, read our blog!
The Bigger Picture: How Are You Using Your Body?
Do you spend hours hunched over a computer, only to go home, cook, dinner, sit on the couch, then go do it all again the next day? Your daily habits play a huge role in how your body feels. The way you sit, stand, and move can all contribute to that persistent pain between your shoulder blades. It’s not just about one joint or muscle; it’s about how your entire body functions as a unit. When we look at the bigger picture, it becomes clear that addressing the pain between your shoulder blades requires a holistic approach that considers your overall movement patterns.
The Role of Surrounding Joints in Your Pain
Have you checked how your neck is moving lately?
Let’s talk about your neck (cervical spine) for a moment. Have you noticed if your head juts forward when you’re working or looking at your phone? This forward head posture puts extra stress on the muscles and joints between your shoulder blades. Research shows that dysfunction in the cervical spine can lead to referred pain in the upper back area (Riley et al., 2014). But before you start stretching your neck endlessly, consider booking a session with a Clinical Exercise Physiologist to assess exactly what is moving (and what is not moving)…
Are Your Shoulders and Scapulae Doing Their Job?
How often do you think about the way your shoulder blades (scapulae) move? Probably not much hey, but they play a critical role in how your upper back feels. If I had a dollar for the amount of times I’ve seen clients with neck, shoulder and/or back pain who also had issues moving their scapulae effectively, I would be a very rich man. If your scapulae aren’t moving properly, it can lead to muscular imbalances and stress in the muscles between your shoulder blades. Stabilising the muscles that support your scapulae ensures they move well and can make a big difference in alleviating your pain (Kibler et al., 2012).
How Does Your Thoracic Spine Fit In?
Your thoracic spine, or mid-back, is designed to be stable but also needs to be mobile enough to allow for natural movement. If it’s stiff, your body might compensate by overusing your shoulder joints or your neck, leading to pain. So, rather than just focusing on one stiff spot, think about how you can improve the mobility of your thoracic spine while also ensuring the rest of your body is moving properly. According to McGill (2016), restoring thoracic spine mobility can help reduce upper back pain by allowing your body to move as it should.
Exercise To Sort Out That Pain Between the Shoulder Blades
Alright, Lets Start From the Top (The Neck).
Neck mobility plays a significant role in how your upper back functions as a whole. Exercises like cervical retractions and rotational movements can be beneficial, but they should be combined with strengthening exercises that promote stability. By strengthening the deep cervical flexors and trapezius muscles, you can potentially create a more stable environment that allows for better overall movement, which can reduce the strain on your upper back (Boyle & O'Leary, 2020).Keep in mind that these are general exercises, and there is no one size fits all, so please consults with a health professional for a personalised exercise program.
And now the part that supports that spot between the shoulder blades (the thoracic region)
The thoracic spine is the central hub for movement in your upper body. Enhancing its mobility through exercises like thoracic spine rotations and/or cat-cow exercises can relieve stiffness and improve overall spinal function. When paired with exercises that enhance core stability, these movements help distribute forces more evenly across your spine, which can significantly reduce the strain on your upper back (McGill, 2016).
How Does Scapular Stability Relate to Your Pain?
Focusing on scapular stability can be a game-changer for relieving pain between the shoulder blades. Exercises such as wall slides, scapular push-ups, and prone T raises help ensure that your scapulae are moving in sync with your arms and neck. This coordinated movement reduces the compensations that often lead to pain, promoting a more balanced and functional upper body (Kibler et al., 2012).
The Problem with Muscle Imbalances
Left vs Right…Same or Different?
Have you ever noticed that one side of your body feels tighter or weaker than the other? To be completely straight up, imbalances are perfectly normal. Perfect symmetry is not a too common in nature. Only when a difference becomes large enough that you notice the difference, or it causes pain, should it then be addressed. Muscle imbalances can contribute to pain between your shoulder blades, especially if certain muscles are doing more work than they should. For example, if your upper trapezius muscles are overactive while your lower trapezius or serratus anterior muscles are underactive, this can potentially create an imbalance that affects how your shoulder blades move. Instead of just trying to stretch it out, consider booking an Exercise Physiology session to make the investigation and treatment a whole lot easier.
Why Is Core Strength Important?
You might be wondering, what does my core have to do with my upper back? A strong core provides a stable base for all your movements, reducing the strain on your upper back muscles. Core exercises, such as planks, dead bugs, and bird dogs, not only strengthen your core but also help you maintain better posture throughout the day, which is key to preventing pain between the shoulder blades (McGill, 2016). Keep in mind that
Posture and Movement Patterns Matter
Are You Aware of Your Posture?
First things first. Is there really a bad posture? Short answer = no. Our bodies are designed to experience many postures. It is only when we spend too much time in one position, can it then have negative impact. Remember, everything in moderation. Though it is easy to slip into ‘poor’ posture throughout the day, especially if you’re sitting at a desk or looking at a screen for long periods. Maintaining proper posture is about more than just standing up straight; it’s about being mindful of how you move and hold your body throughout the day. Small changes, like adjusting your desk setup or taking regular breaks to stretch, can make a big difference (O'Sullivan et al., 2012). The key = finding and moving between position that place as little stress on your body.
The Impact of Sedentary Behaviour on Pain
Sedentary behaviour, such as prolonged sitting or lack of movement, is a significant factor contributing to pain in general. When you sit for long periods, especially in a slouched position, the muscles in your upper back and shoulders can become tight and strained. Incorporating regular movement breaks, even just standing up and stretching 20 minutes or so, can help counteract the negative effects of being sedentary and reduce the risk of developing persistent pain (Owen et al., 2010).
How Can Ergonomics Help?
Have you ever adjusted your workspace to better suit your body? Ergonomic adjustments can play a significant role in preventing pain between the shoulder blades. Simple changes like using a chair with good lumbar support, keeping your computer monitor at eye level, and taking breaks to move around can help reduce strain on your upper back (O'Sullivan et al., 2012).
When to Seek Professional Help
If your muscular pain persists despite trying self-management strategies, it might be time to seek help from a Clinical Exercise Physiologist. But what can you expect from a session? A Clinical Exercise Physiologist will assess your movement patterns, identify areas of dysfunction, and design a personalised exercise program that targets the underlying causes of your pain. The goal isn’t just to treat the pain but to improve your overall movement and function, reducing the likelihood of future issues (Page et al., 2010). With online sessions available, you can receive personalised care from the comfort of your own home. Get in contact to find out. Top of Form
Conclusion
Pain between the shoulder blades can be frustrating, but it doesn’t have to be a permanent part of your life. By focusing on the big picture—how your whole body moves and functions—you can address the root causes of your pain and prevent it from coming back. Remember, it’s not just about finding the exact spot of pain; it’s about improving your overall movement and health. If you’re struggling with persistent pain, don’t hesitate to seek help from a Clinical Exercise Physiologist who can guide you on the path to recovery.
References
Kibler, W. B., Sciascia, A., & Wilkes, T. (2012). Scapular dyskinesis and its relation to shoulder pain. Journal of the American Academy of Orthopaedic Surgeons, 20(6), 364-372.
McGill, S. M. (2016). Low back disorders: Evidence-based prevention and rehabilitation. Human Kinet
O'Leary, S., Falla, D., & Jull, G. (2009). Recent advances in therapeutic exercise for the neck: Implications for patients with head and neck pain. The Journal of Manual & Manipulative Therapy, 17(4), 208-215.
O'Sullivan, P. B., Dankaerts, W., O'Sullivan, K. J., & O'Sullivan, L. (2012). Fear of movement and avoidance behaviour toward physical activity in chronic low back pain: A prospective cohort study. Clinical Journal of Pain, 28(4), 364-370.
Riley, S. P., & Skalko, T. K. (2014). Cervical spine dysfunction in patients with interscapular pain: A clinical perspective. Journal of Orthopaedic & Sports Physical Therapy, 44(1), 41-49.
By Scott Howard (Clinical Exercise Physiologist) │ 16/08/2024 │ Alignment Exercise Physiology
