Many people venture to see their doctor or physical therapist for upper back pain. I’m not a betting person, but the odds are very high that when I ask a patient to show me where he or she is experiencing pain, he/she will point to the area between the spine and the shoulder blade. When I ask her/him how long pain has been present, it is often times months to years, with no known specific injury.
So what’s the deal with this upper back and shoulder pain? Pain in between the shoulder blades is not comfortable.
Often times, people experience pain in this region due to a muscular strain to the rhomboids, upper trapezius, or levator scapula; fancy names for the muscles in this area that attach the shoulder blade to the spine. A person may feel “knots” in this area, and massage helps the pain, but only temporarily. After a day, or even just hours, the pain returns.
(Source of photo here)
It’s a bit of a repetitive theme we see in therapy, but poor posture and poorly moving joints lead to strain. In the spine, a person may develop cervical (neck), thoracic (mid back) or lumbar (low back) dysfunctions that cause the joints to move poorly or minimally.
For example, a person may have arthritic changes in his/her neck and he/shes finds turning the neck to the left is more limited than turning to the right. As a result, compensation occurs by twisting the spine to the left in order to see. Over time, a muscle pattern of increased rotation of the spine to the left develops, leading to stiffness when turning the body and neck to the right. Then (you can see the snowball building momentum…) the shoulder blade does not sit properly in the upper back region because of the rotational twist that has developed over time. When the arm is moved the shoulder blade does not move well, so (wait for it….) the muscles that attach to the shoulder blade work more strenuously and become strained. Just like that pain develops!
That was a long run on sentence, but you get the idea. A person can massage that area of the upper back all day long, but unless the root cause of the pain is addressed, it will not be "fixed." Luckily, a Physical Therapist will examine you as a whole, determine the CAUSE of your pain, and provide you with treatments to fix your mechanical issues.
There is not one specific cause of shoulder blade pain, but the idea is that when there is a disturbance somewhere in the body, whether the shoulder or the spine, fixing this issue will lead to the treatment of your pain. We just do not want to treat the symptom. So you may wonder, why is my Physical Therapist moving my neck around when it’s my right shoulder blade that hurts, but now you know there is good reason!
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