Not a pain in the rear, a pain in the neck, or a pain in the back, you have a pain between the shoulder blades. Like a knife in the back, this pain can be stabbing or searing. Like a muscle cramp, this pain can be aching or gripping. This pain can feel like many things, yet there are only a few common causes of a pain between the shoulder blades. And all these problems have one common root: the shoulder girdle muscles.
Sometimes, the pain around the shoulder blades actually comes from the complex system of muscles that stabilize the shoulder called the “shoulder girdle” muscles. Two primary muscles in this system are very prone to weakness, overuse and strain: the rhomboid and the trapezius muscles. Just by looking at the position at which the shoulder blade rests, called the scapular start position, a professional can actually see the effects of a weakened shoulder girdle. A typical abnormal start position is drooping (depressed) shoulder blades which tend to spread apart (abducted). When the shoulder blades are held in this sagging position, the trapezius and rhomboid muscles are stretched to the limit and are virtually incapable of holding up the weight of the arm against the constant pull of gravity. Like anchors, the arms constantly pull on sensitive neck muscles and nerves. As the body weight increases, so does the weight of the arms. Eventually, the whole system fails. And shoulder girdle failure leads to all types of pains around the neck, down the arm, and between the shoulder blades. Preventing such pain problem is a good reason to maintain core strength and an ideal body weight.
Core strength can also help to prevent referred neck pain, another primary cause of pain between the shoulder blades. If the shoulder blades are not resting in the proper position then that means the shoulders and the neck are also in a misaligned position. One typical abnormal posture is called the forward shoulder/head posture. As the shoulders drift forward (in front of the collar bone), the head drifts forward like a turtle peeking out from his shell. I call this the “turtle posture” in my book, High Heels to Hormones: A Woman’s Guide to Spine Care. This “turtle” posture places stress on many cervical spine structures like the discs, ligaments, and joints. All of these parts of the neck can cause referred pain between the shoulder blades. (Referred pain means that the pain is felt one place but is generated in another; like the pain from a heart attack can be felt in the arm.) Preventing this referred pain can be as easy as keeping the shoulders back, the chest out, and the core muscles strong.
Good posture can also help to prevent thoracic spine stiffness and misalignment, another cause of pain between the shoulder blades. The area of the spine that lies between the shoulder blades is called the upper thoracic spine. Because ribs also attach to the spine in this area, the upper thoracic spine is prone to stiffness and boney misalignment. A misaligned rib might need adjustment. A stiff thoracic segment might need mobilizing. Boney adjustments by a manual therapist or chiropractor could be just what the doctor ordered for some types of pain between the shoulder blades. However, without good muscle tone in the shoulder girdle, boney posture and alignment cannot be maintained.
In fact, all of the common reasons to have a pain between the shoulder blades lead back to one ultimate root: muscle weakness. Muscles are what keep the shoulders moving properly. Muscles are what support the shoulder blades as they glide across the chest wall. Muscles are what hold the arms up against the constant pull of gravity. If it feels like there is a knife between your shoulder blades, it might be time to tone some important muscles—the shoulder girdle muscles.