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Got Pain in the Shoulder Blade?

Got Pain in the Shoulder Blade? Barefoot Rehabilitation Clinic

13 Feb Got Pain in the Shoulder Blade?

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Got pain in the shoulder blade?

If you do, you already know that this location can be stubborn and annoying. It’s one of those places you get massages for and foam roll, relieving it temporarily, only to have it come back with a vengeance later on.  Or at other times, it’s not even there at all, despite the fact that you’re deadlifting or downward-dogging your little toosh off.

The question is “What’s the diagnosis?”

The answer is not a “Deficiency of Massages.”

Are you sure there is pain in shoulder blade?

First, let’s determine the precise location of your pain.

Is it actually on the shoulder blade, underneath it, or around it?

Many patients in our office blindly label their pain as “shoulder blade pain” when the pain is actually off of it, underneath, or even pain shooting from another location. Our rugby patient, Leenie, thought her pain was mainly in the shoulder when it was really in her neck.

See the picture below.


The shoulder blades’ borders are outlined in light green.

  • If your pain is located where “A” is, you’re correct that you have shoulder blade pain.
  • If your pain is located where “B” is, you actually have spine pain.

The biggest mistake people make in identifying pain in the shoulder blade is thinking the pain is on the shoulder blade when it’s really located where “B” is.

What makes the pain worse when you have a problem at “A”?

According to the location of your pain, if you have pain in shoulder blade, you can be fairly confident that this is a rotator cuff problem.

The rotator cuff is four muscles connecting the shoulder blade and the arm bone (the humerus). Those muscles are:

  1. infraspinatus (this muscle is most commonly involved due to the amount of surface area it covers on the shoulder blade.)
  2. teres minor (this muscle is involved in shoulder blade pain when the pain is close to the arm pit on the back side.)
  3. subscapularis (this muscle is involved when your pain is in the arm pit.)
  4. supraspinatus (this muscle is the most common painful rotator cuff tissue, although it is rarely the cause of the problem in the first place.)

Other possible problems include thoracic disc problems, rib and intercostal muscle problems, and organ-based issues. But these are all very rare.

You know with greater certainty that you have a rotator cuff problem if:

  • your pain worsens when you bring your arm out to the side and try to touch your bicep to your ear (like it does in this 30 second video. If you move as hesitantly as this and your range of motion has a mid-range arc your body is trying to avoid, you’ll need an arthogram).
  • your pain worsens when you do anything that is strictly shoulder dominant (like doing shoulder exercises that don’t involve the neck).

What makes the pain worse when you have a problem at “B”?

If your pain is spine pain, figuring out where the problem is located is a bit more complex.

  • If your pain is present constantly, 100% of the day, you probably have an acute injury and inflammation in the spine. Your medical doctor may want to prescribe anti-inflammatories or steroids to help you.
  • If your pain is worse with sitting, you probably have a neck (cervical spine) injury. Don’t get your big toe adjusted if you have a neck issue.
  • If your pain is worse when you bring your chin to your chest, you probably have a neck (cervical spine) injury.
  • If your pain is not worse with neck movements, you probably have a back (thoracic spine) injury. Your doctor will need a good reason to keep treating your neck if this is the case.
  • If your pain is worse with deep breaths or back (thoracic spine) rotation, you probably have an intercostal or rib injury. Therefore, you should get the ribs and rib muscles worked on.

You might be thinking:

But wait! My pain is worse with multiple movements and postures!

Well, that’s because most pains and injuries do not happen in isolation. There’s rarely only one problem in the very complex human body to be fixed.

And if you’re like most people, you’re in your 30’s to 40’s before your pain is ever bad enough to see a professional. You’ve been letting your body compensate for some time, which means that you’ve allowed various injuries to happen to various body parts as you’ve been living your life.

Practically speaking, once your pain is fixed with one of these movements, then you and/or your health professional can fix the next test.

What’s the most common cause of pain at “B”?

There is one problem that is extremely common but is almost never known by patients in our office at Barefoot Rehab.

You know you have it if:

  • You have exacerbations on a consistent basis, whether that’s bi-weekly, monthly, or quarterly.
  • You’ve been having exacerbations for months to years.
  • Exacerbations last between 2 – 10 days.
  • Your pain is made worse by neck movement.
  • Your pain is located at “B.”

This problem is called internal disc derangement (IDD). IDD is a low-level disc arthritis and when untreated, worsens with severity and duration over the long haul.internal-disc-derangement

It’s not an outright disc herniation or bulge of the neck, which is why so many healthcare practitioners ignore it as a problem. It equally confuses patients because the pain is in the mid-back, but the problem is coming from the  neck.


If this information describes you, the best way to stop the pain from coming back and minimize the progression of the wear-and-tear of your neck is to get all of the adhesion removed from your neck. As always, when people reach out to us from across the country about fixing their injuries, the first place we look for a practitioner is on Integrative Diagnosis’s Find a Provider application.

Final Words

Pain isn’t fun. It’s even worse than the pain isn’t going away.

You can always try foam rolling, stretching, lacrosse ball-ing, massaging, chiropractic adjustments, ice, and heat. I hope these things work for you. But please don’t let yourself become a victim to the Kitchen Sink Paradox.

If any treatment isn’t working or if your pain has lasted more than a few weeks, it’s time to stop messing around with your body. So many people could get out of pain relatively quickly if they would just get a diagnosis and get properly fixed by a professional as soon as their pain monster peaks its ugly head.

If you live in NJ or NYC, come see us at Barefoot Rehab. We’re good at what we do. : )

speechbubblesIf you have pain in shoulder blade, what do you think is causing it after reading this post? Is it the neck, mid-back, intercostals or ribs, or the rotator cuff? Feel free to share in the comments below.


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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, is a Sports Therapy & Chronic Pain Resolution Specialist with Barefoot Rehab in Parsippany, NJ.  When you're in pain that hasn't gone away and you've been to at least 3 other doctors, Dr. Chris wants to help you. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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  • Amanda
    Posted at 03:49h, 17 May Reply

    I have horrible pain in my shoulder blade and its getting so miuch worse, you are right massage can’t even touch it. I now have neck pain and I just keep working out thinking its magically going to go away! So dumb…I am in San Diego, CA any recommendaitons??

    I have a lot of sholder pain, down into my elbow no too but the constant pain inside my shoulder blade is always there. Now if I lift my head up I feel it strain and it is hard to look down as well. I drive boats all day and shift a gazillion times a day, I workout regularly, and have a hard time taking time off 🙂

    I would love any recommendations cause I am starting to be in a ton of pain!

    • Dr. Chris
      Posted at 11:52h, 17 May Reply

      Hi Amanda, you have a lower cervical disc problem. Guaranteed. Same as described above. There are no Integrative Diagnosis practitioners in the area. Your best bet is to go to activerelease.com and find the provider with the most certifications and testimonials there. If you don’t experience permanent relief in 5 treatments or less, you’ll need to fly to an ID doctor. FYI – I drive from NJ to Boston at least once a month for treatment. Good treatment beats no treatment, any day.

  • Livia
    Posted at 23:55h, 27 September Reply

    I would love any advice!!
    My pain started very mildly under my right shoulder blade about a year ago not due to anything I can remember. I’ve the year, the pain has increased and feels as though it is up in my right side neck, under armpit and down arm. It’s not constant and it’s not always really painful. If moves in those areas and is sometimes gone completely. It’s driving me nuts. Massage helps for the day and then it’s worse the next few days. Painting made it brutal for 3 weeks. I’m trying Pilates now but think I’m just masking one pain for another.
    Any clue as to what I have done or what I can do to make it better?? Thank you!!

    • Dr. Chris
      Posted at 11:35h, 29 September Reply

      Hi there Livia.

      Under the right shoulder blade is an elusive location that probably requires an exam.

      What you can do right now, is test some things.

      Turn your head all the way to the right, left, down, and all the way back. Does any of this provoke the symptoms under the shoulder blade? If YES, you’ve just confirmed a NECK problem.

      Bring your biceps to your head. Does this provoke the symptoms under the shoulder blade? If YES, you’ve just confirmed a SHOULDER problem.

      Is the pain down your arm numb, tingly, burning, or lightning-like? If YES, you’ve confirmed a NERVE problem.

      Yeah, the problem with massage, chiropractic, PT, or regular meds is that these all work for very simple, low level problems. Once your problem becomes BIGGER, you need to find someone who knows what they’re doing to fix it..

      : )

  • Corinne A Barker
    Posted at 14:21h, 28 September Reply

    I have pain under my shoulder blade that seems to get worse throughout the day. Heat helps and rest but as soon as I activate my back/shoulders/neck I feel it for the rest of the day. I do a lot of computer work and relax at the casino, someone there said it’s probably RMS?
    Ty Coirrine

    • Dr. Chris
      Posted at 11:37h, 29 September Reply

      Hi Corrine,

      Read my response to Livia above. My best guess from the little information you gave me is, again, a disc problem in your neck.

      The best thing you can do is respect the sit-slide-lean rule. People are almost always surprised by how, when they sit properly, their symptoms get better. barefootrehab.com/sitting-correctly-sit-slide-lean-rule/

  • Bryan
    Posted at 05:51h, 03 October Reply

    I have constant tightness in both my traps at the base of the neck and down to between my shoulder blades that never goes away. Some days it causes my neck to cramp up from the base of my neck to the base of the skull. The pain then causes a headache which turns into a migraine if not reduced with pain meds.. I was told that I had a “clean MRI” but it doesn’t improve.

    • Dr. Chris
      Posted at 11:57h, 03 October Reply

      Hi Bryan, most people with symptom patterns like this have a lower cervical disc problem. MRIs are under-weighted if there is no serious problem that makes you a candidate for surgery. My recommendation is to find a good adhesion removal doctor/therapist and have them help you get rid of the constant tightness and occasional pain. It’ll be worth it because this will get worse as you get older if you don’t.

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