Pain between the Shoulder Blades and Spine? This helps!

I watched the most popular YouTube videos on the topic of pain between the shoulder blades and spine and have to say that I was quite disappointed because very outdated, one-dimensional approaches are shown. And I want to change that with this article.

Commonly Mentioned Causes

By far the most frequently mentioned cause is muscle tension. These muscle tensions are supposed to be the cause of the pain between the shoulder blades.

Secondly, vertebral blockages in the upper back area are cited as a cause.

The third cause mentioned is posture. For example, people may breathe too shallowly, causing the rib cage to collapse inward. This can cause the shoulders to slump, which then increases tension and leads to pain.

Lastly, some videos mention that internal organs could be the cause and suggest seeking medical advice for clarification.

Treatment Suggestions for Pain Between the Shoulder Blades

To relieve muscle tension, stretching or mobilization exercises are recommended. If the muscle tension is due to a blocked vertebra, the vertebral blockage should be resolved. Regarding posture, it is recommended to use tape, for example. This tape is applied between the shoulder blades to help straighten the thoracic spine.

Other suggested treatments include deeper breathing and stretching the spine for better posture, as well as increasing abdominal tension.

Important note: These are not my words, but the recommendations given in the most popular YouTube videos on this topic.

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What Does the Science Say?

Muscle Tension as a Cause?

The likelihood that muscle tension is the cause of your pain is extremely low. It is more likely that you first experience pain, and then muscle tension increases. This means that if you work on the tension, you are only addressing the symptom, not the cause.

In fact, muscle activity and tension in the affected muscles often lead to reduced pain. This is not new information; we have known this since the last century, as shown by studies like those by Knost et al. (1999).

Furthermore, I would be very critical if someone tells you, “Oh yes, you are totally tense here, that is definitely the cause of your pain.”

Why? Because neither therapists nor doctors can reliably diagnose muscle tension. Studies such as those by Maigne et al. from 2012 show this.

The authors examined whether therapists could determine if a person had pain on the right or left side of the neck or the right or left side of the lumbar spine simply by touching and feeling the muscle tension. They found that the therapists correctly identified the side only 55-65% of the time, which is not much better than flipping a coin.

But assuming the tension was the cause of your pain, stretching or loosening the fascia with foam rolling would likely have permanently solved your problems. I assume they haven’t. Therefore, I would recommend a more holistic approach, which I will discuss shortly.

Blockages as a Cause?

I’ve said it a thousand times, but I’ll say it again here. Vertebrae cannot get blocked. A vertebra can feel blocked, don’t get me wrong, which is why many people say, “I feel like it just needs to crack” or “It’s so blocked back there.”

The cause is not that the vertebra is not in the right position or that there is a physical blockage. But Gino, my whole spine cracks when I go to the osteopath, chiropractor, or physio. I get it.

The cracking occurs because a sudden movement creates a vacuum in the joint. This vacuum causes small air bubbles to form, and this process leads to the cracking sound, nothing more.

Posture as a Cause?

The likelihood that posture is the cause of these complaints is also extremely low. Here I must mention the study by Swain et al. from 2019, which found no connection between any posture and back pain.

To be fair, the study looked at lower back pain, but even for the thoracic and cervical spine, there is no proven connection between any posture and pain.

There are also studies on the cervical spine regarding forward head posture, and they found no connection between the degree of forward head posture and neck pain.

In general, posture is poorly correlated with pain. If someone tells you that your posture is causing your pain, I would strongly question it. Various studies, such as those by Swain et al. (2019), invalidate this statement. So, be cautious there.

You can positively influence your pain by changing your posture if a posture is currently causing pain. Sure, but it is not the cause of your pain.

Treatment Methods

Stretching exercises do not seem to sustainably change muscle tension. The study situation is so controversial that no strong statement can be made, like “do the stretches, because they will reduce the tension.” Some studies even clearly state that stretching has no effect on severe tensions, such as spasticity. This is shown, for example, by the study by Bovend’Eerdt et al. from 2008.

In relation to posture, stretching exercises also seem to have no proven effect. Studies such as those by Rosa et al. (2017) show this. They looked at whether stretching exercises for the chest muscles lead to changes in shoulder function or scapula movement. Both in people with and without shoulder pain, there was no proven effect.

Let’s move on to spinal manipulations. We have already clarified that they do not release a blockage. Nevertheless, they seem to help some people. There is the well-known paper by Nim et al. from 2021, which examined this topic in detail, whether manipulations on the spine have a local effect exactly at the vertebral segment where the manipulation is performed or whether it is more of a global effect. They concluded that it is more of a global effect.

Why this is so is not entirely clear. There are various theories, but we can discuss that in another article.

Kinesio tape also does not seem to be effective beyond the placebo effect.

Scientific Recommendations

A very important point that none of these videos mention is the cervical spine. Many nerves that supply the upper body emerge from the cervical spine. The paper by Tanaka et al. from 2006 showed that in over 50% of people with a nerve root affected in the cervical spine, pain also occurs in the shoulder blade area, i.e., in the middle between the shoulder blades.

Often, such nerve pain is thought to radiate, for example, along the entire neck, into the arm, down to the hand, and possibly also into the shoulder blade area. Tanaka et al. found that for some people, it starts exactly between the shoulder blades and may even remain only in that area. I know, the topic of the cervical spine and nerves is always like, oh my god, please not, disaster.

Please don’t misunderstand. I am not saying that any nerve in your cervical spine is damaged or anything like that. It may simply be that the nerve is currently sensitive for some reason, which brings me perfectly to the holistic approach I have been promising you throughout this article.

Here, the analogy of the danger bucket fits perfectly again.

All the stressors in your life, such as work stress, relationship stress, poor diet, lack of sleep, inactivity, these are all things that can fill the bucket with water. Once the bucket overflows, pain is a possible response from your body to tell you, hey, it’s time to change something.

So, the holistic approach would be to not focus too much on this area and think, okay, it is definitely my muscles between the shoulder blades that are tense and causing my pain.

Instead, zoom out and ask yourself, hey, am I getting enough sleep right now? Is my diet balanced? Am I experiencing a lot of stress at work? Am I much less active than usual?

These are major influencing factors that you can change and that will have a lasting impact on pain. This applies not only to this specific area but also if you have pain elsewhere in your body.

I know some of these lifestyle factors are not easily changeable. This should not drive you crazy either. Focus on the low-hanging fruit that you can easily change.

I’ll give you some examples, such as eating more fruits and vegetables, moving more and more regularly, especially if you have a job where you sit a lot. Not that sitting is inherently bad. But if it is currently causing your symptoms, try standing up every 30 to 60 minutes, mobilizing your cervical spine, and your thoracic spine.

I will also mention a few exercises you can do. Additionally, you can focus more on your sleep hygiene, such as not scrolling through Instagram 10 minutes before bed, but maybe winding down an hour before bed, adjusting the lighting, sleeping in a dark, cool room. These are things that can be easily changed and can have a big impact on pain.

In terms of exercises, you can do so much. It is not like many videos say that there is a perfect, magical exercise that must be done exactly to relieve pain.

Since I mentioned the cervical spine as a possible cause, you can mobilize it and work on flexibility with exercises like CARS, Anterior Posterior Glides, or Lateral Glides. You can easily integrate these exercises into your daily routine.

Of course, you can positively influence the pain in the shoulder blade area by mobilizing the thoracic spine. Work on it with exercises like Cat-Cow, the 90-90 Stretch with Arm Sweep, Jefferson Curls, or the Loaded T-Spine Extension. You can do so many exercises. If you don’t know the exercises, just check out the YouTube video.

Just pay attention to how your body reacts. Start with the simple exercises without additional weight first. If your body handles it well, you can gradually add some weight.

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