What Causes Pain Between the Shoulder Blades? Common Causes, Treatment, and Relief

Pain between the shoulder blades is a common problem that can affect your comfort at work, during exercise, or while performing everyday activities. You may experience a dull ache in your upper back, sharp pain when turning your neck, muscle tightness after sitting for hours, or discomfort that spreads toward your shoulders and arms.

So, what causes pain between the shoulder blades? In many cases, the discomfort comes from muscle strain, poor posture, prolonged sitting, or irritation in the neck and upper back. However, some cases may be associated with spinal conditions or pain referred from internal organs.

Understanding the possible causes can help you decide how to manage your symptoms and when to seek professional care. This guide explores common reasons for pain between the shoulder blades, practical relief strategies, exercises, and warning signs you should never ignore.

What Is Pain Between the Shoulder Blades?

The shoulder blades, also known as the scapulae, are the flat bones located on the upper back, one on each side of the spine. Several muscles connect these bones to the neck, ribs, shoulders, and spine, helping you move your arms and maintain upper-body stability.

Pain between the shoulder blades usually affects the upper or middle back, around the thoracic spine. It may develop gradually after repetitive activity or prolonged sitting, or it may begin suddenly following an injury.

Depending on the underlying cause, symptoms may include:

• A dull ache between the shoulder blades
• Sharp pain when turning or bending
• Tightness across the upper back
• Muscle spasms or tenderness
• Pain that spreads toward the neck or shoulders
• Discomfort when taking a deep breath
• Tingling, numbness, or weakness in an arm

The type and location of your symptoms can provide useful clues. However, they cannot confirm the cause without considering your medical history and other symptoms.

8 Common Causes of Pain Between the Shoulder Blades

1. Muscle Strain and Tension

Muscle strain is one of the possible explanations for pain between the shoulder blades. The muscles in this area help control shoulder movement, stabilize the shoulder blades, and support the upper body.

Repeated movements, lifting heavy objects, unfamiliar exercise, or sudden twisting can overload these muscles. Stress may also contribute to muscle tension, particularly around the neck and shoulders.

Common symptoms include:

• Aching or tightness in the upper back
• Tenderness when pressing the affected muscles
• Discomfort when moving the shoulders
• Pain that increases after physical activity
• Stiffness after remaining in one position

For example, carrying heavy bags on one shoulder or suddenly increasing the intensity of a workout may aggravate the muscles around the shoulder blades.

Mild muscle-related pain often improves with gentle movement, temporary activity modification, and gradual return to normal activities. Persistent or severe pain should be assessed to rule out other causes.

2. Poor Posture and Prolonged Sitting

Spending long periods sitting at a desk, looking down at a phone, or working with your shoulders in an awkward position may contribute to upper-back discomfort.

When you remain in one position for a long time, the muscles around your neck, shoulders, and upper back may become tired or uncomfortable. Poorly arranged workstations can also encourage repetitive or sustained positions that aggravate symptoms.

You may notice:

• Pain after working at a computer
• Tightness between the shoulder blades
• Stiffness when standing up after sitting
• Discomfort when looking down for extended periods
• Symptoms that improve after changing position or moving

Posture is not the only possible cause of upper-back pain, and there is no single perfect posture that everyone must maintain. Regular movement, a comfortable workstation, and changing positions throughout the day may be more helpful than trying to hold a rigid position for hours.

Consider adjusting your chair, positioning your screen near eye level, and taking brief movement breaks during prolonged work.

3. Neck Problems and Cervical Spine Conditions

Pain between the shoulder blades may originate in the neck rather than the upper back itself.

The cervical spine contains joints, discs, muscles, and nerves that help support and move the head. Irritation in these structures can cause pain that spreads into the shoulder blades or upper back.

Possible causes include muscle tension, age-related changes in the cervical spine, and irritation or compression of a nerve root.

Additional symptoms may include:

• Neck stiffness or reduced movement
• Pain when turning your head
• Discomfort spreading into one shoulder or arm
• Tingling or numbness in the arm or hand
• Weakness in certain arm or hand movements

When a nerve root is irritated, the resulting symptoms may extend beyond the neck and shoulder blade area.

If you develop new arm weakness, significant numbness, difficulty walking, or rapidly worsening symptoms, seek urgent medical assessment. You can read more in the NHS guide to cervical spondylosis.

4. Thoracic Spine Problems

The thoracic spine is the section of your spine located in the upper and middle back. Problems affecting its joints, discs, surrounding muscles, or other structures may cause pain between the shoulder blades.

Symptoms may develop after repetitive movements, lifting, twisting, or an injury. In some cases, discomfort becomes more noticeable when bending, rotating the torso, or remaining in one position.

Possible symptoms include:

• Aching along the middle of the upper back
• Stiffness when twisting
• Pain during lifting or reaching
• Muscle tightness around the ribs and shoulder blades
• Discomfort that changes with movement

The exact cause varies from person to person. Persistent upper-back pain, particularly pain that occurs at night, becomes progressively worse, or is accompanied by unexplained weight loss or feeling unwell, needs medical evaluation.

For additional information, see the Cleveland Clinic guide to upper-back pain.

5. Shoulder Blade Movement and Muscle Weakness

The shoulder blades move across the rib cage whenever you raise, lower, or rotate your arms. Several muscles coordinate this movement, including the trapezius, rhomboids, and serratus anterior.

If these muscles are irritated, weak, or not coordinating effectively, you may experience discomfort around the shoulder blades during repetitive arm movements.

This can occur in people who perform overhead work, participate in sports, or repeatedly lift and carry objects.

You might notice:

• Pain when reaching overhead
• Fatigue around the shoulder blades
• Discomfort during pushing or pulling movements
• Reduced tolerance for repetitive arm activity
• Difficulty maintaining comfortable shoulder movement

A physiotherapist can assess shoulder movement, muscle strength, and activity patterns to determine whether targeted exercises may help. Treatment should be based on the findings rather than assuming muscle weakness is always responsible.

6. Injury From Exercise, Lifting, or an Accident

Pain between the shoulder blades may begin after a fall, collision, sudden twisting movement, or lifting something heavy.

Depending on the mechanism, an injury may affect muscles, ribs, joints, ligaments, or the spine. The severity can range from a mild strain to an injury requiring urgent medical care.

Signs of a possible injury include:

• Sudden pain during a specific movement
• Tenderness or swelling
• Pain with movement or deep breathing
• Bruising after an impact
• Difficulty moving the neck, shoulder, or upper back

If the pain follows a significant accident, do not assume it is simply a muscle strain. Seek prompt medical assessment, especially if you have severe pain, difficulty breathing, weakness, numbness, or difficulty moving normally.

7. Stress and Muscle Tension

Stress can affect how the body responds to discomfort. Some people unconsciously tighten their neck and shoulder muscles during periods of anxiety, concentration, or emotional strain.

Over time, sustained muscle tension may contribute to aching around the upper back and shoulder blades. Stress can also affect sleep and increase sensitivity to pain.

Possible signs include:

• Tight shoulders during stressful situations
• Upper-back discomfort after a demanding workday
• Muscle tension without an obvious injury
• Symptoms that fluctuate with stress or poor sleep

Gentle movement, regular breaks, adequate sleep, and relaxation techniques may help reduce tension. However, new or persistent pain should not automatically be attributed to stress, particularly when other symptoms are present.

8. Referred Pain From Internal Organs

Sometimes, pain between the shoulder blades originates outside the muscles and spine. This is known as referred pain, in which a problem elsewhere in the body is felt in another location.

Possible sources include certain heart conditions, lung problems, and digestive conditions.

The pattern of symptoms matters. Pain associated with heart or lung conditions may occur alongside chest discomfort, shortness of breath, sweating, dizziness, nausea, or pain spreading into the arm, neck, or jaw.

Call your local emergency number immediately if you develop sudden or severe upper-back pain with chest pain, difficulty breathing, faintness, cold sweating, or other symptoms suggestive of a heart or lung emergency. Do not assume the pain is muscular simply because it is located between the shoulder blades.

Pain that becomes worse with breathing may also require medical assessment, particularly when it starts suddenly or occurs with breathlessness or coughing up blood.

What Does the Location of the Pain Tell You?

The exact location of the discomfort may help guide further assessment, but it cannot identify the cause on its own.

If your symptoms do not fit a clear pattern, or if they are persistent or worsening, arrange an assessment rather than relying on the location alone.

How to Relieve Pain Between the Shoulder Blades

The most appropriate treatment depends on the cause. If your pain is mild, began after prolonged sitting or ordinary activity, and you have no warning signs, the following measures may help.

1. Keep Moving Gently

Avoid staying in the same position for long periods. Short walks and gentle shoulder movements can help you change position and reduce stiffness.

You do not need to exercise intensely. Start with comfortable movements and gradually increase your activity as symptoms allow.

If movement causes severe pain, new tingling, or weakness, stop and seek medical advice.

2. Try Heat or Cold

A warm pack may help some people with muscle tightness, while a cold pack may feel more comfortable after a recent minor strain.

Apply either option with a protective layer between the pack and your skin. Use it for around 15–20 minutes and avoid excessive heat or cold.

Do not apply heat or cold to skin with reduced sensation without professional advice.

3. Improve Your Workstation

If you spend much of the day at a computer, consider making small changes to your setup:

• Position the screen so you can look ahead comfortably.
• Keep your keyboard and mouse within easy reach.
• Support your back with a comfortable chair.
• Relax your shoulders rather than holding them raised.
• Change positions regularly throughout the day.

These adjustments may reduce strain during prolonged work, although they will not address every possible cause of upper-back pain.

4. Avoid Temporarily Aggravating Activities

If heavy lifting, repetitive overhead work, or a particular exercise increases your pain, reduce that activity temporarily.

Continue comfortable daily movement where possible, then return to more demanding activities gradually as symptoms improve.

Avoid repeatedly stretching or twisting into painful positions in an attempt to force the discomfort away.

5. Consider Professional Advice About Pain Relief

A pharmacist or healthcare professional can advise whether an over-the-counter pain reliever is suitable for you. Some medications are not appropriate for people with certain medical conditions or those taking other medicines.

If the pain is severe, unexplained, or persistent, seek an assessment rather than relying on pain medication alone.

Exercises That May Help Pain Between the Shoulder Blades

Gentle exercises may help some people with muscle-related upper-back discomfort. However, the appropriate exercises depend on the cause of the pain, your mobility, and your overall health.

Do not begin exercises to treat unexplained severe pain, pain after a significant accident, or symptoms associated with chest discomfort, breathing problems, or neurological changes.

Shoulder Rolls

1. Sit or stand in a comfortable position.
2. Slowly lift your shoulders toward your ears.
3. Gently roll them backward and lower them.
4. Repeat several times within a comfortable range.

Keep the movement relaxed and avoid forcing your shoulders into an extreme position.

Gentle Shoulder Blade Retractions

1. Sit or stand with your arms relaxed by your sides.
2. Gently draw your shoulder blades slightly toward each other.
3. Keep your shoulders relaxed rather than lifting them toward your ears.
4. Hold briefly, then release.

The movement should feel controlled rather than forceful. Stop if it increases your pain.

Gentle Upper-Back Movement

1. Sit in a stable chair with your feet supported.
2. Place your hands comfortably across your chest.
3. Slowly rotate your upper body a small distance to one side.
4. Return to the centre and repeat in the opposite direction if comfortable.

Keep your movement gentle and avoid twisting through pain.

These exercises are general examples, not a personalized rehabilitation plan. If your symptoms persist or keep returning, a physiotherapist can determine which movements are appropriate and whether additional assessment is needed.

How Physiotherapy Can Help

Physiotherapy may be helpful when pain between the shoulder blades is related to muscle strain, movement difficulties, certain neck or upper-back conditions, or problems tolerating everyday activities.

A physiotherapist may review your symptoms and medical history, assess neck and upper-back movement, examine shoulder function, and identify activities that reproduce your pain.

Depending on the findings, your treatment may include:

• Individualized mobility exercises
• Strengthening for the shoulder and upper-back muscles
• Advice on workstation setup and movement habits
• Gradual return to exercise and everyday activities
• Strategies to manage recurring muscle tension
• Education about symptom management and prevention

Treatment should address the underlying problem rather than simply trying to relieve pain temporarily.

If upper-back discomfort is interfering with your daily activities, learn more about Ritz Clinic’s physiotherapy services. A qualified healthcare professional can help determine whether physiotherapy is appropriate for your symptoms.

Remember that physiotherapy is not a substitute for urgent medical assessment when symptoms suggest a heart, lung, spinal, or other serious condition.

When Should You See a Doctor?

Although many cases of upper-back discomfort are related to muscles or movement, certain symptoms need prompt attention.

Seek Emergency Medical Care If You Have:

• Sudden or severe pain between the shoulder blades with chest pain
• Difficulty breathing, faintness, or cold sweating
• Sudden severe pain with symptoms spreading into the arm, jaw, or neck
• Upper-back pain following a serious accident
• New weakness, difficulty walking, or major neurological changes

These symptoms may indicate a serious condition and should not be treated at home.

Arrange Prompt Medical Assessment If You Have:

• Severe pain that starts suddenly or gets worse quickly
• Pain accompanied by fever or feeling generally unwell
• Persistent pain that does not improve or repeatedly returns
• Pain that is worse at night or does not improve with rest
• Unexplained weight loss or a history of serious illness
• New numbness, tingling, or weakness in an arm
• Pain that is aggravated by breathing or coughing

A healthcare professional can assess your symptoms and determine whether further testing is necessary. Imaging is not always required; the decision depends on the history, examination, and suspected cause.

For further guidance, see the NHS information on back pain and Cleveland Clinic’s overview of upper-back pain.

How Can You Prevent Pain Between the Shoulder Blades?

Not all causes of upper-back pain can be prevented, but certain habits may help reduce recurring discomfort.

Take Regular Movement Breaks

If you work at a desk, change positions regularly instead of remaining seated for hours. Brief walks and gentle shoulder movements can help you avoid prolonged static postures.

Build Strength Gradually

Appropriate exercises for the upper back, shoulders, and trunk can help you tolerate everyday activities. Increase resistance and training intensity gradually rather than suddenly changing your routine.

Use Comfortable Lifting Techniques

Keep loads manageable, hold objects close to your body, and avoid sudden twisting while carrying heavy items. Ask for help with loads that are difficult to control safely.

Make Time for Recovery

Adequate sleep and recovery between demanding activities may help you manage physical fatigue. If stress contributes to muscle tension, relaxation techniques and regular breaks may also be useful.

Address Recurring Symptoms Early

If pain repeatedly returns during the same activity, review the movement, workload, or workstation that may be aggravating it. Persistent symptoms deserve professional assessment, especially if they are becoming more frequent or intense.

Frequently Asked Questions

What is the most common cause of pain between the shoulder blades?

Muscle strain, muscle tension, prolonged positioning, and other musculoskeletal problems are common explanations. However, the cause varies, and pain in this area can occasionally come from the neck, spine, or internal organs.

Can poor posture cause pain between the shoulder blades?

Prolonged or uncomfortable positions may contribute to muscle fatigue and upper-back discomfort. Regular movement, a comfortable workstation, and appropriate strengthening may help. However, posture should not be assumed to be the cause of every case of pain.

Why does the pain between my shoulder blades get worse when I breathe?

Pain with breathing can occur with certain muscle or rib problems, but it can also be associated with lung or other medical conditions. Sudden pain, breathlessness, chest discomfort, or coughing up blood requires urgent medical evaluation.

Can stress cause pain between the shoulder blades?

Stress may contribute to muscle tension in the neck and shoulders and can make pain feel worse. Nevertheless, persistent or unexplained symptoms should be assessed rather than automatically attributed to stress.

Can physiotherapy help pain between the shoulder blades?

Physiotherapy may help when the pain is related to muscle strain, movement limitations, or certain neck and upper-back conditions. A physiotherapist can assess your symptoms and recommend an appropriate exercise and activity plan.

How long does pain between the shoulder blades last?

Recovery depends on the underlying cause. Mild muscle-related discomfort may improve over several days, while some injuries or persistent conditions take longer. Seek medical advice if the pain is severe, worsening, recurring, or not improving.

Is pain between the shoulder blades a sign of a heart attack?

It can sometimes be referred from the heart, although many cases have musculoskeletal causes. If the pain occurs with chest pressure, shortness of breath, sweating, dizziness, nausea, or pain spreading to the arm or jaw, call your local emergency number immediately.

Conclusion

Pain between the shoulder blades can result from muscle strain, prolonged sitting, neck problems, thoracic spine conditions, shoulder movement difficulties, or an injury. In some cases, it may also be referred from internal organs, making it important to pay attention to accompanying symptoms.

For mild discomfort without warning signs, gentle movement, workstation adjustments, and temporarily avoiding aggravating activities may help. If the pain persists, returns frequently, or interferes with daily life, seek professional assessment to identify the underlying cause.

Most importantly, do not ignore sudden severe upper-back pain accompanied by chest pain, breathing difficulties, faintness, or neurological symptoms. These signs require urgent medical care.

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