Shoulder blade pain | The symptoms, causes, and treatments

  • Overview
Back and Neck Help and advice Musculoskeletal health
Bridget Bazell Bridget Bazell Triage Team Lead Physiotherapist
Pinpointing the exact cause of pain in and around your shoulders can be a difficult task. Often, discomfort is linked to issues in the mid-back, neck, or even the lower back. Understanding more about the shoulder blade and how things can go wrong is crucial to finding long-term relief and starting effective physiotherapy treatment.

The shoulder at a glance

The shoulder blade (scapula) is a flat triangular-shaped bone on the back of the ribcage that joins the collar bone (clavicle) and upper arm (humerus). Lots of muscles attach to the shoulder blade and the main function is to provide a link between your torso and your arm.  

Pain around the shoulder blade is not always simple to diagnose as it can happen for many reasons that are commonly related to the mid back (thoracic spine) rather than the shoulder blade itself. It’s also common to experience pain between the shoulder blades and pain in our lower back or neck.

Symptoms of shoulder blade pain

Shoulder blade pain can be felt in many different ways, including:

  • Dull throbbing
  • Sharp stabbing
  • Aching
  • Burning
  • Tingling
  • Pinching between the shoulder blades

Pain can be localised to one area or referred to a different area of the body such as the arms, neck or lower back. It may be there all the time, or it may come and go depending on what you are doing.

Common causes of shoulder blade pain

The most common causes of pain in the shoulder blade area are non-serious, with the most common of all being sustained postures that are often labelled either “good” or “bad”.

Less common causes of shoulder blade pain include nerve pain from the spine or a viral illness like shingles. In these cases, a GP assessment is always recommended.

Other less common but serious causes include fractures after a traumatic injury or pain related to an underlying organ in the chest, such as the heart or lungs. If your upper back or shoulder blade pain started after you experienced a traumatic injury or fall, or it’s associated with chest pain, shortness of breath, and tingling or numbness in the arm, then an urgent medical assessment is recommended.

If your symptoms are ongoing despite trying to manage it yourself, or if you are worried about your pain, you should book an assessment with either a GP or physiotherapist.

Is shoulder blade pain caused by bad posture?

This is a very difficult question to answer. When it comes to posture, there isn’t an inherently “good” or “bad” option. Issues typically arise when we are unable to sustain any given posture for a long period of time. Recent research supports this idea and seems to confirm that staying in one position for a prolonged period is more harmful than the postural position itself.

A good way to picture this is to remember how our body feels during a long meeting or on a long-haul flight. Our body is crying out to be moved and it communicates that through pain and stiffness. If you are experiencing pain in the shoulder blade region or upper back, then it is advisable to take regular breaks from whatever you are doing and move about; and remember that doing anything is better than doing nothing.

The best option is to take a microbreak and to perform some regular amount of exercise at regular intervals throughout the day. If possible, it’s best to do something more challenging than getting up to go to the toilet or making a cup of tea. The best way to get the most out of a microbreak is to stretch or mobilise the affected area for several minutes. A good way to picture mobilising is to think of it as the squirming we do to get out of an uncomfortable position, only with more repetitions and purpose.

Can stress make it worse?

We know that there is a strong link between stress and bodily pain. We also know this is especially true when it comes to pain that’s localised in the upper back and shoulder blade area.

You can even test this out for yourself. Think of something stressful (picture yourself sitting in endless traffic) and focus on what happens to your body. Notice anything? Some common bodily responses to stress include:

  • Your shoulders creeping up towards your ears
  • Clenching of the jaw
  • Tightness in your chest
  • Accelerated breathing
  • Tingling pain in certain areas
  • Headaches

Next time you recognise you are starting to feel stressed, take a deep breath and drop your shoulders away from your ears. Hold your head tall and start taking some deep breaths. This will help encourage calm and prevent us from entering ‘fight or flight’ mode.

Fight or flight

As well as our body’s visible reaction to stress, the ‘fight or flight’ response we experience in stressful situations can also change our hormone levels. When we experience a stressful situation, our brain sends certain chemicals out into our body which increase our blood pressure, accelerate our heart rate, and speed up our breathing. This response can even affect circulation and how ready our muscles are to work.

Rest and digest

To help keep us calm and healthy, we need to strike a balance between our flight or flight and rest and digest systems. This balance will help keep our hormones, emotions, and bodily systems in sync. It also plays a role in the management of pain, as our rest and digest system can help dampen and minimise the magnitude of our pain response.

The fight and flight system is always active in people experiencing chronic stress, meaning they never see their rest and digest system kicking in, hence a lack of relaxing chemicals and the constant presence of an ‘always alert’ feeling in their body.

Problems we see regularly

There’s a pinching pain in my shoulder blade…

Different people will experience different sensations in their body, especially when pain manifests in an area as large as the back. Most pain in the upper back and shoulder blade area is ‘non-specific', which means there is no specific identifiable tissue or structure that’s causing it.

While it’s hard to provide a concrete cause of pinching pain in the shoulders without examining the individual, what we do know is that our nervous system can go into “protection mode” from time to time. This can cause muscle spasms and mobility issues that prevent us from moving as smoothly as we normally would.  This could give rise to different pain sensations such as pinching.

I can’t lift my arms above my head…

Difficulty raising your arms above your head could be because the upper back and shoulder blades are restricting your mobility. These areas are the foundation on which your arms move, so any damage, inflammation, or restriction here can limit how high you can lift your arms.

My shoulders click when I move…

It is common and quite normal to experience clicking in your shoulders, especially when you’ve just woken up or you haven’t moved for a while. Most of the time these clicking noises aren’t painful and don’t cause any harm at all.

The stiffness in my shoulder blade won’t go away…

Often discomfort or tightness in muscles will go away by itself within a few days to a few weeks. However, sometimes this doesn’t happen. In this case, it is advisable to seek advice via a physiotherapist or GP. Please note if the arm is stiff rather than the problem being around the shoulder blade or upper back, this may be a separate issue.

Treatment options for shoulder blade pain

Regular movement

The most important treatment in cases of acute upper back or shoulder blade pain is to keep moving in a way that is still manageable for you. Try to continue completing light to moderate tasks that don’t cause any issues. If you start to become aware of pain in a wider area across the upper back, try taking a 20 to 30-minute break in a sitting or lying-down position.

In the long term, it’s important to review your daily patterns of activity.

  • How long are you using a laptop or desktop for at a time?
  • Could you change your desk setup to make it more user-friendly?
  • How regularly do you move during the day?
  • How often do you change positions while working?
  • Could you take the stairs rather than using the lift?
  • Could you have a cup of water rather than a bottle and therefore get up regularly to refill it?
  • Are you stretching at all during the day?
  • Are you able to fit in more microbreaks than you currently are?

Any small changes you can make to your daily routine that encourage movement in the area will help relieve pain and improve your condition in the long run.

Painkillers

Many people have questions about taking painkillers and other medications like ibuprofen and paracetamol when they’re in pain.

If you’re unsure of what medication is safe for you or you’re struggling with your pain levels, have a chat with your local pharmacist about what options are best to take as part of your wider treatment plan.

Heat therapy

You may find relief by applying a hot water bottle or heat pad to the affected area.

This relaxing technique can help soothe inflammation and provide some short-term pain relief. When using heat therapy techniques, always ensure there’s a barrier between the heat source and your skin to prevent burns.

Gels and lotions

Skin creams that produce a burning or cooling sensation aren’t the same as physical heat. These can provide short-term relief from your pain but shouldn’t replace primary treatment options like movement and mobility.

How physiotherapy can help

Seeing a physiotherapist is by far the most effective way for you to understand more about your back and treat the source of your pain and discomfort.

When you see a physio for the first time, they’ll start by assessing your current physical condition and asking you a few questions about your routine and your activity levels to get a better understanding of what might be causing the pain.

They’ll also walk you through some exercises and movements that are geared towards mobilising and strengthening the area in question.

Interested in seeing one of our physios? Click here to get started

Our expert authors

This article was written by Bridget Bazell and the Physiotherapy Triage Team at Nuffield Health, with assistance and expert information being provided by:

  • Sally Lynch
  • Katrine Ross
  • Paul Staines
  • Lauren Broome
  • Lianne Price
  • Jo Baxter

Last updated Thursday 8 August 2024

First published on Thursday 8 August 2024

Back and Neck Help and advice Musculoskeletal health