Pain between the shoulder blades: 9 possible causes (and what to do?)

pain between the shoulder blades

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Also called interscapular pain, a pain between the shoulder blades can sometimes be incapacitating, not to mention the anxiety it generates due to the proximity of the chest and the heart.

What is the meaning of back pain? What are the various possible causes who explains it? Is that bad ? This article shares with you 9 potential causes explaining your symptoms, as well as several ways to relieve yourself (without forgetting the moment when it is imperative to consult).

Definition and anatomy of the interscapular region (upper back)

To better understand the causes of pain between the shoulder blades, it is necessary to identify the anatomical structures present in the upper back (spine and interscapular region). All of these structures can be affected in one way or another, and be responsible for the symptoms experienced.

Between the shoulder blades, we find:

  • The skin
  • Muscles, including the rhomboids and the middle and lower trapezius, all of which play a vital role in keeping the shoulder blades in optimal position.
  • The thoracic spine (or dorsal spine)
  • The thoracic aorta
  • Part of the esophagus
  • A part of the heart
  • Part of the lungs

A pain in the interscapular region can radiate towards the sternum, upper back and neck, or even down the arm. Depending on its cause and severity, it may be aggravated by movement, breathing or coughing. She is sometimes even present at rest in more severe cases.

In the next section we will cover 9 causes of potential pain between the shoulder blades.

9 causes of pain between the shoulder blades (and in the upper back)

1. Muscle damage

You should know that the scapula is a muscle attachment point for 17 different muscles. This stabilizes the scapula on the thorax (scapulothoracic joint), in addition to providing strength to the upper limb and synchronizing the movement of the glenohumeral (the joint that moves the shoulder). As a bonus, the scapula serves as the foundation for the activation and optimal functioning of the rotator cuff.

Muscle damage is the most common cause of pain between the shoulder blades and in the upper back. It can develop following a excessive load lifting, a surcharge in a sporting setting, twisting motion abrupt, etc. Often, it occurs when the person tries a new gesture, or participates in an activity to which he was not accustomed in the past.

Muscle damage can cause myofascial pain syndrome by causing interscapular pain and pain points radiating to other areas of the body. Likewise, she is greatly influenced by stress and cause headaches.

2. Posture (and bad postures)

Personalized postural disorders can obviously cause pain in the middle of the spine. On the one hand, it can be structural attacks such as the following:

In addition to the anatomical changes presented above, a bad posture (or rather, a prolonged and static posture) can generate back and interscapular pain. This is often the case in people with sedentary work. Be careful, however, not to imagine that a straight posture would automatically eliminate any pain in the neck or dorsal column.

Finally, a bad sleeping posture may cause joint or muscle pain. Often it is aggravated when the person adopts a position they are not used to (such as sleeping on their stomach with limited neck range of motion). Or, it can get worse if there is a weak structure that is compressed during sleep (like sleeping on your side with an injured shoulder).

In some cases, a bad pillow or mattress can promote back pain. It is for this reason that it is preferable to sleep in a conducive environment to relaxation, and which makes it possible to avoid any pathology.

For the physiotherapist's opinion on the best type of pillow to use, see the following article. 

3. Cervical and dorsal involvement

A damage to the cervical region may cause pain between the shoulder blades due to irritation or pressure on the nerves in the cervical spine and thoracic spine (the top of the spine).

Cervical conditions that can cause interscapular pain include:

Other symptoms may include numbness or tingling in the fingers, as well as pain that radiates to the upper limb.

Often, we will observe an onset of symptoms during cervical movements. For example, lifting the head skyward or tilting it to the affected side could reproduce the pain between the shoulder blades.

4. Dorsal hernia

In the dorsal region, there is very little space around the spinal cord. So, a herniated disc at this level can be more serious as hernias located at the cervical or lumbar level. In some cases, a back hernia can even cause weakness in the muscles below the waist, even leading to paralysis.

The location and type of symptoms experienced depend on the irritated spinal nerve(s), as well as the degree of tearing of the intervertebral disc. In addition, a spinal cord injury will greatly influence the prognosis. This type of hernia can in particular cause pain between the shoulder blades.

To learn more about dorsal hernia, see the following article.

5. Costal involvement

Damage to the rib generally causes chest or chest pain. But it often happens that these pains radiate towards the scapular region. Rib injuries that can cause pain between the shoulder blades include:

6. Heart trouble

Contrary to popular belief, the heart attack, especially in women, do not always start with a chest pain. In a study of people who had suffered a heart attack, 3% of them had pain between the shoulder blades. This pain is typically accompanied by shortness of breath and lightheadedness.

7. Gallbladder

Gallbladder involvement often manifests as sharp pain between the shoulder blades. In addition to the clinical picture, there are nausea and upper abdominal pain (right side). Symptoms are often increased after a high fat meal.

8. Osteoporosis

A compression fracture ( vertebral compaction) occurs when a vertebral segment weakens and compresses, causing back pain that can radiate to the shoulder blades. Compression fractures are most commonly caused by osteoporosis in older people.

To learn more about osteoporosis, see the following article.

9. Shingles

Shingles can cause pain almost anywhere depending on where the virus is located in the nerve roots. As the pain can sometimes appear before the skin changes, it is possible that the diagnosis is not clarified at the outset. This includes interscapular pain that usually affects only one side of the body.

When to worry? (and consult urgently)

Although rare, some causes of middle back pain can be serious and constitute medical emergencies. Examples include the following conditions:

  • cancer (lung, breast, liver, lymphoma, esophagus, mesothelioma, bone metastasesEtc.).
  • infection
  • pulmonary embolism
  • rupture of the thoracic aorta

Please consult urgently if you ever observe any of the following signs:

  • chest pain
  • Shortness of breath
  • dizziness
  • excessive sweating
  • pain, swelling or redness in the legs
  • if you cough up blood
  • fever
  • fast or irregular heartbeat
  • sudden difficulty speaking
  • vision disorders
  • paralysis on one side of the body
  • loss of consciousness

Treatment: How to relieve pain in the back and between the shoulder blades?

Fortunately, the vast majority of causes of spinal pain can be managed and cured. Here are the treatment modalities typically used by healthcare professionals to relieve symptoms and improve function:


This advice, you already know it. Between the anti-inflammatory, painkillers, relaxing or muscle relaxants, anti-epileptics, there are many medications that can relieve your pain between the shoulder blades (with varying results!).

Beware, however, of Side effects and addiction risk. Be sure to consult a doctor to choose the right medications, and for appropriate management.

To learn all about medications for back pain, see the following article.

heat and ice

There is not really any scientific evidence demonstrating a superiority of the heat or ice to treat injuries.

In general, we apply ice when you suspect a inflammatory process. For example, you might put on cold after feeling a sharp pain between your shoulder blades from lifting a heavy load.

Furthermore, we use the heat when looking to relax tense muscles. For example, if you feel stiffness in the periscapular muscles (around the shoulder blade), applying heat can promote a relaxed environment and reduce spasms. 


Postural correction

En avoiding prolonged postures, it is possible that your pain between the shoulder blades will subside (especially if it comes from a mechanical cause).

As mentioned previously, the important thing is not to adopt a straight posture at all times. Indeed, it is not necessarily the arched back which causes interscapular pain. Thus, it is more the frequent change of position which will lubricate the joints, prevent muscle atrophy and prevent the installation of cervico-dorsal stiffness.

In cases where standing up straight relieves symptoms, it may be appropriate to use accessoiries to support the spine and straighten the back. It should be mentioned, however, that these gadgets must be used sparingly, and in the short term. The products available are as follows (with recommendations):

If you wish to benefit from advice from the physiotherapist to improve your posture (including exercises), see the following article.

Sleep optimization

It goes without saying that a bad sleeping position can influence the symptoms, and aggravate the pain between the shoulder blades.

The choice of a optimal pillow (like this memory foam orthopedic pillow) can improve the quality of sleep, and indirectly reduce pain.

To learn all about back pain and sleep (including tips for sleeping better at night), see the following article.

Tennis ball and other accessories

If the pain comes from a trigger point of muscular or myofascial origin, it could be relieved by a tool as simple as a tennis ball (or other massage ball). As a reminder, a trigger point is a mini-contracture in the region of a muscle that can cause irradiation of pain when pressure is applied.

The idea with the massage ball is to apply a specific and sustained pressure on sensitive points to cause relaxation at this level. Basically, just position the ball on the painful spot between the shoulder blades, and apply pressure using the wall or the floor. The sensation should be strong but tolerable. If you wince in pain, you should definitely reduce the pressure.

Hold the pressure for about a minute, then move the ball around to find another sore spot. You can also rock back and forth so that the tennis ball provides a dynamic massage to the sore area.

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In addition to the tennis ball, it is possible to relax the muscles using effective and safe accessories. It is possible to do this independently using the following products (with recommendations):

Massage and mobilizations (manual therapy)

If you can afford it and see a therapist (like a physiotherapist or an osteopath), the latter will probably have recourse to manual techniques to help relieve your symptoms.

Different types of massage will have the effect of relaxing the interscapular and cervical musculature (even more specifically than the massage tools).

Mobilizations will improve joint and vertebral mobility. Sometimes manipulations (crunching the back) will also help reduce pain between the shoulder blades.

In short, a qualified therapist will be able to adapt his techniques to your condition, and provide you with relief through various manual treatments.

Therapeutic exercises and stretching

If the pain comes from a muscular or postural attack, it is essential to integrate therapeutic exercises into the treatment. This will allow toaccelerate healing, return to work safelyand to prevent recurrences of injury.

Again, a qualified therapist (such as a physical therapist or physiotherapist) will be able to guide you in finding suitable, safe and progressive exercises.

What about grandmother's remedies? (natural solutions)

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

  • Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
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  • Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
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  • Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

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  • Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
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  • wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.
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