Upper Back Pain Between the Shoulder Blades: Causes and Care

Upper back pain between the shoulder blades most often comes from three sources: tired postural muscles, a strained muscle, or an irritated joint where a rib meets the spine. These causes are mechanical, they usually respond to simple home care, and they tend to change with movement or position. A small share of cases come from the heart, lungs or other organs, and those need a medical work-up before anyone treats the back. This guide explains how to tell the difference and what to do next.

What Causes Pain Between the Shoulder Blades?

The area between your shoulder blades is the thoracic spine, the twelve vertebrae that connect to your ribs. It is built for stability more than motion. Layers of muscle cross it, including the rhomboids, the middle and lower trapezius, and the long muscles that hold you upright. Each rib attaches to the spine through small joints on both sides.

When this area hurts, the source is usually one of these tissues. The pain tends to be an ache, a burning patch or a sharp catch, and it changes when you move, twist, breathe deeply or press on the spot. That pattern points to a mechanical problem.

Pain can also be referred from somewhere else. The joints and discs of the lower neck commonly send pain to the inner edge of the shoulder blade. Less often, an internal organ is the source. That possibility is the reason the warning signs later in this article matter.

Posture: The Most Common Trigger

Hours at a laptop, a phone held low, or a long drive on I-95 put the upper back in the same position: head forward, shoulders rounded, shoulder blades drifting apart. The muscles between the blades stay stretched and working the whole time. They are not injured. They are fatigued, and fatigued muscle aches and burns.

Posture-related pain has a recognizable pattern:

• It builds through the day and is worse after long sitting or screen time.
• It feels like a dull ache or a burning line along the inner border of one or both shoulder blades.
• It eases when you get up, move around or change position.
• It is usually better on days off and worse during busy work weeks.

Muscle Strain and Trigger Points

A strain happens when muscle fibers are overloaded. Common causes are lifting something heavy overhead, a new workout, a weekend of painting or yard work, carrying a child on one side, or sleeping in an awkward position. A hard coughing spell can do it too.

Strain pain is usually easy to locate. You can put a finger on the sore spot, it hurts when you use that muscle, and it may feel tight or knotted. These tender knots are often called trigger points. They can send a dull ache toward the shoulder or neck.

Most mild strains settle over days to a few weeks with gentle movement. Complete rest tends to slow recovery because the muscle stiffens.

Rib Joints and a Stiff Mid Back

Each rib connects to the spine at small joints. When one of these joints becomes irritated or stops moving well, the pain is often sharp and very specific. Patients describe it as a knife or a pinch next to the spine.

Signs that a rib joint may be involved

• A sharp catch when you take a deep breath, cough, sneeze or laugh.
• Pain when you twist your trunk or reach across your body.
• A tender spot one or two finger widths to the side of the spine.
• Pain that sometimes wraps around the rib toward the side or front of the chest.

Because this pain can change with breathing and can travel toward the chest, it overlaps with symptoms of heart and lung problems. If you are not sure which one you have, treat it as a medical question first. The next sections explain when.

Home Care That Helps

For pain that behaves mechanically and has no warning signs, these steps are a reasonable start:

• Keep moving. Walk and stay gently active. Avoid long bed rest.
• Break up sitting. Stand, roll your shoulders and reach overhead every 30 to 45 minutes.
• Use heat or ice. Apply either one for 15 to 20 minutes with a cloth between it and your skin. Heat often feels better for tight muscles. Ice may help a fresh strain.
• Stretch the chest. Stand in a doorway with your forearms on the frame and lean forward gently. Tight chest muscles pull the shoulders forward.
• Squeeze the shoulder blades. Draw them back and down, hold for five seconds and repeat ten times, a few times a day.
• Adjust your screen. Raise the monitor to eye level and bring the keyboard close so your elbows rest near your sides.
• Check your sleep setup. Use one pillow that keeps your neck level. Sleeping on your stomach twists the upper back.

Over-the-counter pain relievers can help some people. Follow the label and ask your pharmacist or physician first if you take other medications or have stomach, kidney or heart conditions.

If the pain is not clearly improving after one to two weeks, or it keeps coming back, it is time for an exam.

When This Pain Needs a Medical Work-Up First

Chiropractic care is not the right first step for everyone with pain between the shoulder blades. Some causes are medical emergencies, and no adjustment, stretch or therapy will help them.

Call 911 or go to the emergency room if you have

• Upper back pain with chest pressure, shortness of breath, sweating, nausea, lightheadedness, or pain spreading to the arm, neck or jaw. Heart attacks can show up as upper back pain, particularly in women.
• Sudden, severe, tearing or ripping pain in the chest or between the shoulder blades.
• Sharp pain with breathing along with shortness of breath, coughing up blood, or a swollen, painful calf.
• New weakness or numbness in the legs, trouble walking, or loss of bladder or bowel control.

See a medical doctor before a chiropractor if you have

• Fever, chills or unexplained weight loss along with back pain.
• A history of cancer and new back pain.
• Constant pain that does not change with position or movement, or pain that wakes you at night.
• Pain after a fall or accident, or sudden pain if you have osteoporosis or take long-term steroids.
• Pain under the right shoulder blade that follows meals, with nausea or upper belly pain.
• A band of burning pain on one side followed by a rash.

If you come to our clinic and your history or exam points to one of these, we will refer you to the right provider instead of treating you. That is part of doing this job properly.

How a Chiropractor Evaluates and Treats Upper Back Pain

A visit starts with questions about how the pain began, what changes it and your medical history. The exam checks posture, mid back and neck motion, rib movement with breathing, muscle tenderness and nerve function. X-rays are taken only when the history or exam calls for them.

When the cause is mechanical, a care plan may include:

• Chiropractic adjustments to restore motion in stiff thoracic and rib joints.
• Physical therapy with exercises to strengthen the muscles between the shoulder blades and improve mid back mobility.
• Laser Therapy applied to sore muscles and irritated joints.
• Spinal decompression when the exam shows the pain is referred from a disc problem in the neck.
• Posture and workstation advice that fits your actual job and habits.

Loucil Chiropractic has one bilingual chiropractor with 8+ years of experience, so you are examined and treated by the same person in English or Spanish. If your pain started after a car accident, tell us at the first visit, because auto injury cases need specific documentation.

Frequently Asked Questions