“Doctor, I’ve Got a Knot Right Between My Shoulder Blades, and I Can’t Get Rid of It!”
If you’ve ever experienced pain between your shoulder blades, you know how frustrating it can be.
You might feel a dull ache in the middle of your upper back.
Perhaps there’s a burning sensation between your shoulder blades after working at a computer.
Maybe it feels like someone is pressing a thumb into one particular spot.
Or perhaps you experience a sharp, stabbing pain when you twist, reach overhead, or take a deep breath.
Patients often tell me:
“Doctor, I think I’ve got a muscle knot that just won’t go away.”
Others say:
“My upper back feels like it’s on fire by the end of the day.”
And occasionally, someone asks:
“Could this be a pinched nerve?”
After nearly four decades of evaluating and treating spinal and musculoskeletal conditions, I’ve learned that pain between the shoulder blades can have several explanations.
Many cases involve muscles, joints, or other mechanical structures.
But not all upper back pain originates in the upper back.
Sometimes the cervical spine refers pain into the shoulder blade region.
Sometimes rib joints or the thoracic spine contribute.
And occasionally, pain between the shoulder blades may be associated with a heart, lung, vascular, digestive, or other medical condition.
That’s why I believe it’s important to understand the difference.
At Advanced Integrated Medical, our goal is not simply to treat the spot that hurts.
It’s to understand why it hurts.
The location of your pain doesn’t always identify its source.
Not Sure Where to Start?
Choose the question that sounds most like yours:
- My upper back aches after sitting at a computer. → See the sections on muscular fatigue and prolonged sitting.
- I have a painful knot between my shoulder blades. → See muscle-related pain and myofascial trigger points.
- Pain travels from my neck toward my shoulder blade. → See cervical referred pain and radiculopathy.
- It hurts when I twist or reach overhead. → See thoracic joints, ribs, and muscular causes.
- I have sharp pain when taking a deep breath. → See rib-related pain and medical warning signs.
- I feel burning or tingling near my shoulder blade. → See nerve-related causes.
- I’m wondering whether ice or heat is better. → See the temperature therapy guide.
- I want to know whether chiropractic treatment can help. → See the treatment section.
What You’ll Learn
In this chapter, we’ll discuss:
- The anatomy of the upper back
- What causes pain between the shoulder blades
- Muscle strain and myofascial pain
- Rhomboid and trapezius muscle discomfort
- Thoracic facet joint irritation
- Rib and costovertebral joint pain
- Thoracic disc problems
- Cervical referred pain
- Cervical radiculopathy
- Nerve-related burning and tingling
- Why sitting and computer work may aggravate symptoms
- Whether poor posture causes upper back pain
- How stress and sleep affect symptoms
- When internal medical conditions must be considered
- When imaging is appropriate
- Safe exercises and stretches
- Ice versus heat
- Chiropractic care and physical therapy
- Pulse wave therapy
- PRP and regenerative medicine
- When to seek urgent or emergency medical care
Quick Answer
Pain between the shoulder blades is often caused by musculoskeletal conditions.
Possible contributors include:
- Muscle strain
- Myofascial pain
- Muscular fatigue
- Thoracic joint irritation
- Rib joint irritation
- Cervical referred pain
- Certain nerve-related conditions
However, pain in this region can occasionally originate from internal organs or serious medical conditions.
Upper back pain accompanied by chest discomfort, shortness of breath, fainting, sudden severe pain, or other concerning symptoms requires urgent medical attention.
First, Let’s Understand the Upper Back
The upper back is largely supported by the thoracic spine.
Your thoracic spine contains twelve vertebrae:
T1 through T12
Unlike the cervical and lumbar regions, the thoracic spine is closely connected to the rib cage.
This provides stability and helps protect important internal organs.
The upper back also contains several large muscle groups that support movement of the shoulders and shoulder blades.
These structures work together throughout the day.
What Structures Are Located Between the Shoulder Blades?
Several structures may contribute to discomfort in this region.
These include:
- Thoracic vertebrae
- Intervertebral discs
- Thoracic facet joints
- Rib joints
- Muscles
- Ligaments
- Tendons
- Spinal nerves
- Other supporting tissues
Pain may also be referred from structures outside the thoracic spine.
What Are the Rhomboid Muscles?
The rhomboid muscles are located between the spine and shoulder blades.
They help stabilize and move the scapulae.
These muscles are active during many everyday activities.
For example:
- Pulling
- Reaching
- Carrying
- Lifting
- Maintaining shoulder position
When these muscles become sensitive or fatigued, patients may experience discomfort between the shoulder blades.
What Is the Trapezius Muscle?
The trapezius is a large muscle extending across the upper back and neck.
It contributes to:
- Shoulder blade movement
- Shoulder elevation
- Scapular stabilization
- Neck and upper-back function
The middle and lower portions of the trapezius help support the shoulder blades.
Muscular discomfort in this region may be associated with prolonged activity or certain movement patterns.
What Are the Thoracic Facet Joints?
Facet joints are small joints located toward the back of the spine.
They help guide spinal movement.
Like other joints, they may become painful.
However, symptoms alone cannot definitively establish facet joint pain.
What Are the Costovertebral Joints?
The ribs connect to the thoracic spine through joints known as costovertebral and costotransverse joints.
These joints move during breathing and trunk movement.
Irritation involving these structures may contribute to localized upper-back discomfort in some patients.
However, pain with breathing can also arise from serious lung, heart, or vascular conditions.
It should not automatically be attributed to a rib joint.
Cause #1: Muscle Strain
Muscle strain is a common cause of upper-back pain.
It may occur after:
- Lifting
- Pulling
- Repetitive reaching
- Unusual exercise
- Sudden movements
- Other physical activities
Symptoms may include:
- Localized aching
- Tenderness
- Tightness
- Pain with movement
- Reduced activity tolerance
Most uncomplicated muscle strains improve with appropriate conservative care.
Cause #2: Myofascial Pain
Myofascial pain involves discomfort associated with muscles and surrounding connective tissues.
Some patients experience tender areas commonly described as:
Trigger Points
Patients often call these areas:
“Muscle knots.”
They may feel like localized regions of tightness or tenderness.
However, the precise mechanisms of myofascial trigger points remain an area of scientific debate.
Why Does a Muscle Knot Feel So Painful?
A sensitive muscular area may produce localized discomfort.
Some patients also experience pain that seems to spread beyond the tender spot.
However, the presence of a palpable knot does not necessarily mean that a muscle is physically twisted or permanently contracted.
Can Muscle Knots Last for Months?
Persistent muscle-related pain can occur.
However, when discomfort lasts for weeks or months, it’s important to consider other contributing factors.
These may include:
- Repetitive activity
- Sleep problems
- Stress
- Cervical referred pain
- Thoracic joint conditions
- Other musculoskeletal or medical problems
Cause #3: Muscular Fatigue From Prolonged Sitting
Patients often tell me:
“Doctor, my upper back starts hurting after I’ve been at my desk for a few hours.”
Prolonged sitting may contribute to muscular fatigue and discomfort in some individuals.
The muscles supporting the neck and shoulder blades may become tired or sensitive.
However, sitting does not automatically damage the spine.
Is Poor Posture Causing My Upper Back Pain?
Posture may influence symptoms in some patients.
However, research does not establish one universally correct posture that prevents upper-back pain.
A person may sit with rounded shoulders and have no pain.
Another may sit upright and still experience discomfort.
The relationship between posture and pain is complex.
The goal isn’t perfect posture. It’s comfortable movement and the ability to change positions throughout the day.
Why Does My Upper Back Hurt After Computer Work?
Possible contributors include:
- Prolonged static positioning
- Muscular fatigue
- Repetitive arm activity
- Neck discomfort
- Stress
- Reduced movement variation
Simple changes may help.
For example:
- Taking short movement breaks
- Adjusting screen height for comfort
- Supporting the arms when appropriate
- Changing positions regularly
- Performing gentle upper-back movements
Cause #4: Thoracic Facet Joint Pain
Thoracic facet joints help guide movement of the upper and middle back.
Some patients experience pain associated with these joints.
Symptoms may include:
- Localized upper-back discomfort
- Pain with twisting
- Pain with extension
- Stiffness
However, these symptoms are not specific enough to establish facet joint pain without further evaluation.
Cause #5: Rib Joint Irritation
The ribs attach to the thoracic spine.
Certain movements may aggravate sensitive rib-related structures.
Patients may report:
- Localized pain near the spine
- Pain with twisting
- Discomfort during reaching
- Pain with certain breathing movements
However, pain during breathing requires careful consideration.
Can a Rib Be “Out of Place”?
Patients sometimes use the phrase:
“I think I have a rib out.”
In everyday clinical conversation, this may describe discomfort around the rib joints.
However, an audible pop or localized tenderness does not prove that a rib has become displaced.
True rib dislocation or fracture is a distinct medical condition that requires appropriate evaluation.
Cause #6: Thoracic Disc Problems
The thoracic spine contains intervertebral discs.
These discs can undergo degenerative changes or develop herniations.
Thoracic disc herniations are less common than cervical or lumbar disc herniations.
Some are asymptomatic.
Others may cause:
- Thoracic pain
- Radiating pain around the chest or trunk
- Neurological symptoms
Severe thoracic spinal cord compression can produce serious neurological findings.
Can a Thoracic Herniated Disc Cause Pain Between the Shoulder Blades?
Yes, in selected cases.
However, upper-back pain does not automatically mean a disc is herniated.
A diagnosis requires appropriate clinical evaluation.
Cause #7: Pain Referred From the Cervical Spine
This is an especially important concept.
Sometimes pain between the shoulder blades originates from the neck.
Certain cervical structures can refer pain toward the upper back or shoulder blade region.
A patient may experience significant pain between the shoulder blades even when neck discomfort is relatively mild.
How Can the Neck Cause Shoulder Blade Pain?
Sensory pathways may allow pain from cervical structures to be perceived in nearby regions.
Possible contributors include:
- Cervical joints
- Cervical discs
- Other cervical structures
However, pain location alone cannot identify the exact source.
Can a Pinched Nerve in the Neck Cause Shoulder Blade Pain?
Yes.
Cervical radiculopathy may produce pain involving the neck, shoulder blade, shoulder, or arm.
Possible symptoms include:
- Radiating pain
- Tingling
- Numbness
- Weakness
- Reflex changes
However, isolated shoulder blade pain does not establish cervical radiculopathy.
How Do I Know Whether My Upper Back Pain Is Coming From My Neck?
Certain clues may suggest a cervical contribution.
For example:
- Pain changes with neck movement
- Symptoms travel into the arm
- Tingling or numbness occurs
- Weakness develops
- Cervical range of motion is limited
However, these findings require interpretation during an examination.
Cause #8: Nerve-Related Pain
Some patients describe burning, tingling, or unusual sensitivity near the shoulder blade.
Possible causes include:
- Cervical radiculopathy
- Thoracic nerve irritation
- Peripheral nerve conditions
- Other neurological disorders
However, burning pain does not automatically mean a nerve is damaged.
What Is Notalgia Paresthetica?
Notalgia paresthetica is a condition associated with itching, burning, tingling, or altered sensation, often near the inner border of one shoulder blade.
Some patients develop a darker patch of skin from repeated scratching or rubbing.
The condition is thought to involve sensory nerve dysfunction.
However, the exact mechanisms may vary.
Patients with persistent symptoms may benefit from medical or dermatological evaluation.
Cause #9: Shoulder Problems
Some shoulder conditions may produce discomfort around the shoulder blade.
These may include:
- Rotator cuff disorders
- Scapular movement dysfunction
- Other shoulder-related conditions
However, shoulder pain and upper-back pain can overlap.
A careful examination helps determine which structures may be contributing.
Cause #10: Stress and Muscle Tension
Stress may contribute to muscle tension and increased pain sensitivity.
Some patients notice that upper-back discomfort becomes more pronounced during stressful periods.
However, stress should not automatically be blamed for persistent or unexplained pain.
Can Anxiety Cause Pain Between the Shoulder Blades?
Anxiety may be associated with muscle tension and heightened awareness of bodily sensations.
However, upper-back pain should not automatically be attributed to anxiety.
New, severe, or unexplained symptoms may require medical evaluation.
Can Sleeping Positions Cause Upper Back Pain?
An uncomfortable sleeping position may contribute to temporary muscular discomfort.
However, there is no single sleeping position that is best for everyone.
The goal is comfortable support and adequate sleep.
Why Does My Upper Back Hurt When I Wake Up?
Possible contributors include:
- Muscular stiffness
- Sleeping position
- Joint sensitivity
- Degenerative changes
- Other conditions
Persistent or prolonged morning stiffness may require evaluation for inflammatory or other medical causes.
Why Does My Upper Back Hurt When I Take a Deep Breath?
This is an important question.
Pain with deep breathing may occur with musculoskeletal conditions involving the ribs or chest wall.
However, it can also occur with serious medical problems.
These include:
- Pulmonary embolism
- Pneumonia
- Pleurisy
- Pneumothorax
- Other cardiopulmonary conditions
New or unexplained pain with breathing—especially with shortness of breath, chest pain, rapid heartbeat, coughing blood, or fainting—requires urgent or emergency evaluation.
Can Heart Problems Cause Pain Between the Shoulder Blades?
Yes.
Some cardiac conditions may produce discomfort involving the upper back.
Heart-related pain may also involve:
- Chest pressure
- Shortness of breath
- Sweating
- Nausea
- Jaw discomfort
- Arm discomfort
- Unusual fatigue
However, symptoms vary.
Women and older adults may sometimes experience less typical symptoms.
Can a Heart Attack Cause Upper Back Pain Without Chest Pain?
Yes.
Although chest discomfort is common, some heart attacks present with less typical symptoms.
Unexplained upper-back pain accompanied by shortness of breath, sweating, nausea, faintness, or other concerning symptoms requires emergency evaluation.
Can an Aortic Problem Cause Sudden Pain Between the Shoulder Blades?
Yes.
Aortic dissection is a serious medical emergency.
It may cause sudden, severe chest or upper-back pain.
Some patients describe the pain as tearing or ripping.
However, symptoms can vary.
Sudden severe unexplained upper-back pain, particularly with chest pain, fainting, neurological symptoms, or signs of poor circulation, requires emergency medical attention.
Can Gallbladder Problems Cause Pain Between the Shoulder Blades?
Yes.
Gallbladder-related pain may sometimes be referred toward the right shoulder blade or upper back.
It may occur with:
- Upper abdominal discomfort
- Nausea
- Vomiting
- Pain after meals
However, these symptoms are not specific to gallbladder disease.
Medical evaluation may be necessary.
Can Acid Reflux Cause Upper Back Pain?
Some digestive conditions may produce discomfort perceived in the chest or upper back.
However, new or unexplained chest or upper-back pain should not automatically be attributed to acid reflux.
Cardiac and other serious causes may need to be excluded.
Can Shingles Cause Pain Between the Shoulder Blades?
Yes.
Shingles may produce burning, tingling, or painful sensitivity along a nerve distribution.
A rash may develop later.
Some patients experience pain before the rash appears.
Prompt medical evaluation is important because antiviral treatment is most effective when started early.
How Do I Know Whether Upper Back Pain Is Muscular or Something More Serious?
Musculoskeletal pain often changes with:
- Movement
- Position
- Local pressure
- Physical activity
However, these features do not reliably exclude serious medical conditions.
A heart or lung problem may occasionally coexist with tenderness or movement-related discomfort.
The full symptom pattern matters.
When Should I Seek Emergency Care?
Call emergency services for symptoms such as:
- Sudden severe chest or upper-back pain
- Upper-back pain with shortness of breath
- Fainting or severe dizziness
- New neurological deficits
- Chest pressure with sweating or nausea
- Coughing blood
- Sudden severe pain suggesting aortic dissection
- Significant trauma with concerning symptoms
Do not attempt to treat these symptoms with stretching, chiropractic manipulation, or home remedies before obtaining appropriate medical care.
How Is Pain Between the Shoulder Blades Evaluated?
A careful evaluation begins with the history.
Important questions include:
When did the pain begin?
Was there an injury?
Is the pain sharp, dull, burning, or aching?
Does it change with movement?
Does it change with breathing?
Does it travel into the arm?
Are there neurological symptoms?
Are there chest or abdominal symptoms?
Is the pain worsening?
What Should the Physical Examination Include?
Depending on the symptoms, the examination may include:
- Cervical range of motion
- Thoracic range of motion
- Shoulder assessment
- Muscle examination
- Rib-related assessment
- Orthopedic testing
- Neurological screening
- Other medical evaluation when indicated
The examination should be guided by the history and potential warning signs.
When Is Imaging Appropriate?
Routine imaging is not necessary for every uncomplicated episode of upper-back pain.
However, imaging may be appropriate when:
- Significant trauma occurred
- Neurological deficits are present
- Serious pathology is suspected
- Symptoms persist despite appropriate care
- Imaging would change treatment decisions
What Can Thoracic X-Rays Show?
Thoracic X-rays may reveal:
- Certain fractures
- Degenerative changes
- Spinal alignment
- Some structural abnormalities
However, X-rays do not directly show spinal nerves or the spinal cord.
What Can Thoracic MRI Show?
Thoracic MRI may help evaluate:
- Intervertebral discs
- Spinal cord
- Spinal canal narrowing
- Other soft tissues
MRI may be particularly important when spinal cord dysfunction is suspected.
What Can Cervical MRI Show?
If symptoms suggest a cervical source, cervical MRI may be appropriate.
It can help evaluate:
- Cervical discs
- Nerve roots
- Spinal cord
- Spinal canal narrowing
However, imaging should be selected based on the clinical findings.
What Treatments Can Help Musculoskeletal Upper Back Pain?
Treatment depends on the diagnosis.
Treatment #1: Activity Modification
For uncomplicated musculoskeletal pain, temporary activity modification may help.
However, prolonged bed rest is generally not recommended.
Gentle movement and a gradual return to normal activities are often reasonable.
Treatment #2: Exercise and Rehabilitation
Selected exercises may help improve:
- Thoracic movement tolerance
- Shoulder blade strength
- Upper-back endurance
- General conditioning
- Functional activity
Exercise should be individualized.
Gentle Upper Back Exercise Routine
The following exercises may be appropriate for some patients with uncomplicated mechanical upper-back discomfort.
Perform them slowly and within a comfortable range.
Stop if symptoms worsen.
Exercise #1: Shoulder Blade Squeezes
Sit or stand comfortably.
Gently draw your shoulder blades toward each other.
Hold briefly.
Relax.
Avoid excessive arching.
Suggested starting point: 5–10 repetitions.
Exercise #2: Shoulder Rolls
Slowly roll your shoulders backward.
Then forward.
Suggested starting point: 5–10 repetitions.
Exercise #3: Gentle Thoracic Rotation
Sit upright with your arms comfortably crossed.
Slowly rotate your upper body to one side.
Return to center.
Then rotate toward the other side.
Avoid forcing the movement.
Suggested starting point: 5 repetitions per side.
Exercise #4: Gentle Chest Opening
Stand or sit comfortably.
Gently move your shoulders backward.
Allow the chest to open without forcing the spine into extension.
Hold briefly.
Relax.
Suggested starting point: 5 repetitions.
Exercise #5: Wall Slides
Stand facing a wall.
Place your hands against the wall.
Slowly slide your hands upward within a comfortable range.
Return to the starting position.
Avoid painful overhead movement.
Suggested starting point: 5–10 repetitions.
Important Exercise Precautions
Stop exercising and seek medical advice if movements produce:
- Increasing pain
- New numbness
- New tingling
- Weakness
- Dizziness
- Shortness of breath
- Chest discomfort
- Other unusual symptoms
Patients with suspected fracture, spinal cord compression, infection, malignancy, or other serious conditions should not begin exercises without appropriate medical guidance.
Ice or Heat: Which Is Better for Pain Between the Shoulder Blades?
This depends on the symptoms.
Some patients prefer heat for muscular tightness.
Others prefer ice during a painful flare-up.
Neither approach is universally superior.
When Might Heat Be Helpful?
Heat may be comfortable when symptoms involve:
- Muscle tightness
- General stiffness
- Aching after prolonged sitting
- Morning discomfort
A comfortably warm pack may be used for approximately 15–20 minutes.
Avoid excessive heat.
Do not sleep on a heating pad.
When Might Ice Be Helpful?
Some patients prefer ice during a painful flare-up.
Cold therapy may temporarily reduce pain sensitivity in superficial tissues.
However, ice does not repair thoracic discs or reverse nerve compression.
How Should I Apply Ice Safely?
A practical approach is:
- Wrap a cold pack in a thin towel.
- Apply it over the painful upper-back region.
- Begin with approximately 10–15 minutes.
- Remove the pack and allow the skin to return to normal temperature.
- Repeat later if needed and if the skin tolerates it.
Never apply ice directly to the skin.
Do not fall asleep with a cold pack in place.
Important Precautions for Patients With Neuropathy
Some patients with upper-back pain also have peripheral neuropathy or reduced sensation.
They may not accurately detect excessive cold or heat.
This increases the risk of skin injury.
Patients with impaired circulation or certain temperature-sensitive conditions may also require special precautions.
If you have reduced sensation or impaired circulation, seek professional guidance before using ice or heat.
Ice vs. Heat for Upper Back Pain
| Situation | Ice | Heat |
| Muscle tightness | Sometimes helpful | Often preferred |
| General stiffness | May help some patients | Often preferred |
| Painful flare-up | May provide temporary comfort | May also help |
| Thoracic arthritis discomfort | May provide temporary comfort | May provide temporary comfort |
| Cervical referred pain | May provide temporary comfort | May provide temporary comfort |
| Nerve compression | Does not reverse compression | Does not reverse compression |
| Reduced temperature sensation | Requires special caution | Requires special caution |
Treatment #3: Physical Therapy
Selected patients may benefit from physical therapy.
Treatment may include:
- Therapeutic exercise
- Movement education
- Strengthening
- Selected manual therapy
- Functional rehabilitation
The goal is to improve symptoms and function.
Treatment #4: Chiropractic Care
Some patients with uncomplicated mechanical upper-back pain may benefit from selected conservative chiropractic approaches.
Treatment may include:
- Gentle mobilization
- Selected manual therapy
- Therapeutic exercise
- Movement education
- Other individualized strategies
However, treatment should follow an appropriate evaluation.
Is Thoracic Manipulation Safe?
Thoracic manipulation is not appropriate for every patient.
Potential adverse effects may include temporary soreness.
Serious complications are uncommon but have been reported.
Manipulation should be avoided when conditions such as fracture, significant osteoporosis, spinal instability, infection, malignancy, or other serious pathology are suspected.
Can Chiropractic Treatment Help Rib-Related Pain?
Selected patients with mechanical rib-related discomfort may benefit from conservative care.
However, pain with breathing must be evaluated carefully to exclude cardiopulmonary and other serious causes.
Treatment #5: Dry Needling
Dry needling may be considered for selected patients with muscular pain.
Some studies suggest short-term benefit for certain myofascial pain conditions.
However, evidence varies.
Dry needling is not appropriate for every patient.
Are There Risks With Dry Needling Near the Shoulder Blades?
Yes.
The lungs are located beneath portions of the upper-back and shoulder blade region.
Improper needle placement may cause pneumothorax, or a collapsed lung.
Other risks include:
- Bleeding
- Bruising
- Infection
- Pain
- Other complications
Dry needling in this region requires appropriate training, anatomical knowledge, and careful technique.
Treatment #6: Pulse Wave Therapy
At Advanced Integrated Medical, pulse wave therapy is among the modalities considered for selected musculoskeletal conditions.
However, evidence for pulse wave treatment specifically for pain between the shoulder blades is limited.
It should not be presented as a proven treatment for every cause of thoracic pain.
Treatment decisions should depend on the diagnosis and available evidence.
Treatment #7: Medications
A prescribing clinician may recommend medications when appropriate.
The choice depends on:
- Medical history
- Symptom severity
- Other health conditions
- Potential adverse effects
Medications may provide symptom relief but do not necessarily address every contributing factor.
Treatment #8: PRP and Regenerative Medicine
At Advanced Integrated Medical, we recognize the growing interest in regenerative medicine.
One approach being investigated for selected musculoskeletal and spinal conditions is:
Platelet-Rich Plasma (PRP)
PRP is prepared from a sample of the patient’s own blood.
The blood is processed to produce a preparation containing an increased concentration of platelets.
Platelets contain growth factors and other biologically active substances involved in tissue signaling and repair processes.
Researchers are studying PRP for selected musculoskeletal and spinal pain conditions.
However, the evidence varies substantially by diagnosis and injection technique.
Can PRP Help Pain Between the Shoulder Blades?
At present, there is insufficient high-quality clinical evidence to establish PRP as an effective routine treatment for nonspecific upper-back pain.
Most uncomplicated muscular upper-back pain does not require injection-based treatment.
Can PRP Help Thoracic Facet Joint Pain?
Research involving PRP for selected spinal joint conditions remains limited.
PRP has not been established as a standard treatment for thoracic facet joint pain.
Can PRP Repair Thoracic Discs?
PRP has not been proven to reliably regenerate thoracic discs, restore normal disc height, or reverse disc degeneration.
Research involving intradiscal PRP remains investigational.
Can PRP Regenerate a Pinched Nerve?
There is insufficient high-quality clinical evidence to conclude that PRP reliably regenerates damaged spinal nerve roots.
PRP has not been proven to reverse nerve-root compression.
Are PRP Injections Around the Thoracic Spine Risk-Free?
No.
The thoracic region contains:
- The spinal cord
- Spinal nerve roots
- Important blood vessels
- The lungs and pleura
- Other sensitive structures
Potential risks may include:
- Bleeding
- Infection
- Neurological injury
- Vascular injury
- Pneumothorax
- Other procedure-specific complications
Thoracic spinal injections require specialized training, careful patient selection, sterile technique, and appropriate imaging guidance.
Is PRP FDA-Approved for Thoracic Disc Regeneration?
No PRP injection has been established as an FDA-approved treatment for regenerating thoracic discs or nerve roots.
Certain PRP preparation devices may have FDA clearance for specific processing purposes.
However, device clearance does not establish that a particular PRP injection is approved or proven effective for thoracic disc regeneration.
What About Wharton’s Jelly and Umbilical Cord–Derived Products?
Some clinics market umbilical cord–derived products, including preparations described as Wharton’s jelly, for spinal and neurological conditions.
These products are different from PRP.
They should not automatically be described as stem-cell treatments.
Their contents, manufacturing methods, and regulatory status can vary.
Importantly, there are no FDA-approved umbilical cord–derived regenerative products for treating nonspecific upper-back pain, thoracic arthritis, thoracic disc degeneration, or thoracic radiculopathy.
Individual patient improvement or clinical experience does not establish that these products regenerate discs or nerves.
Because of important safety, effectiveness, and regulatory considerations, they should not be presented as established treatments for thoracic spinal disorders.
At Advanced Integrated Medical, we believe patients deserve clear information about the difference between emerging research and established clinical treatments.
Dr. Dee’s Clinical Pearl: Regenerative Medicine and Upper Back Pain
A patient may ask:
“Doctor, could PRP fix the problem between my shoulder blades?”
My response begins with an important distinction.
PRP is being studied for selected musculoskeletal and spinal conditions.
But research has not established that PRP reliably treats nonspecific upper-back pain or regenerates thoracic discs.
Before considering any injection, we need to understand:
Is the pain muscular?
Could it be coming from the neck?
Are the thoracic joints involved?
Could a nerve be contributing?
Are there warning signs suggesting an internal medical condition?
What conservative treatments are reasonable?
The right treatment begins with identifying the source—not simply treating the spot that hurts.
How We Evaluate Upper Back Pain at Advanced Integrated Medical
At Advanced Integrated Medical, I believe pain between the shoulder blades deserves a thoughtful evaluation.
We want to know:
When did the pain begin?
Was there an injury?
Is the pain sharp, dull, burning, or aching?
Does it change with movement?
Does it change with breathing?
Does it travel into the arm?
Are there neurological symptoms?
Could the cervical spine be involved?
Could thoracic joints or ribs be contributing?
Are there chest or abdominal symptoms?
Would imaging change treatment decisions?
Depending on the findings, the evaluation may include:
- Cervical range of motion
- Thoracic range of motion
- Shoulder assessment
- Muscle examination
- Orthopedic testing
- Neurological screening
- Review of existing imaging
When appropriate, medical evaluation, imaging, or specialist referral may be recommended.
About Dr. Dee
Dr. D. Scott (“Dee”) Stevens has spent nearly four decades helping patients with spinal pain, joint conditions, and nerve-related symptoms.
Throughout his career, he has worked with patients from many backgrounds, including professional, collegiate, and Olympic athletes.
One thing I’ve learned is that patients often assume the painful spot identifies the problem.
A patient may point directly between the shoulder blades and say:
“Doctor, that’s exactly where the problem is.”
Sometimes that’s correct.
But sometimes the pain originates from the cervical spine or another structure.
And occasionally, it may reflect a medical condition that requires evaluation outside the chiropractic office.
That’s why I believe we should never assume the cause based solely on the location.
Dr. Dee’s Clinical Pearl
A patient may ask:
“Doctor, if the pain is right between my shoulder blades, doesn’t that mean it’s a muscle problem?”
My response is:
“Not necessarily. Muscles are a common source of upper-back pain, but the cervical spine, thoracic joints, ribs, nerves, and even internal medical conditions can produce discomfort in that region.”
The location is important.
But so are:
The quality of pain
Associated symptoms
Triggers
Duration
Movement patterns
Neurological findings
The painful spot is a clue—not the entire diagnosis.
Dr. Dee’s Office Conversation
The following is an illustrative conversation, not an actual patient testimonial.
Patient: “Doctor, I’ve had this knot between my shoulder blades for months.”
Dr. Dee: “Does it change when you move your neck?”
Patient: “Actually, yes. Sometimes turning my head makes it worse.”
Dr. Dee: “That makes me consider whether your cervical spine could be contributing.”
Patient: “But the pain isn’t really in my neck.”
Dr. Dee: “Pain doesn’t always originate exactly where you feel it.”
Patient: “Could an adjustment help?”
Dr. Dee: “Selected conservative treatments may help some mechanical conditions, but we first need to identify the source.”
Patient: “What about PRP?”
Dr. Dee: “PRP hasn’t been established as a routine treatment for nonspecific upper-back pain. The diagnosis should guide the treatment.”
Facing One of the Biggest Fears
“Could Pain Between My Shoulder Blades Mean Something Serious?”
This is an understandable concern.
Most uncomplicated upper-back pain is musculoskeletal.
However, certain symptoms require prompt evaluation.
The important questions include:
Did the pain begin suddenly and severely?
Is there chest discomfort?
Is there shortness of breath?
Is there fainting?
Are there neurological symptoms?
Is there fever?
Was there significant trauma?
Are symptoms progressively worsening?
Most upper-back pain is not an emergency—but serious warning signs should never be ignored.
Back & Spine Health Success Principle #14
Follow the Source—Not Just the Sore Spot
Patients often focus on the exact location of pain.
But pain can be referred.
The cervical spine may produce discomfort near the shoulder blade.
A thoracic joint may cause localized pain.
A muscle may become sensitive.
And occasionally, an internal medical condition may produce upper-back discomfort.
The goal is to identify the source.
Don’t simply treat where it hurts—understand why it hurts.
Ask Dr. Dee
“Doctor, how do I know whether the pain between my shoulder blades is muscular or coming from my neck?”
The symptoms can overlap.
Muscle-related pain may be associated with tenderness, certain movements, or prolonged activity.
Cervical referred pain may change with neck movement.
Cervical radiculopathy may produce radiating arm pain, numbness, tingling, weakness, or reflex changes.
However, these patterns are not definitive.
A careful history and examination are often necessary.
A Lesson I’ve Learned in Nearly 40 Years
The Most Painful Spot Isn’t Always the Source
Over the years, I’ve learned that patients often assume the most tender area must be the source of the problem.
But the nervous system doesn’t always work that way.
Pain may be referred from one region to another.
And different conditions may produce similar symptoms.
That’s why I believe good healthcare begins with careful questions.
Not simply:
“Where does it hurt?”
But also:
“What does it feel like?”
“When does it happen?”
“What makes it worse?”
“What other symptoms occur?”
Understanding the pattern is often more valuable than simply locating the pain.
The Hope Principle
Pain between the shoulder blades can interfere with:
- Work
- Sleep
- Driving
- Exercise
- Household activities
- Concentration
- Quality of life
But many musculoskeletal causes respond to appropriate conservative care.
The important thing is identifying the cause, recognizing warning signs, and choosing reasonable treatment options.
Some patients benefit from exercise.
Others may benefit from selected manual therapy.
Some require imaging or specialist evaluation.
And occasionally, urgent medical assessment is necessary.
Persistent upper-back pain doesn’t have to control your life—but understanding the source is the first step toward better management.
“I believe the best healthcare decisions are made when patients understand their condition. My job isn’t simply to treat symptoms—it’s to help you understand why they’re happening and what your options are.”
— Dr. D. Scott (“Dee”) Stevens
Frequently Asked Questions
- Why do I have pain between my shoulder blades?
Possible causes include muscle strain, myofascial pain, thoracic joint irritation, cervical referred pain, nerve-related conditions, and occasionally internal medical problems.
- What muscles cause pain between the shoulder blades?
The rhomboids, trapezius, and other upper-back muscles may contribute to discomfort.
- Can poor posture cause upper-back pain?
Certain sustained positions may aggravate symptoms, but posture alone does not explain every case.
- Can a pinched nerve in the neck cause shoulder blade pain?
Yes. Cervical radiculopathy may produce pain near the shoulder blade.
- Can cervical arthritis cause pain between the shoulder blades?
Certain cervical conditions may refer pain into the upper back, but imaging findings alone do not establish the cause.
- Can a thoracic herniated disc cause upper-back pain?
Yes, although thoracic disc herniations are less common than cervical or lumbar disc herniations.
- Can rib joints cause pain near the spine?
Yes. Certain rib-related structures may contribute to localized discomfort.
- Why does my upper back hurt when I take a deep breath?
Musculoskeletal conditions may cause pain with breathing, but serious lung, heart, and vascular conditions must also be considered.
- Can heart problems cause pain between the shoulder blades?
Yes. Some cardiac conditions may produce upper-back discomfort.
- Can gallbladder problems cause shoulder blade pain?
Yes. Gallbladder-related pain may sometimes be referred toward the right shoulder blade.
- Can stress cause upper-back pain?
Stress may contribute to muscle tension and increased pain sensitivity in some patients.
- Can sleeping positions cause upper-back pain?
An uncomfortable sleeping position may contribute to temporary muscular discomfort.
- Should I use ice or heat?
Either may provide temporary comfort. Heat is often preferred for muscular tightness, while some patients prefer ice during a painful flare-up.
- Can chiropractic care help upper-back pain?
Selected conservative approaches may help some patients with uncomplicated mechanical upper-back pain.
- Can dry needling help muscle knots?
Dry needling may provide short-term benefit for selected muscular pain conditions, but evidence varies and risks must be considered.
- Can PRP help pain between the shoulder blades?
There is insufficient high-quality clinical evidence to establish PRP as a routine treatment for nonspecific upper-back pain.
- Do I need an MRI?
Not necessarily. Imaging depends on the symptoms, examination, warning signs, and whether the results would change management.
- When should I seek emergency care?
Sudden severe upper-back pain, chest discomfort, shortness of breath, fainting, new neurological deficits, or other concerning symptoms require emergency evaluation.
Key Takeaways
- Pain between the shoulder blades has several possible causes.
- Muscle strain and myofascial pain are common contributors.
- Rhomboid and trapezius muscles may become sensitive or fatigued.
- Thoracic facet joints and rib joints may contribute to pain.
- Thoracic disc problems are less common than cervical or lumbar disc problems.
- Cervical conditions may refer pain into the shoulder blade region.
- Cervical radiculopathy may produce upper-back pain with arm symptoms.
- Nerve-related conditions may cause burning, tingling, or unusual sensitivity.
- Prolonged sitting may contribute to muscular fatigue.
- There is no single universally perfect posture.
- Stress and poor sleep may influence pain sensitivity.
- Pain with breathing requires careful evaluation.
- Heart, lung, vascular, and digestive conditions may occasionally produce upper-back pain.
- Sudden severe unexplained pain or cardiopulmonary symptoms require emergency care.
- Gentle exercise may help selected patients with uncomplicated musculoskeletal pain.
- Ice and heat may provide temporary comfort.
- Chiropractic care may help selected patients after appropriate evaluation.
- Dry needling near the thorax carries a risk of pneumothorax.
- PRP has not been established as a routine treatment for nonspecific upper-back pain.
- Umbilical cord–derived regenerative products are not FDA-approved for thoracic spinal disorders.
- The location of pain doesn’t always identify its source.
Why Patients Choose Advanced Integrated Medical
At Advanced Integrated Medical, we believe patients deserve a thoughtful evaluation of upper-back pain.
We want to understand:
When did the pain begin?
Was there an injury?
Is the pain sharp, dull, burning, or aching?
Does it change with movement?
Does it change with breathing?
Could the cervical spine be involved?
Could thoracic joints or ribs be contributing?
Are there neurological symptoms?
Are there chest or abdominal symptoms?
Would imaging change treatment decisions?
Would exercise or rehabilitation help?
Could ice or heat provide safe temporary relief?
Is chiropractic treatment appropriate?
Would medical or specialist referral be beneficial?
Our goal is to help patients understand their condition and make informed decisions about their care.
Continue Exploring the Back, Neck & Sciatica Learning Center
You may also want to read:
- Article #66: Why Does My Lower Back Hurt? Understanding the Most Common Causes of Back Pain
- Article #67: What Is Sciatica, and What Causes It? Understanding Pain That Travels Down Your Leg
- Article #68: What Is a Bulging or Herniated Disc—and Does It Always Cause Pain?
- Article #69: What Is Lumbar Spinal Stenosis—and Why Do My Legs Hurt When I Walk?
- Article #70: Why Does My Back Hurt When I Sit? Understanding Disc Pain, Posture, and Prolonged Sitting
- Article #71: Can Chiropractic Treatment Help Lower Back Pain? What the Research Really Says
- Article #72: How Many Chiropractic Treatments Will I Need for Lower Back Pain?
- Article #73: Why Does My Neck Hurt? Understanding the Most Common Causes of Neck Pain
- Article #74: What Is a Pinched Nerve in the Neck? Understanding Cervical Radiculopathy, Arm Pain, and Hand Numbness
- Article #75: What Is Cervical Spinal Stenosis? Understanding Spinal Cord Compression, Hand Clumsiness, and Balance Problems
- Article #76: Why Do I Wake Up With Neck Pain? Understanding Sleeping Positions, Pillows, Morning Stiffness, and Cervical Arthritis
- Article #77: Why Does My Neck Crack or Pop? Understanding Cervical Crepitus, Joint Sounds, and When to Be Concerned
- Article #78: Why Do I Get Headaches That Start in My Neck? Understanding Cervicogenic Headaches, Tension Headaches, Migraines, and Occipital Neuralgia
Medical Disclaimer
This article is intended for educational purposes only and does not replace individualized medical diagnosis or treatment.
Upper-back pain may result from muscular, joint-related, disc-related, neurological, inflammatory, vascular, pulmonary, cardiac, gastrointestinal, infectious, or other medical conditions.
The location of pain does not establish the diagnosis.
Patients with new, unusual, severe, progressively worsening, or unexplained upper-back pain should seek appropriate medical evaluation.
Sudden severe upper-back pain, chest discomfort, shortness of breath, fainting, new neurological deficits, significant trauma, coughing blood, or other concerning symptoms may indicate a medical emergency.
Pain with breathing should not automatically be attributed to rib dysfunction or muscle strain.
Thoracic spinal manipulation may be inappropriate in patients with fracture, significant osteoporosis, instability, infection, malignancy, spinal cord compression, or other serious conditions.
Dry needling near the thorax carries a risk of pneumothorax and other complications.
Ice and heat may provide temporary symptom relief but are not established methods of repairing thoracic discs or reversing nerve-root compression. Patients with reduced sensation, peripheral neuropathy, impaired circulation, or certain temperature-sensitive conditions should seek professional guidance before using thermal therapies.
PRP injections for thoracic spinal conditions remain investigational. PRP has not been proven to regenerate thoracic discs, reverse thoracic arthritis, or repair spinal nerve roots.
FDA clearance of a PRP preparation device does not establish FDA approval of PRP as a treatment for thoracic disc regeneration.
Umbilical cord–derived regenerative products are not FDA-approved for treating nonspecific upper-back pain, thoracic arthritis, thoracic disc degeneration, or thoracic radiculopathy.
Exercise, rehabilitation, medications, injections, and other treatments are not appropriate for every patient.
Treatment decisions should be individualized based on the patient’s history, examination, neurological findings, imaging when appropriate, medical conditions, available evidence, and preferences.
Ready to Learn More?
If you have pain between your shoulder blades, don’t automatically assume:
“It must be a muscle knot.”
Or:
“My posture is ruining my back.”
Instead, ask:
Could muscular fatigue be contributing?
Could the pain be coming from my neck?
Could thoracic joints or ribs be involved?
Are there neurological symptoms?
Are there warning signs suggesting an internal medical condition?
Would a clinical evaluation help?
What conservative treatments are reasonable?
Would exercise or rehabilitation help?
Is chiropractic treatment appropriate?
At Advanced Integrated Medical, we believe understanding the source of upper-back pain is the first step toward choosing appropriate care.
Follow the source. Recognize the warning signs. Move comfortably. Choose appropriate care.
Advanced Integrated Medical
1635 N 200 E
Logan, UT 84341
Phone: (435) 999-3953
Advanced Care • Natural Healing • Real Results
Selected Scientific References and Further Reading
- Blanpied PR, et al. (2017). Neck Pain: Revision 2017. Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy.
- Cohen SP. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings.
- American College of Radiology. ACR Appropriateness Criteria: Thoracic Back Pain.
- American College of Radiology. ACR Appropriateness Criteria: Cervical Pain or Cervical Radiculopathy.
- American Heart Association. Educational resources on heart attack symptoms and aortic dissection.
- National Heart, Lung, and Blood Institute. Educational resources on pulmonary embolism and other cardiopulmonary conditions.
- National Institute of Neurological Disorders and Stroke. Educational resources on back pain and neurological conditions.
These references provide background on upper-back pain, cervical and thoracic conditions, imaging, and medical warning signs. They do not establish that every treatment discussed is effective or appropriate for all patients.