What lies between the shoulder blades?
Between the shoulder blades are the thoracic vertebrae, the joints where the ribs meet the spine, and muscles including the rhomboids, middle trapezius and spinal extensors. These structures hold the shoulder blades in place and keep you upright. Nerves from the neck also supply sensation to this area, so neck problems are often felt here. Organs in the chest and upper abdomen share nerve pathways, which explains why heart, lung or gallbladder problems can cause pain here too.
Common causes
- Posture: head forward and shoulders rounded at screens or while driving.
- Muscle strain: from lifting, carrying a heavy bag, sport or sudden movement.
- Stiff thoracic joints: sharp pain on turning or deep breathing.
- Neck problems: facet joint irritation or a pinched nerve; see neck muscle strain.
- Sleeping position and unsupportive pillows.
- Stress and muscle tension.
- Scoliosis or kyphosis changing how load is distributed.
Less common but important causes
- Heart attack: pain between the shoulder blades can be a symptom, especially in women, with fatigue, breathlessness or nausea.
- Gallstones: pain after meals spreading to the right shoulder blade.
- Acid reflux: burning that may be felt in the back.
- Lung problems: pleurisy, pneumonia or a blood clot.
- Shingles: burning pain followed by a rash on one side.
- Aortic dissection: rare, sudden tearing pain, an emergency.
- Spinal fractures in people with osteoporosis.
Relief at home
- Keep moving and avoid long periods in one position.
- Use heat for 15–20 minutes to relax tight muscles.
- Adjust your workstation so your screen is at eye level and your elbows are supported.
- Take a movement break every 30–45 minutes.
- Carry bags evenly or use a backpack with both straps.
- Sleep on your back or side with a pillow that keeps your neck straight.
- Paracetamol or an anti-inflammatory for a few days if suitable.
Exercises for pain between the shoulder blades
- Shoulder blade squeezes: draw the blades back and down, hold 5 seconds, 10 times.
- Chin tucks: glide the head back, 10 times.
- Thoracic extension over a chair back, 10 times.
- Doorway chest stretch, 30 seconds.
- Cat–cow on hands and knees, 10 times.
- Thread the needle, 8 each side.
- Band rows and reverse flys, 3 × 12, to strengthen the upper back.
- If one shoulder blade area is more painful, see our guide to a pulled muscle near the shoulder blade.
Preventing it from coming back
- Build upper back and shoulder strength with regular exercise.
- Stay active with walking, swimming or other exercise you enjoy.
- Review your desk set-up and use a headset for calls.
- Manage stress with relaxation, breathing or exercise.
- Warm up before sport and lifting.
When to see a doctor or physical therapist
See a doctor if pain lasts more than two weeks, keeps getting worse, wakes you at night, is not linked to movement, or comes with fever, cough, weight loss, arm numbness or weakness. Seek emergency care for the warning signs above. Once serious causes are ruled out, a physical therapist can assess posture, neck and upper back mobility and build an exercise plan. Most mechanical pain improves within a few weeks.
Three common situations
- Remote worker on a laptop at the kitchen table: a raised screen, external keyboard and regular breaks often relieve the ache within days.
- New parent with pain from feeding and carrying: vary feeding positions, support the arms with pillows and add gentle stretches.
- Woman with pain between the shoulder blades, breathlessness and nausea: treat as a possible heart problem and call emergency services.
Setting up your desk to protect your upper back
- Top of the screen at or slightly below eye level, about an arm’s length away.
- Keyboard and mouse close, with elbows bent at about 90 degrees and supported.
- Chair height so that feet are flat and hips slightly higher than knees.
- Back supported by the chair, with a small cushion at the lower back if needed.
- Laptop users: a stand plus separate keyboard and mouse.
- Phone calls on speaker or a headset, not cradled between ear and shoulder.
Key points to remember
- Pain between the shoulder blades is usually postural or muscular.
- Movement, heat, workstation changes and exercises help.
- Chest symptoms, breathlessness or sudden severe pain need urgent care.
- See a doctor if pain persists, worsens or comes with other symptoms.
Questions about pain between the shoulder blades
These answers are general information and do not replace an examination or individual medical advice.
When should I worry about pain between my shoulder blades?
If it is sudden and severe, tearing, linked with chest pressure, breathlessness, sweating or nausea, or comes with fever, weight loss or night pain.
Can stress cause pain between the shoulder blades?
Yes. Stress increases tension in the upper back muscles and can cause or worsen pain.
Can acid reflux cause pain between the shoulder blades?
Sometimes. Reflux can cause burning pain felt in the chest or back, often after meals or when lying down.
What is the best sleeping position for upper back pain?
On your back or side, with a pillow that supports the neck and keeps it in line with the spine.
How long does pain between the shoulder blades last?
Muscular pain usually improves within days to a few weeks with movement and exercise.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.