Best Management for Pain in the Shoulderblade
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Have you ever had that sharp pain that feels like it's under or on your shoulder blade?
It's usually a sharp or stabbing sensation, and it can make it hard to breath, sit up straight, or roll over in bed.
This is one of the most common conditions that comes into the clinic, and it can be really nasty when it first flares up.
When I first started in physio I would massage and stretch and crack the middle of the back to little benefit and scratch my head wondering why I couldn't help these people make a change.
That was when, with the help of a mentor, I learned to hunt around more during assessments. Through that process, I found out more about what that sharp pain is, where it comes from, and what to do about it.
Where Does the Problem Originate?
Often the people presenting with this condition will have the same feeling of being stuck. Having tried any number of solutions: heat pack, foam roller, stretching, maybe even massage already. But still, no relief.
These cases are ones where the muscular sources have been considered (in the mid back, or shoulder, around the shoulder blade) but the other possible causes aren't identified or treated.
So where could the irritation be coming from?
Nerves in the body follow a general pathway of spinal cord => nerve root => joint => muscle => skin. Irritation generated anywhere along this pathway could be felt as an irritation elsewhere (i.e referred pain). Therefore, an assessment for a mid-back problem should work backwards
Find the area where irritation is felt
Check the skin and superficial tissues
Check the muscles, and don't forget the adjacent ones which share a nerve supply with the affected area
Check the underlying joints, as well as the joints closer to the midline of the body/base of the skull
Check nerve provocation/"neural tension"/other nerve functions
By doing this, the area/joint/tissue that reproduces "THE sensation" can be found. Without going through this process, applying treatments only to the mid-back or shoulder where the pain is felt is throwing [you know] at the wall to see what sticks.
So, the first thing to do is actually figure out the source of the problem, then treatments can be applied that best suit the areas contributing to the discomfort felt around the shoulder blade.
What to do about it
Now that we know there could be a few different causes, let's look at what they are, and the solutions.
Generally speaking, the solutions will be a combination of exercises, heat, non-steroidal anti-inflammatories (NSAIDs, if appropriate), manual therapy, and "postural support" taping.
Cervical Facet Joint Dysfunction (Neck)
If the irritation is originating in the neck, hands on treatments (massage, joint mobilisation) and exercises should be applied primarily to the neck. Heat applied over the neck/top of the shoulder may help to relax muscle tension in the area, and NSAIDs may be helpful for more acute inflammations. Movement with Mobilisation (MWM) exercises seem to be particularly effective, especially exercises/treatments known as "rotational SNAGs".
Thoracic Facet Joint Dysfunction, Costovertebral Joint Irritation (Middle Back)
If the irritation is originating in the upper back, hands on treatments (massage, joint mobilisation) and exercises should be applied primarily to the middle back. Range of motion exercises such as cat/came and thread the needle, alongside resisted exercises for the back and shoulder muscles such as rows, cable rotations and lateral raises. In some cases taping for the upper back can be very relieving, and in the case of more acute inflammations NSAIDs may be helpful.
Myalgia (Muscle Pain, from the neck/upper back/shoulder)
In some cases, the issue is as simple as muscular or referred pain. Any area in the neck, upper back, shoulder or even lower back or chest are fair game. In this instance, standard treatments for muscles typically work best: massage, heat, and stretching, followed by maintaining/increasing upper body (pulldowns, rows, chest presses, lateral raises, etc) or trunk (cable rotations, side planks, etc) resistance exercises.
Suprascapular Nerve Irritation (Nerve Pain)
Not to be left out, but less common, for those who wear heavy packs (hikers, students) or work equipment (electricians, emergency services workers, landscapers/gardeners) there can be a compression/traction of the nerve that courses over the top of the shoulderblade.
Assuming there are no more serious signs (like wasting of muscles around the shoulder and loss of strength in raising the arm to the side/rotating the arm outwards), removal of the offending load (changing bags, introducing a waist strap, variation in posture during work activities, etc) will usually be the biggest help in resolving the concern.
Aside from wanting the nagging sensation around your shoulder blade to go away, and you may have to be patient because they can linger or recur, the next best reason to seek management for this condition is to find the true underlying factors that contribute to its onset so that your management plan works best.
How to Best Manage Middle Back Pain - In Summary
Dealing with sharp pain under or around your shoulder blade can feel frustrating and limiting, especially when it interferes with breathing, sleeping, or everyday activities.
The journey
By identifying the root cause of your discomfort—whether it’s muscular, joint-related, or nerve-based—you can take steps toward lasting relief.
As you progress through targeted treatments and exercises, there may be moments of discomfort or setbacks, but consistency and tailored care will guide you through.
Ultimately, you’ll move from feeling stuck and uncertain to regaining control and confidence in your movement.
Don’t let pain hold you back.