Shoulder Blade Pain

Clues or common symptoms? 

• Pain between the middle of your spine and shoulder blades (medically called your scapulae) that feels “muscular” but might also feel hot, sharp, cramp, spasm, numb, and spread around the upper back in random and confusing directions. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome? - PMC Sometimes, you can initiate the pain with specific neck movements. Management of thoracic spine pain and dysfunction: A survey of clinical practice in the UK - Musculoskeletal Science & Practice. Sometimes, you might have a sore spot on a muscle, historically called “trigger spots.”  

• Concerning symptoms or clues suggesting another condition include: 

  • Soreness or pain on top of the central bones in the middle of your back.

  • Feeling or someone else observing a hard palpable mass, not from a sore muscle. 

  • Unexplained swelling. 

  • Redness (not related to the effects of a lacrosse ball massage in that area).

  • Reduced ability to fully raise your arm or a loss of visual muscle mass around the shoulder blades (especially concerning if you have had recent shoulder or neck surgery). 

  • Pain starting after high-speed sport or vehicle collision/accident. Red flags to screen for vertebral fracture in people presenting with low back pain - PMC. 

  • These much less common symptoms are indicative of different and rarer conditions than this blog covers. If you recognise any, you should now promptly seek face-to-face medical opinion rather than try to self-manage, as the advice in this article may not be appropriate for your case.

    
    

What is actually wrong

Shoulder blade muscle pain without any other concerning symptoms is usually from a cranky or grumpy nerve and/or joint around the central joints of the neck or upper back. Muscle soreness is a symptom of this cranky source. Corresponding Scapular Pain with the Nerve Root Involvement, 2010 + Cervical roots as origin of pain in the neck or scapular regions - PubMed (nih.gov) + Management of thoracic spine pain and dysfunction: A survey of clinical practice in the UK - Musculoskeletal Science & Practice

These images are just for your reference to marvel at the complexity of our neuro-immune partnerships. The coloured or shaded areas of each image suggest where you might feel “symptoms” if a joint and associated nerves in your upper back/neck might be provoked in a controlled medical experiment. Note the overlap of potential sources. Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome? - PMC.

The images are not to encourage you to try and find your “pain generator location” but to help you understand why your symptoms spread around and can be confusing and can’t be explained by what we might have thought of as “muscle injury.” 

What causes a cranky nerve or/and joint that is felt in the shoulder blade region?

Often, a contribution of various risk factors can cause a cranky joint that predisposes you to less tolerance of “harmless movement” that might have initiated symptoms or are less tolerable now. Neck pain: global epidemiology, trends and risk factors - PMC What can leave a joint cranky for weeks to months include recent changes in the last week to months of often an accumulation of:

• Increased mental stress from work, family, social, work dissatisfaction.  Are job strain and sleep disturbances prognostic factors for neck/shoulder/arm pain? - PubMed + Chronic psychological stress impairs recovery of muscular function and somatic sensations over a 96-hour period - PubMed

  • This includes unhelpful pain beliefs like tensing the back/neck/shoulder blades to maintain the “perfect posture” or increased future concern of the shoulder blade pain “getting worse.” Identifying risk factors for first-episode neck pain: A systematic review - PubMed

• Poor sleep Sleep disturbance is associated with neck pain: a 3-year longitudinal study- PubMed.

• Illness.

• Smoking

• Reduced daily movement or physical activity is sometimes followed by “too much, too soon, too fast.” 

Although many might think something is damaged or strained, that is often untrue. Think of your symptoms as a “headache of the upper back,” not caused by damage but a real nuisance. These nerves and joints are not “fragile.” Still, our neuro-immune system is good at becoming highly “aware” during periods of high stress, which can cause or mediate lifestyle choices that do not help reduce shoulder blade sensitivity. 

What can I do about it? 

Educate yourself on the condition by asking us for validated, up-to-date information (unfortunately, there is lots of unhelpful physio fluff out there promising “quick fixes”).

Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain | Physical Therapy |+ The Contemporary Management of Neck Pain in Adults: Pain Management 

• The best management involves:

  • Regular changes of sustained position that might be “rubbing salt on the wound.” “Your next posture is your best posture.”

  • Exercise with tolerable pain is safe for shoulder blade pain. Sometimes, the initiation of a gradually progressive upper back and shoulder exercise training program can improve your tolerance to the activities that have become painful. Lower body exercise can also be helpful because any muscle being exercised releases powerful anti-inflammatory medication like chemicals throughout the body. 

  • Prioritised lifestyle choices that can either reduce persistent daily mental stress or improve coping to increased, inevitable to being human, periods of increased mental stress, such as:

    • Complete more of your fun hobbies

    • Enjoyable exercise and meeting or exceeding the Australian Physical Activity guidelines

    • Good sleep

    • Anything that “improves your general health” will likely be helpful for shoulder blade pain.

• How long will it take? Thanks to our neuro-immune system contribution, shoulder blade pain, like a headache or cold and flu symptoms, can resolve in a couple of days, weeks, or months. It is normal to be concerned that exercise might aggravate the condition. Initial guided exercise by an exercise expert, in this case might help you get back to your usual exercise routine. Persistence often depends on whether you can modify your risk factor/s for persistent nerve/joint pain. Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review - ScienceDirect Pain flare-ups are common and not a reflection of nerve or joint structural changes getting worse. Flare-ups are a temporary upregulation of the “neuro-immune” pathways that increase sensitivity around a joint or nerve. Realistically, it is part of being an active, healthy human to get headaches or a cold or flu throughout the year, and general aches and pains or any joint can be similar. When they become persistent or frequent and affect your quality of life, seeking medical professional help should be useful

What can Physiotherapy or Exercise Physiology at MH offer? 

• We can offer individual advice to help tailor an upper back health exercise program at a specific dosage you can tolerate and help guide you to a realistic progression plan each week. 

• We can provide reassurance and an initial set of guided exercises so that your confidence returns and you gain improved pain self-efficacy.

• We can be your support crew to encourage lifestyle changes that can improve your general health, such as coaching you on sleep, guiding you through ways to reduce mental stress, or adding things to your life to better cope with stress. 

• Suppose you have had persistent shoulder blade pain and are very confused about why you still have it. In that case, we can help you make sense of the pain, highlight management areas to prioritise or be more optimistic about, and give you individual guidance to assist in managing and resolving your shoulder blade pain. 

Busting Common Beliefs that relate to Shoulder Blade Pain

• Manual therapy, including massage, joint manipulation, needling, and instrument/foam roller/lacrosse ball-assisted massage can all be equally helpful through similar chemical mechanisms to completing your favourite type of exercise or hobbies. However, manual therapy on its own does not offer 100’s of health benefits as well as pain relief like exercise does.

• Manual therapy can be helpful but provides short-term relief just like exercise and does not change muscle structure or “realign joints.”

• Manual therapy or exercise does not have to be specific to the exact joint or sources of symptoms to be helpful.

• Taping anywhere around the shoulder blades provides sensory feedback to avoid sustained positions but does not increase muscle activation or joint strength. Please don't spend much money on postural devices/back straps/shirts promising the “perfect posture.”

  • Any posture held for long periods can become painful.

  • Often, when a specific posture is reported as painful, other lifestyle factors are also present that likely reduce tolerance to prolonged positions, such as increased mental stress, boredom or low job satisfaction, poor sleep, low levels of physical activity.

  • “Posture exercise” can be helpful without changing posture as an outcome.

  • Neck flexibility does not relate to pain severity.

  • There is no perfect posture, as no posture consistently causes pain for everyone.

Read more through these Links: Prolonged slumped sitting causes neck pain and increased axioscapular muscle activity during a computer task in healthy participants – A randomized crossover study - ScienceDirect + Perceived musculoskeletal discomfort and its association with postural shifts during 4-h prolonged sitting in office workers - ScienceDirect Pain, Work-related Characteristics, and Psychosocial Factors among Computer Workers at a University Center Exercise interventions to improve postural malalignments in head, neck, and trunk among adolescents, adults, and older people: systematic review of randomized controlled trials - PMC Neck Muscle Stiffness Measured With Shear Wave Elastography in Women With Chronic Nonspecific Neck Pain | Journal of Orthopaedic & Sports Physical TherapyUnraveling the Mechanisms of Manual Therapy: Modeling an Approach | Journal of Orthopaedic & Sports Physical Therapy + Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care - PMC +  Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial - PubMed + Dry Needling Adds No Benefit to the Treatment of Neck Pain: A Sham-Controlled Randomized Clinical Trial With 1-Year Follow-up - PubMed + The Effects of Massage Therapy on Sport and Exercise Performance: A Systematic Review + Effects of manual therapy on fear avoidance, kinesiophobia and pain catastrophizing in individuals with chronic musculoskeletal pain: Systematic review and meta-analysis - ScienceDirect + The Effectiveness of Spinal Manipulative Therapy in Treating Spinal Pain Does Not Depend on the Application Procedures: A Systematic Review and Network Meta-analysis | Journal of Orthopaedic & Sports Physical Therapy Factsheets - Exercise is Medicine AustraliaThe neurophysiological effects of a single session of spinal joint mobilization: does the effect last? - PMC 

Three-dimensional mathematical model for deformation of human fasciae in manual therapy - PubMed + Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses - PubMed Kyphosis in older women and its relation to back pain, disability and osteopenia: The study of osteoporotic fractures | Osteoporosis International + Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents - PubMed + Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers - PubMed + Relationship between Forward Head Posture and Tissue Mechanosensitivity: A Cross-Sectional Study - PMC + Association Between Text Neck and Neck Pain in Adults - PubMed + Why sitting posture is mostly irrelevant to future pain — Greg Lehman + Perfect posture doesn't exist  Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study - PubMed + An investigation into the production of intra-articular gas bubbles and increase in joint space in the zygapophyseal joints of the cervical spine in asymptomatic subjects after spinal manipulation - PubMed Region-specific Exercises vs General Exercises in the Management of Spinal and Peripheral Musculoskeletal Disorders: A Systematic Review With Meta-analyses of Randomized Controlled Trials - ScienceDirect + Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials - PubMed Taping for conditions of the musculoskeletal system: an evidence map review | Chiropractic & Manual Therapies | Full Text + Placebo effect of facilitatory Kinesio tape on muscle activity and muscle strength - PubMed The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence – a scoping review of the literature + Acute Effects of Posture Shirts on Rounded-Shoulder and Forward-Head Posture (2016)