Pain between the shoulder blades, medically termed interscapular pain, is a frequent complaint. This discomfort is often described as a dull ache, a burning sensation, or a sharp, localized pain. It is prevalent among individuals with prolonged static postures, such as those with desk jobs, or those experiencing high levels of stress. This pain manifests in the thoracic region of the spine, located between the neck and lower back. Determining if the pain originates locally in the muscles and joints or is referred from internal organs is the first step toward finding relief.
Musculoskeletal Causes of Pain
The majority of interscapular pain stems from issues within the body’s supporting structures, including the muscles, ligaments, and joints of the upper back and neck. These causes typically involve strain, fatigue, or mechanical dysfunction that develops over time. The pain is often aggravated by specific movements or postures and may improve with rest or position changes.
Poor Posture and Ergonomics
Prolonged static positions are a primary contributor to upper back discomfort, forcing muscles to work harder to maintain an unnatural position. Sitting with a rounded upper back and forward head posture, often called “tech neck,” places strain on supporting structures. This posture overstretches the shoulder blade retractors, such as the rhomboids, while tightening the chest muscles. This sustained tension leads to fatigue and pain, which can become chronic if postural habits are not corrected.
Muscle Strain
The muscles most commonly implicated in interscapular pain include the rhomboids, the trapezius, and the levator scapulae. The rhomboid muscles connect the shoulder blades to the spine and pull the shoulders back. They become strained by repetitive arm movements, heavy lifting, or holding the shoulder blades in a protracted position for long periods. The levator scapulae muscles run from the neck to the top of the shoulder blade; strain here can cause pain radiating into the upper medial angle of the scapula. The trapezius muscle, covering much of the upper back, is susceptible to strain from overuse or emotional stress. This muscular discomfort is often felt as a dull ache or a sharp, localized pain that increases with movement.
Trigger Points
Interscapular pain frequently involves trigger points, which are hyperirritable spots within a taut band of muscle. These localized areas of tightness, often described as a “knot,” cause localized pain and tenderness. When pressed, a trigger point may reproduce the characteristic deep, aching pain felt between the shoulder blades.
Joint Issues
While soft tissue problems are more frequent, the joints of the thoracic spine can also cause pain in this area. Each thoracic vertebra connects to the ribs and has small facet joints that allow movement. Dysfunction or irritation of these facet joints can cause localized pain between the shoulder blades that may feel stiff or sharp, especially with twisting or bending.
Referred Pain from Internal Systems
Although musculoskeletal issues account for most cases, pain between the shoulder blades can manifest from a problem originating elsewhere, known as referred pain. This occurs because the nerves supplying internal organs share pathways with the sensory nerves of the upper back. Referred pain is often described as deep, constant, and typically does not change in intensity with positional adjustments or rest, distinguishing it from muscular pain.
Digestive System
Several digestive organs can refer pain to the interscapular region. Gallbladder issues, such as gallstones or inflammation (cholecystitis), frequently cause pain that radiates to the right upper abdomen and beneath the right shoulder blade. This occurs because the gallbladder shares nerve pathways with the sensory nerves of the upper back. Other gastrointestinal issues, including stomach ulcers or acid reflux (gastroesophageal reflux disease), can present as a burning sensation or discomfort in the upper back. Conditions affecting the pancreas can also cause deep back pain in the upper abdominal and back regions.
Cardiac Concerns
Pain referred from the heart can be a symptom of a serious cardiac event. While chest pain is the classic symptom of a heart attack, discomfort can also radiate to the jaw, arms, and between the shoulder blades. This presentation is sometimes more common in women, who may experience less typical symptoms. Any new onset of pain accompanied by shortness of breath, dizziness, excessive sweating, or chest pressure requires immediate medical attention. The location of the pain alone is not diagnostic, but its association with systemic symptoms is a serious warning sign.
Pulmonary Issues
Conditions affecting the lungs can also be perceived as pain in the upper back due to shared nerve roots in the thoracic spine. Lung issues, such as pneumonia, a pulmonary embolism, or irritation of the pleura (the lining of the lungs), can cause pain that radiates to the shoulder blade area. This pain may be sharp and worsen with deep breaths, coughing, or sneezing.
Immediate Relief Measures
For mild to moderate interscapular pain linked to muscle strain or poor posture, several self-management strategies can provide immediate relief. The goal is to reduce muscle tension, improve local circulation, and provide temporary comfort.
Gentle Stretching and Movement
Gentle movements can help interrupt the cycle of muscle spasm and pain. A simple chest opener, performed by standing in a doorway and pressing forearms against the frame while stepping forward, can stretch tight chest muscles and relieve back strain. Shoulder rolls and scapular retractions, where the shoulder blades are gently squeezed together, can activate and loosen fatigued muscles. Perform these stretches slowly and only to the point of comfortable tension, avoiding any sharp increase in pain.
Temperature Therapy
Applying heat or cold helps manage acute muscular discomfort by affecting blood flow and nerve signals. Heat, such as a heating pad or warm compress, works best for muscle stiffness and chronic tension by increasing blood flow and promoting relaxation. For acute pain or inflammation, cold therapy like an ice pack can help numb the area and reduce swelling. Both treatments should be limited to 15 to 20 minutes at a time, with a layer of fabric protecting the skin.
Over-the-Counter Options
Non-prescription medications can temporarily reduce pain and inflammation, allowing for easier movement and stretching. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, work by blocking the production of pain-causing chemicals. Topical pain relief creams or gels, which contain ingredients like menthol or salicylates, can be rubbed directly onto the affected muscle area for localized relief.
Ergonomic Adjustments
Addressing the physical environment can prevent further strain on the upper back. If sitting at a desk, ensure the computer monitor is positioned at eye level to prevent the head from tilting forward and straining the levator scapulae. Using a small cushion or rolled towel to support the natural curve of the lower back can help maintain better posture in the thoracic spine.
Identifying When to See a Doctor
While most interscapular pain resolves with self-care, certain accompanying symptoms, or “red flags,” indicate the need for professional medical evaluation. Immediate attention is warranted for any pain that is severe, sudden in onset, or follows a traumatic injury, such as a fall or car accident. Medical consultation is needed if the pain is accompanied by systemic symptoms like a fever, unexplained weight loss, or persistent night sweats. If the pain is associated with neurological changes, such as numbness, tingling, or weakness radiating down the arm or into the legs, a doctor should be consulted. Pain that is unrelieved by rest, is constant, or persists for more than two weeks despite home treatment should also be assessed to rule out serious underlying conditions.