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Pain between the shoulder blades

Tim Stevenson explaining pain between the shoulder blades

‘I get this achy, nagging pain between my shoulder blades, it doesn’t really bother me’…… said no one, ever.

 

This is one of those annoying sites of discomfort that is miserable to live with putting it in the same category as mouth ulcers and haemorrhoids.

 

Whilst those two ailments might resolve themselves with time, mid-back pain between your scapulae might not.

 

My obligatory pre-cursory research review pulled up a plethora of blogs and articles with the reported root cause being anything from a heart attack and gall bladder problem all the way to poor posture, for which ‘stretching exercises’ were the recommended strategy.

 

I’m going to come at this from a musculoskeletal standpoint so if you have any wider health problems or concerns, get those checked out first.

 

For everyone else, let’s see if we can do a bit better than ‘stretching’.

 

Heads up: as with many movement problems the answer is multifaceted. It is rarely as simple as getting a massage and thinking everything will be ok for ever. If it was, people wouldn’t need to keep going back to the therapist for the same problem over and over.

 

What I know is that people who can move well and have appropriate levels of strength get less pain and need less massages.

 

Where I am leading you is that we need to look at a systems approach.

 

Why? Because plain and simple that is how the body works. And because explaining this systems approach is multifaceted and complex, we need to go on a little journey, so stay with me.

 

What’s involved

You’ll often find that mid-back pain comes hand-in-hand with ‘knots’ that can feel pretty gnarly if you do any self-massage or get hands on treatment.

 

What you’ll also find is that this only provides temporary relief. Things feel better for a week or so and then you’re back wondering whether a dose of haemorrhoids would have been preferable.

 

Pain between the shoulder blades is a movement problem, moreover, it is often a lack of movement problem.

 

There is a lot of stuff going on in that space and we need to identify the root cause.

 

Root causes lead to long-term solutions rather than short-term fixes so follow this process and see what resonates with you.

 

A systems approach: Understanding the Parts

Let me give you the headlines as to how we can resolve pain between the shoulder blades and then I will explain how each piece fits together.

 

Headlines

·       You need to get your spine moving

·       You need to get your ribcage moving

·       You need to get stronger

 

1.   Restore Spinal Mobility

You might have read that the pain you are experiencing is a ‘posture problem’ or that you have ‘poor posture’.

 

This is a bit of a misnomer because it is difficult to say what ‘good posture’ looks like because how the segments of the body stack and align can come in many different forms. And those postures can often perform just fine. Until they don’t. That is a conversation for another time, but for now, don’t blame your pain on posture alone.

 

In nutshell, you need to have the mobility, stability and strength to exist and move in the world you live and participate in. That therefore needs to factor in your training and sport.

 

If you sit at a desk all day in a slouched position and you have been doing that for years, you might find that you don’t extend through the thoracic spine that well. How your body stacks and aligns might have changed as a result. Why? Because by sitting all day you told your brain that this was an important thing to do and because the brain wants to stay at equilibrium it tries to nullify stresses through adaptation and as a result, made you much better at sitting.

 

If you never need to get into an overhead position very often and you don’t need to load bare in that position, that posture might be just fine.

 

But you started CrossFit, strength training or a new sport and suddenly want to go overhead with weight or repetition. How your body stacks and the amount of spinal mobility you have could now become a problem because it’s not easy for you to get out of your 10 hours a day sitting shape.

 

There is a tonne of detail I could dive into here but for the sake of brevity remember this;

 

Spinal movement is everything.

 

Your spine should be able to flex, extend and rotate. If it can’t do that, you will at some point run into problems and restoring movement to your spine could be part of the solution you need.

 

2.   The ribcage

You might have never thought about ribcage mobility before but the ability of your ribs to expand can be an important part of resolving your mid-back pain.

 

Your ribcage is not just there to house the lungs. It creates an important interface with your scapula which is the site between which you are experiencing the pain.

 

 

To give you an example, if the ribcage can’t expand posteriorly, we compromise a level of function at the shoulder.

 

For the upper limb to move well we need the scapula, which is concave, to sit on the ribcage, which is convex. The ribcage provides a base of support for the scapula as it moves through its many positions and patterns.

 

If we lack posterior expansion of the ribcage, it may mean that the train (scapula) is not on the tracks (ribcage).

 

Due to this the movement mechanics around the scapula are compromised meaning that muscle tissues in the mid-back may have to work harder to compensate.

 

Whilst these muscles will do their best, they may get to the stage where they are clinging on for dear life and just can’t handle the demands being placed upon them. So, they get jacked up and that is where the gnarly knotty feeling comes in.

 

3.   You need to get stronger

The muscle pain between your shoulder blades will most likely in some part be because you aren’t moving your spine and ribcage enough or effectively.

 

But what has that got to do with strength?

 

Strength creates tolerance. The muscles in your mid-back could be having a hard time because they aren’t strong enough to deal with the positions, patterns and durations that you’re exposing them too.

 

Now before you dive in and think that the pain is in my rhomboids and therefore, I need to think about squeezing my shoulder blades together more, it’s not going to work like that.

 

There are 17 muscles that attach to the scapula. Those 17 muscles need to work together to co-ordinate movement and how we distribute forces across those muscles throughout the day and when we move is the key. If some of the muscles acting on the scapula are working too hard or not hard enough your brain may resort to finding other ways to pick up the slack.

 

Your strategy to address this will therefore include increasing strength around the scapula musculature to ‘offload’ tissues that are having to work too hard and better share the load amongst the players at the table.

 

A systems approach: Embracing the complexity

 

Let me bring this together with an example

 

You spend a lot of time sitting and working on a computer. As such your spine spends most of the day in a level of flexion and the shoulder is more internally rotated. Your rhomboids and middle fibres of trapezius are now sat in a lengthened position. Due to stress or poor breathing mechanics, your ribcage isn’t moving as it should and it’s not expanding posteriorly meaning that the demand placed on certain muscles is exceeding their physiological capacity in some way.

 

You decide to do something about it, so you start moving your spine more and combine this with some breathing exercises to restore mobility, movement and improve the kinematics of the scapulothoracic joint.

 

Try the single arm crab reach exercise

The single arm crab reach helps us build some overhead mobility linked in with spinal extension.



Try the supported squat breathing exercise

In the supported squat based pattern it allows us to bias the posterior expansion of the ribcage.



This helps to restore ranges of motion which allow you to move better in your athletic pursuits and manage the day-to-day ‘postural stress’ you place on your body.

 

You also include strength exercises designed to improve shoulder function, particularly those acting on the scapula so that all muscles involved are doing their job with an appropriate level of contribution to the whole.



Finally you integrate all of this into some systemwide athletic patterns because that is how the body is designed.

 

After doing this consistently, the pain between your shoulder blades decreases.

 

Why? Because you have addressed the system, not just the site of pain.


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