What Causes Pain Between the Shoulder Blades?

Pain between the shoulder blades is easy to ignore at first.

It often starts as a tight, nagging ache that you notice at the end of a workday or after a long drive.

For most people it comes from muscles, posture, or the joints of the upper back. Sometimes it is actually coming from the neck. Occasionally it is not coming from the spine at all.

That last group is rare, but it is the reason this area deserves more attention than a sore lower back. This guide covers the common sources, how to tell them apart, and which symptoms need prompt medical care rather than a wait and see approach. If your pain seems to start higher up, our neck pain page may also help.

Where The Pain Is Actually Coming From

The area between the shoulder blades is crowded.

Several structures sit close together, and each can produce a similar ache:

• The rhomboid and middle trapezius muscles that hold the shoulder blades in place
• The joints of the upper back, known as the thoracic spine
• The small joints where the ribs attach to the spine
• Nerves that exit the lower neck and refer pain downward
• Organs in the chest and upper abdomen that can refer pain to the back

Because these overlap, the location of the pain alone rarely tells you the source.

How it behaves usually tells you more.

Muscle Strain And Posture

This is the most common source by a wide margin.

The muscles between the shoulder blades work constantly to hold the shoulders back against gravity. When the head drifts forward and the shoulders round, those muscles stay on longer than they were built to.

Everyday habits that often feed it:

• Long hours at a desk or laptop
• Looking down at a phone for extended periods
• Driving for long stretches
• Carrying a heavy bag on one shoulder
• Repetitive reaching or lifting at work
• Sleeping on your stomach with the head turned

Muscle related pain tends to feel worse late in the day and better after moving around, a warm shower, or a weekend away from the desk.

If tension tends to settle in your neck and shoulders during stressful stretches, our page on stress and physical tension covers that pattern.

Upper Back And Rib Joint Irritation

The thoracic spine is built for stability, but its joints can still become stiff or irritated.

Each rib connects to the spine at small joints on either side. When one of those joints is irritated, the pain can feel surprisingly sharp and specific.

Signs that point toward a joint source:

• One spot you can point to with a single finger
• A catch or stab with a deep breath
• Pain with twisting or reaching overhead
• Discomfort that started after a sudden movement, cough, or lift
• Stiffness when you try to sit up tall

A sharp pain with breathing can feel alarming. When it is joint related, it usually changes with position and movement, which is a useful clue.

When The Neck Is The Real Source

This is the one people miss most often.

Nerves and joints in the lower neck can refer pain down into the area between the shoulder blades, even when the neck itself does not hurt much.

It is more likely to be neck related if you notice:

• The shoulder blade pain changes when you turn or tilt your head
• Neck stiffness alongside the upper back ache
• Headaches that start at the base of the skull
• Tingling, numbness, or weakness into the arm or hand
• Pain that is worse after looking down for long periods

When arm symptoms are part of the picture, a nerve may be involved. Our article on whether a chiropractor can help with a pinched nerve explains that pattern in more detail.

A similar thing happens with the shoulder itself. This article covers it: Is Your Shoulder Pain Actually Coming From Your Neck?

When It Is Not Coming From The Spine

Most pain between the shoulder blades is musculoskeletal.

But this area can also receive referred pain from the heart, the large blood vessels in the chest, the lungs, and the gallbladder. That is why it is worth knowing the warning signs, even though they are uncommon.

Call 911 or go to an emergency department if pain between the shoulder blades comes with:

• Chest pressure, tightness, or pain
• Shortness of breath
• Sweating, nausea, or lightheadedness
• Pain spreading into the jaw, neck, or either arm
• A sudden, severe, tearing pain that feels different from anything before

Heart symptoms do not always look like the classic picture. Women in particular are more likely to feel upper back pain, unusual fatigue, or nausea rather than crushing chest pain.

Other patterns that deserve a medical visit rather than a chiropractic one:

• Pain on the right side that flares after fatty meals, which can point to the gallbladder
• Pain that worsens sharply with every breath alongside a cough or fever
• Pain that does not change at all with position or movement
• Pain alongside unexplained weight loss or night sweats

None of these are common. They are the ones worth knowing anyway.

Is It Worse On One Side?

Many people notice the pain mostly on the left or mostly on the right.

One sided pain is usually still muscular or joint related. It often matches your dominant arm, the side you carry a bag on, or the direction you turn to look at a second monitor.

Side still matters in two situations:

• Left sided pain with any of the heart warning signs above needs emergency care
• Right sided pain that follows meals is worth raising with your doctor because of the gallbladder

Outside of those, which side hurts matters less than what makes it better or worse.

What Often Helps At Home

For muscle and posture related pain, small changes repeated daily tend to beat one big fix.

Things many people find helpful:

• Standing up and moving every thirty to forty five minutes
• Raising a screen so you look straight ahead rather than down
• Gentle shoulder blade squeezes and chest opening movements
• Heat on the area for fifteen to twenty minutes
• Switching which shoulder carries your bag
• Short walks, which move the upper back more than most people expect

Stretching alone rarely settles this area for long, because the muscles are usually tired from holding a position rather than short and tight.

If a movement sends pain into your arm or brings on tingling, stop and have it evaluated rather than pushing through.

When To Get Pain Between The Shoulder Blades Checked

Most cases settle within a few days to a couple of weeks.

It may help to have it examined if you notice:

• Pain lasting longer than two weeks despite changing your habits
• Pain that keeps returning every few weeks
• Tingling, numbness, or weakness in the arm or hand
• Pain that wakes you up at night
• Pain that started after a fall or car accident
• Pain that is steadily getting worse rather than better

If the pain began after a collision, even a minor one, it is worth reading about whiplash, which often shows up in the upper back as well as the neck.

How Chiropractic Care May Help

Care depends on what the examination finds.

A muscle and posture pattern is approached differently than an irritated rib joint, and both are approached differently than pain referred from the neck.

Depending on the findings, care may include spinal manipulation for stiff upper back or rib joints, manual therapy or instrument-assisted soft tissue massage for tight or overworked muscles, and postural correction therapy when sustained positions keep the problem going.

Chiropractic care is one part of conservative care. It is not appropriate when the pain is coming from the heart, lungs, or gallbladder, which is why the examination starts by ruling those patterns out.

Frequently Asked Questions

Why do I get pain between my shoulder blades when sitting?

Sitting for long periods usually lets the head drift forward and the shoulders round. The muscles between the shoulder blades then work for hours to hold you up, and they start to ache.

Can a pinched nerve cause pain between the shoulder blades?

Yes. A nerve irritated in the lower neck can refer pain into the area between the shoulder blades, sometimes with tingling or numbness into the arm.

Is pain between the shoulder blades a sign of a heart attack?

It can be, although that is uncommon. Pain with chest pressure, shortness of breath, sweating, nausea, or pain spreading to the jaw or arm needs emergency care right away.

How long does pain between the shoulder blades last?

Muscle related pain often improves within a few days to two weeks. Pain that lasts longer, keeps returning, or comes with arm symptoms is worth having examined.

Should I use heat or ice between my shoulder blades?

Heat is usually more comfortable for muscle tightness and posture related aching. Ice is sometimes preferred in the first day or two after a specific strain.

Upper Back Pain Evaluation In Niagara Falls

At Niagara Falls Spine & Chiro, we look at how your neck, upper back, and ribs move, and what makes your pain better or worse.

If pain between your shoulder blades keeps coming back or has not settled with simple changes, an examination can help identify what is driving it.

Get started here.