Do you have an annoying pain behind your shoulder blade? An ache that flares-up and settles again, but never really goes away? The kind of pain and discomfort you can’t really put your finger on? If this sounds like you, you could have rhomboids muscle spasm.

Shoulder blade muscle spasm is quite common, especially if you spend long hours in the same position, for instance in front of a computer. Does that mean it’s normal and you should just get used to it? Definitely not! A muscle spasm or muscle tightness is always trying to protect something else like a nerve or joint. In some cases the spasm is protecting the muscle itself, but these are usually the times when you know what caused the problem. Like after a heavy session in the gym or after washing and hanging curtains.

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Let’s start with some of the structures at the back of your shoulder

Your scapula, or shoulder blade, is a triangular bone at the back of your shoulder joint. The interesting thing about a scapula is that it isn’t attached to the rest of your skeleton like all your other bones. This means that your shoulder can move in almost any direction without a bony joint stopping the movement. However, your shoulder blade is also the only starting point for most of the muscles that control your shoulder movements. So why doesn’t your scapula just get dragged along whenever your arm moves?

The answer lies in all the muscles that link your shoulder blade to your skeleton. Some of these muscles cross your shoulder joint to move your arm in different directions, but others control the movement and stability of your scapula itself.

Your scapula should provide an anchor when the muscles that move your arm contract or lengthen. Things usually start to go wrong if there’s an imbalance somewhere in this system. So let’s have a look at where you can find some of these muscles and what they do.

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Muscles between your spine and shoulder blade

  • Rhomboids minor and major
    These muscles connect your last neck vertebrae and first 5 upper back vertebrae to the inner border of your shoulder blade. This means that your rhomboids can help to stabilise your scapula when you move your arm. Actions of these muscles are moving your shoulder blade backwards, upwards or tilting the lower edge towards your spine.
  • Levator scapulae
    This muscle starts at the upper 4 vertebrae in your neck and runs diagonally to insert onto the upper part of your shoulder blade. When the muscle contracts the lower edge of your scapula will tilt towards your spine.

Muscles that cross over your scapula

  • Trapezius
    This large, flat muscle is usually divided into three parts according to their actions, namely upper-, middle- and lower trapezius. The muscle originates from the bottom of your skull and every vertebrae in your neck and upper back. It inserts onto the outer part of your collar bone, top of your shoulder (acromion) and the spine of the scapula. Actions of the trapezius muscle includes shrugging (upper part), pulling your shoulder back (middle part) and pressing your shoulder blade down (lower part).
  • Serratus anterior
    Serratus anterior actually runs underneath your shoulder blade from the outer part of your ribs and it inserts onto the part of your scapula that is closest to your spine (medial border). It is sometimes called the “boxer’s muscle”, because it draws your shoulder blade forwards like when you throw a punch.

Muscles between your shoulder blade and upper arm

  • Rotator cuff
    These 4 muscles are responsible for the stability of shoulder joint and can also move your upper arm in different directions.
    Supraspinatus is found at the top of your shoulder blade and inserts on the outside of your upper arm. This muscle lifts your arm to the side.
    The Subscapularis muscle starts underneath your scapula and inserts onto the front part of your shoulder. It rotates your arm inwards like when you put your hand behind your back.
    Infraspinatus and teres minor originate from the lower part of your scapula and insert onto the back part of your upper arm. These muscles turn your arm outwards like when you want to throw a ball.

So what causes shoulder blade muscle spasm?

A muscle spasm can be defined as a “persistent, involuntary muscle contraction”. The involuntary part is what causes the problem. If a muscle contraction is voluntary, it means that it is under your control. For instance, to have a drink of water the muscles in your upper arm contract to lift the glass and move it to your mouth. After you’ve finished the movement the muscles relax and return to normal tension or tightness. With a muscle spasm this muscle contraction stays there even after you’ve finished the action and you experience this as tightness or a knot in the muscles.

The main reason a muscle spasm causes pain, is because it interferes with blood flow to the area. This pain is a message and a warning that the muscle tissue is not getting enough oxygen. But why does it happen?

Fine yesterday, not so fine today

Shoulder blade or scapula pain can be caused by acute (sudden) overuse like repeated arm movements. Most of the muscles controlling your arm movements are attached to your scapula, so whenever you use your arm these muscles are working. Under normal circumstances this doesn’t cause any problems. However, if the muscles are only strong enough to cope with your normal daily routine, any extra work can cause muscle spasm. This happens because your shoulder blade muscles get tired from supporting your arms. When the muscle gets too tired it goes into a spasm or “knot”.

This spasm is a signal that something is wrong, but also your body’s way of still getting the job done. The muscle spasm allows you to still use your arms even though the muscles are too tired to contract normally. Examples of acute overuse will be things like painting a wall, hanging pictures on walls, moving heavy furniture or packing boxes.

Similarly sustained positions can also cause shoulder blade muscle spasm, especially positions you aren’t used to. In this case the reason your muscles get tired is slightly different, but with the same resulting muscle spasm. Sitting in the same position for long periods, like driving long distances or working at your computer, puts the muscles around your scapula in a stretched or elongated position. The muscles are in a stretched position, otherwise your hand won’t reach far enough to perform the activity. But the muscles are also contracting to hold your shoulder in position and give you enough stability to use your hand. Consequently the muscles will fatigue which leads to shoulder blade muscle spasm

When the pain creeps up on you

Looking at muscle spasm around your shoulder blade with a gradual onset, the mechanism will be similar to sudden onset. However, the muscle spasm creeps up on you as it slowly gets worse over time. Initially the muscle spasm will just be discomfort at the end of the day that disappears after a good night’s rest. Over time discomfort becomes pain and later on you start wondering if there was ever a time where you didn’t have tightness in your upper back.

A slouched posture is one example where the muscles around your scapula are constantly in an elongated position. As a result the muscles continue to get weaker over time, so even if you try to sit upright your upper back muscles don’t have the strength or endurance to keep you there for long.

Constant tension on your shoulder is another cause, but in this example the muscles have to work extremely hard for long periods at a time to keep your arm up. For instance sitting too far away from your keyboard at work or steering wheel while driving. Imagine holding a glass filled with water up to shoulder height. For the first few minutes you have no trouble because the glass isn’t heavy. Now imagine holding the glass up in the same position for 8 hours and repeating this every day for weeks and months. That is exactly what happens if you spend a lot of time each day with your arm stretched out. Even though the muscles can rest when you lower your arm, these short periods of recovery can’t balance out the hours of overuse.

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Symptoms of shoulder blade muscle spasm

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How to test if my pain might be due to muscle spasm

  • Sitting on a chair, put your one arm behind your back.
  • Now look down at the floor by dropping your chin towards your chest.
  • Keep your head down and turn your head away from the arm behind your back, towards your armpit.
  • The test can indicate muscle spasm if you feel a stretch, pain or tightness at the top of your shoulder blade.
  • Sitting on a chair, move your arm across your chest towards the opposite shoulder.
  • Then place your other hand on the back of your elbow and gently pull the arm closer to your shoulder. Almost like you are giving yourself a hug.
  • A stretching sensation, stiffness or pain at the back of your shoulder can indicate muscle spasm.
  • Move your arm backwards, then bend your elbow to put your forearm against your lower back.
  • If tightness around your shoulder prevents this motion or your feel pain and stiffness at the back of your shoulder you probably have shoulder muscle spasm.
  • Move your other arm across your chest towards your opposite (painful) shoulder blade. Ask someone to help if you can’t reach.
  • Apply pressure to area where you experience pain.
  • If your pain increases with this added pressure, you have shoulder blade muscle spasm.

How worried should I be about the pain behind my shoulder blades?

Just a “niggle”…

At first you will have a vague tightness around the back of your shoulder. You will notice that your posture isn’t great because sitting upright is just too much effort. The muscles in your upper back get tired and tight quickly, so slouching is just the most comfortable position at this stage. Changing positions like making a cup of coffee or stretching will help a bit, but as soon as you sit down in front of your computer the “niggle” will be back. In the morning you will get out of bed rested so you forget about the previous day’s discomfort. That is until you sit down to start working again and the cycle gets repeated day after day.

Why won’t this niggle go away?

Instead of going away, this niggle will just keep getting worse the longer you ignore it. Sitting at a table or desk results in mild discomfort that becomes pain and stiffness during the day. Stretching to relieve the stiffness will be painful, but will also give you a bit of relief afterwards. Making yourself sit in an upright posture for more than a couple of minutes will make the discomfort so intense that you will just stop trying. Taking a break during the day will help slightly, but the tightness in your upper back will never go away completely. Even everyday extra loads like carrying groceries or stretching to put on a jacket will become an effort as the muscles around your shoulder blades struggle to cope. In the morning you might feel a bit better after the night’s rest. However, as soon as you get out of bed and stretch the pain will be right there waiting for you.

Constant, irritating and burning

Finally, you will have intense pain and discomfort all day every day. At night you will struggle to find a comfortable position and might even wake up at night when you turn around. Even coughing or taking a deep breath gives you a sudden, sharp pain. Any shoulder or upper back stretch will be excruciating and will only give you a tiny bit of relief, if any.

Don’t wait until you reach this stage! Call us and let us help you when your pain starts as an irritating “niggle”.

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Physiotherapy diagnosis

Physiotherapists are experts in human anatomy and movement, with the necessary experience to find the cause behind your shoulder blade pain. We understand how muscles and joints work together to let you get up and go. Looking at your upper back, neck and shoulder we can accurately diagnose which muscles are weak and/or tight. A thorough evaluation is crucial for effective treatment of your shoulder blade pain and that is exactly where our physiotherapists’ skill and expertise will come in.

During your physiotherapy evaluation, we will stretch and stress the muscles around your shoulder blade to determine which one’s are causing your pain. We can accurately identify where your spasm is coming from. Testing the surrounding structures like joints and nerves and assessing your posture allows us to plan an appropriate treatment plan with the correct exercises and advice.

Sonar

Diagnostic ultrasound, or sonar, is used to identify damage to soft tissue structures in your body. Soft tissue will include muscle tears, calcifications or tendon injuries. With shoulder blade muscle spasm there usually won’t be any tissue damage, so this imaging is unnecessary. If you physiotherapist suspects otherwise you will be referred to the right place for a sonar.

X-rays

X-rays only show the bony elements of your body, so this test is not useful to diagnose shoulder blade muscle spasm. However, if your muscle spasm started after trauma like a fall or car accident, your physiotherapist might refer you for X-rays to rule out fractures to your scapula or upper back.

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MRI or CT scan

A CT scan or MRI can be used to detect injuries to the deeper structures in your upper back and under your shoulder blade, for instance upper back disc injuries, lung problems not seen on X-rays or hairline fractures to the ribs under your shoulder blade. These injuries are not common, but if your physiotherapist suspects a deeper problem you will be referred to the right specialist for the right tests and treatment.

Why is my shoulder blade pain not going away?

The pain between your shoulder blades is a warning sign that something is wrong, like the buzzing of a mosquito. Just chasing the mosquito away from your ears won’t solve the problem. In the same way stretching your shoulder blade muscles or clicking your upper back will give you temporary relief. The underlying problems and muscle weakness will still be there, so the muscle spasm will always be back.

Another reason stretching, medication or clicking your back won’t solve the problem can be your daily routine. Working in a hunched over position like dentists, bobbies like knitting or sewing and sports like cycling will all put you in a bent over position for long periods of time. The short stretch and change of position can’t reverse the hours, weeks and years of slouching.

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What NOT to do

  • Keep taking muscle relaxants – it won’t solve the underlying problem.

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us.

  • Apply deep pressure to try and find the pain.

  • Stretch into pain.

  • Ignore the discomfort until it turns into pain.

  • Use a sling to support your arm.

What you should do

  • Apply a hot pack (comfortable heat to avoid burning).

  • Gentle movements of your neck, shoulders and upper back.

  • Make an appointment to confirm the diagnosis and determine the severity of your problem.

  • Keep doing your prescribed exercises.

  • Take enough short breaks during the day.

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Making the injury worse

  • Sitting in awkward position.

  • Training through pain.

  • Extreme stretches.

  • Clicking your back.

  • Prolonged sitting.

  • Driving long distances.

  • Forcing yourself into a “correct” posture.

Big problems we see with upper back muscle spasm

Looking for a quick fix

Asking someone to click your back or massage the muscles between your shoulder blades will give you some relief. Unfortunately, you have to go back to the postures and habits that caused the problem. Over time you will need these “quick fixes” more often until you reach the point where nothing helps anymore. If you don’t find the underlying cause of your shoulder blade muscle pain, you will never get rid of the stiffness and discomfort in your upper back.

“It’s only stress”

Another big problem we see is that patients write off their upper back muscle pain to stress or tension. Going for a massage or spa treatment helps a bit, but the problem comes back time and again. If you are at the point where you have to go for a massage every week just to keep your pain under control, rather call us and make an appointment. We can give you a diagnosis to help you find a solution to the pain between your shoulder blades.

Jumping between treatment options

By the time the stiffness between your shoulder blades bothers you enough to seek help, it has usually been there for weeks or months. Consequently, the problem won’t go away with only one treatment. Over time the muscles would have gotten weaker and weaker and the joints in your upper back will be stiff as well. You only see your physiotherapist for an hour and then have to go back to your old habits. As a result the muscle spasm will come back in between treatments, because your muscles will take time to get strong enough to maintain the improvement. The problem comes in when patients want instant results and get frustrated with what they feel is slow progress. This leads to jumping from option to option like chiropractic, acupuncture, stretching and any other ideas Google can suggest.

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Physiotherapy treatment for relief from shoulder blade muscle pain

Physiotherapists can assess, diagnose and treat the causes of your shoulder blade muscle pain. We have seen many patients with this problem and provide the best possible treatment for a faster recovery. A detailed assessment also allows us to identify all the factors contributing to your upper back pain and rule out any deeper pathology.

Your specific treatment will be determined by various factors, for instance pain intensity and contributing factors. To give you an idea, though, most of our physiotherapy treatments include:

  • Electrotherapy like laser and ultrasound for pain relief.
  • Soft tissue treatment like therapeutic massage and dry needling to help relieve muscle spasm and tightness.
  • Postural re-education to decrease tension and stress on your upper back and to prevent future episodes of pain.
  • Strapping to help with support of the painful area and remind you when you sit in a posture that causes strain on your upper back muscles.
  • Exercises to strengthen the muscles around your upper back and shoulder.
  • Information about your condition and teaching you how to manage your pain.

Rehabilitation

Phase 1: Information 

Your treatment journey will start with information about your diagnosis. We will explain what caused the problem, how we are going to treat it and what you should do throughout the process. This includes things like changing your habits and doing your home exercises. Your physiotherapist guides the process, but you also have a major part to play in your recovery. 

After your first appointment you should know what is wrong and have a good idea of what your treatment will entail.

Phase 2: Treating the muscle spasm

This stage of treatment will focus on managing your upper back muscle pain. We will use techniques like therapeutic massage, dry needling, electrotherapy, strapping and stretches to treat the muscle spasm behind your shoulder blades. Your role in your rehabilitation will also start during this phase. By doing your home exercises and changing habits you will see results faster and also ensure you don’t just fall back into old habits in between treatments.

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Phase 3: Restore range of motion

To get you moving again, we will use joint mobilisation techniques for your upper back and exercises through range of movement. As your pain improves you should be able to move your upper back and shoulder through full range of motion without pain or stiffness. Your treatment will also start to include more activation and strengthening exercises during this phase. Just getting the mobility back won’t be enough for long-term relief from your shoulder blade pain. Therefore, we make sure that the muscles around your shoulder blades have the strength and endurance to maintain the range of motion that you’ve gained.

Phase 4: Strengthening shoulder girdle

As you continue treatment your strengthening exercises will start to include the muscles that support and control your arms. These muscles must be strong enough to provide stability when you use your arms throughout the day. Otherwise the muscles behind your shoulder blade will have to work twice as hard to stabilize your upper back, shoulder blade and arms. Strengthening exercises will start to get more complex with added load like resistance bands or weights.

By the end of this phase you should be able to carry around packages etc without struggling with scapular pain the next morning.

Phase 5: Treat associated problems

We often find that neck pain or a stiff upper back go hand in hand with pain behind your shoulder blade. Just as pain between your shoulder blades can cause neck pain due to compensation and postural overload, the reverse can also be true if the neck pain was there first. The same applies to upper back stiffness.

No matter which one was there first, our treatment will address all the factors contributing to your shoulder blade pain. We will use joint mobilisation techniques to restore mobility of your neck- and upper back joints. Your exercises will also start to include positions that challenge your neck muscles while we continue upper back strengthening.

Phase 6: Testing return to activity

Before you are discharged from treatment we will retest the movements restrictions and muscle tightness that were present during your initial assessment. This is one way of making sure your treatment was effective and that you are ready to go back to all your activities. We will also test the individual muscles around your shoulder blade to determine if the muscles can tolerate the load of everyday activities.

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How often will I need treatment?

Depending on the severity of your symptoms and initial inflammation, you will need physiotherapy treatment up to twice a week for the first two weeks. After this, your treatment sessions can be spaced to once a week or once every two weeks. After your pain is under control and you are comfortable with your home exercises, your final follow-up will be scheduled after about 4-6 weeks. This is to test your return to activity and if you can manage possible flare-ups. If your shoulder blade muscle pain comes back with a vengeance during this time, your physiotherapist will know how to adapt your home exercises and advice.

The muscle spasm causing pain between your shoulder blades will almost always be due to another problem. This could be posture, muscle weakness or even a spinal problem in your upper back. So it is important to find the underlying issue is and then we will have an idea of how long healing will take.

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What other treatments are available for shoulder blade muscle pain?

Ergonomics

Using an ergonomic chair and making sure that your workstation setup is comfortable will be very helpful to get rid of rhomboid muscle pain.

Chiropractic

Depending on the cause of your muscle spasm, a chiropractor may help with stiffness in your thoracic spine. Still, just getting rid of the stiffness won’t solve the underlying causes like muscle weakness that caused the pain between your shoulder blades.

Postural brace

A postural brace will make you more aware of your posture and force you to sit upright. This may sound like a good idea, but the muscles that should be holding you up will just keep on getting weaker as the brace takes over their responsibilities.

Sling

Using a sling might help to relieve your shoulder blade muscle pain, but only because you won’t really be using your arm. A sling puts your arm in a dysfunctional position and your upper back muscles in a stretched position. Of course, this stretched position is often what caused your muscle spasm in the first place.

General practitioner

Your GP can prescribe muscle relaxants and other medication for your painful upper back. On the one hand the medication will help with pain relief, but on the other hand it won’t solve the actual problem. Almost like hanging a picture over a crack in the wall. The crack will still be there even though you can’t see it.

Biokineticist

After completing treatment with your physiotherapist, you will have relief from your shoulder blade pain, but might not be strong enough to be completely rid of the problem. Our muscles take time to adapt, so getting stronger is a longer process, especially if multiple areas are causing your pain. This is where a biokineticist comes in. They can help you with a supervised exercise program and keep on adapting your exercises as the muscles around your upper back and shoulder get stronger.

Surgery

Surgery is rarely a treatment option for shoulder blade muscle spasm. Surgery for muscle “spasm” is usually only indicated in very specific cases where the muscle is permanently shortened. This is called a muscle contracture rather than a muscle spasm and can happen in conditions like cerebral palsy, rheumathoid arthritis or large burns to your skin.

Shoulder blade muscle pain is also known as:

What else could be causing my symptoms?

  • Neck disc injury – neck problems can cause referred shoulder blade pain. If this is the case, you will have a deep, burning pain that gets worse when you turn your head or look down.
  • Neck joint degeneration – painful facet joints in your neck can also cause referred shoulder blade pain. However, looking up or tilting your head towards the painful shoulder blade will make your pain worse.
  • Scoliosis – there is a sideways curve to the spine and you may notice that the edge of one shoulder blade is more prominent when compared to the other side.
  • Rotator cuff muscle injury – pain will be at it’s worst lifting your arm out to the side, away from your body.
  • Thoracic spine facet joint – in this case pain will be much sharper and you will be able to point to the exact painful spot.