Pain between the shoulder blades: causes, warning signs and what helps

Pain between the shoulder blades is one of the most common complaints in those who spend many hours at a computer, drive a lot or carry weight. It is often described as a “knot”, a burning feeling or a pressure that will not go away, worse at the end of the day, which improves with a good massage and returns the following week.

In the great majority of people, the cause is muscular and postural, and there is a lot that can be done. But this area has one particular feature: it is also where pain from internal organs, such as the heart, aorta, lungs or gallbladder, can be referred. That is why this article begins with the signs that should not be ignored.

First: the warning signs

Before thinking about contractures and posture, it is worth knowing when this pain may have a serious cause.

None of these scenarios is the most likely. But that is why a massage should never replace an assessment when something does not seem “just muscular”.

The anatomy of the area and the most common causes

Between the shoulder blades (scapulae) and the thoracic spine there are several layers of muscle: the trapezius (especially the middle and lower part), the rhomboids, which connect the spine to the inner border of the shoulder blade, and deeper muscles that stabilise the spine. They are constantly working to keep the shoulder blades in place and the posture upright.

Common musculoskeletal causes

An important note: the idea that a muscle “knot” is a physical structure that “comes undone” with massage is debated in research. What is known is that there are more sensitive, tense areas of muscle, which improve with movement, heat and pressure, but the exact explanation is still debated.

Posture, work and stress

Posture at the computer

Hours on end looking at a low screen, with the head pushed forward and the shoulders rounded, increase the load on the neck and upper back muscles. There is no “perfect posture” that prevents pain: research suggests that the most important thing is not to stay in the same position for long, whatever it is. The best posture is the next one.

Phone, backpack and car

• Looking at your phone for a long time with the neck flexed.
• Heavy backpacks on one shoulder only.
• Prolonged driving, with arms outstretched and shoulders tense.

Stress and tension

Stress is not “just psychological”. In situations of tension, many people raise their shoulders and tense the muscles of the neck and back without realising, and the perception of pain also increases. Sleeping badly has the same effect. That is why pain between the shoulder blades often gets worse in phases of intense work or worry.

Little physical activity

Poorly trained muscles tire more quickly when holding positions. A sedentary lifestyle is one of the factors most associated with chronic neck and back pain.

What helps

1. Movement, not absolute rest

In muscle pain, staying active helps more than rest. Walk, move the shoulders and neck within what is comfortable, and gradually resume normal activities.

2. Regular exercise: the foundation with the best evidence

Reviews on neck and upper back pain show that exercise programmes, especially strengthening of the neck, shoulders and upper back, reduce pain and improve function in the medium term. Some simple exercises:

• Shoulder blade retraction: seated or standing, gently draw the shoulder blades back and down, hold for 5 seconds, relax. 10 repetitions, several times a day.
• Band row: pull a band fixed in front towards the trunk, elbows close to the body. 2 to 3 sets of 10 to 15.
• Thoracic extension: seated, hands behind the head, gently lean the trunk back over the back of the chair.
• Trunk rotation: lying on your side, knees bent, open the upper arm to the opposite side, following it with your eyes.
• Chest stretch: in a doorway, arms resting on the frame, gently move the trunk forward.

If the pain increases a great deal during or after the exercises, stop and seek guidance from a physiotherapist.

3. Breaks and ergonomics

• Screen at eye height, about an arm's length away.
• Keyboard and mouse close to the body, elbows at about 90 degrees.
• Short breaks every 30 to 45 minutes to change position and move the shoulders.
• Alternating between sitting and standing, if possible.

4. Heat

A hot-water bottle or heat pad for 15 to 20 minutes relieves muscle tension. Avoid sleeping with heat sources and protect the skin.

5. Painkillers

For acute episodes, over-the-counter painkillers or anti-inflammatories may help in the short term, if you have no contraindications. Ask the pharmacist or doctor for guidance.

6. Sleep and stress management

Sleeping well, regular physical activity and relaxation techniques reduce tension and the perception of pain.

And massage? What the evidence says

Massage is probably what many people seek first for this pain, and for good reasons: it relieves, relaxes and makes you feel better. What research shows is more nuanced:

• A 2015 systematic review, with 26 randomised trials and more than 2,500 participants with common musculoskeletal pain, concluded that massage has short-term benefits compared with no treatment, especially for shoulder pain and for function in several conditions. For neck pain, the benefit for pain was not clear. The quality of the evidence was low to moderate.
• Compared with other active treatments, no clear advantage was found.
• The effects tend to be temporary, from hours to days or weeks.

In practice, this means that massage is a good complement: it relieves pain and tension, helps you relax, and can make it easier to return to movement and exercise. It does not replace exercise, breaks or managing workload, which are what keep the result.

What type of massage

• Therapeutic or deep tissue massage directed at the neck, shoulders and upper back area.
• Pressure on painful points, always within what is tolerable.
• Relaxing massage, when stress is the dominant factor.

A massage does not have to hurt to work. Severe pain during or after, bruising or worsening of symptoms are not signs that it is “working”.

When massage is not indicated

• Any of the warning signs described above.
• Fever or infection.
• Skin lesions, wounds or shingles in the area.
• Recent or suspected fracture.
• Recent thrombosis.
• During cancer treatment, only with medical advice.

At Luxmed, therapeutic massage, carried out by a massage therapist, begins with questions about your pain and your health, to work out whether it is appropriate. We adapt the technique and intensity and give suggestions for exercises and breaks to maintain the relief. If we notice signs that warrant a medical assessment, we will tell you.

This article is for information purposes and does not replace a medical consultation. In case of sudden, severe pain or with warning signs, call 112.

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