Pain between the shoulder blades is most often caused by overloading of the muscles and joints of the thoracic spine, e.g. after many hours of work in one position, or it spreads from the cervical spine. It usually changes with movement and eases within a few weeks. Less often the source is the heart, lungs, aorta or abdominal organs – such symptoms require urgent help.
We explain how to recognise muscle and joint pain, which symptoms require an immediate response, what you can do yourself and how a physiotherapist helps.
In brief
- Pain that changes with movement, breathing or pressure more often comes from muscles and joints, but this does not rule out other causes.
- Pain with breathlessness, sweating, chest pain or sudden “tearing” pain is a reason to call for help – 112.
- Pain between the shoulder blades can spread from the neck – especially from the C5–C7 levels.
- Physiotherapy consultation in Rydułtowy: PLN 180, spinal massage: PLN 140, Mon–Fri 7:00–20:00.
Contents
What are the most common causes of pain between the shoulder blades?
The most common causes of pain between the shoulder blades are overloading of the paraspinal and shoulder blade muscles, irritation of the joints of the thoracic spine and the costovertebral joints, and pain spreading from the cervical spine. Long hours at a computer, driving, lifting and low physical activity all contribute. Such problems usually change with movements of the trunk or head.
Pain from the neck often causes symptoms precisely between the shoulder blades, sometimes without pain in the neck itself – it is worth keeping this in mind when reading our article neck pain from computer work. Less common causes are shingles (the pain can appear a few days before the rash), lung and pleural diseases, gallstones (usually pain under the right shoulder blade), peptic ulcers, pancreatitis, heart and aortic diseases, and osteoporotic vertebral fractures.
When should you see a doctor first about pain between the shoulder blades?
With pain between the shoulder blades, call 112 immediately if it comes with pain or pressure in the chest, breathlessness, cold sweats, nausea or palpitations, or if it started suddenly and is very severe and “tearing”. Pain with fever, a cough or coughing up blood, and pain that gets worse when breathing, also need urgent investigation.
The following also require a doctor’s visit before physiotherapy:
- pain unrelated to movement and position, including at night;
- pain linked to eating, with vomiting or yellowing of the skin;
- pain after a fall, or in a person with osteoporosis or taking steroids;
- a history of cancer, unexplained weight loss;
- numbness or weakness in the arms or legs, difficulty walking;
- burning or tingling of the skin on one side of the trunk (possible shingles).
In women, older people and people with diabetes, a heart attack can be atypical and may show mainly as back pain, breathlessness or weakness.
What helps with pain between the shoulder blades?
For muscle and joint pain between the shoulder blades, frequent breaks from work and changing position every 30–60 minutes help, as do gentle thoracic spine mobility exercises, a warm compress and gradual strengthening of the shoulder blade muscles. Keeping still for long periods does not speed up improvement. If the pain does not ease after 2–3 weeks, it is worth booking a consultation.
- Seated trunk rotations. Sit up straight, cross your arms over your chest and slowly turn your trunk to the right and left. 10 repetitions per side, 2–3 times a day.
- Open book. Lie on your side with your knees bent and your arms straight out in front of you. Move your top arm in an arc to the other side, rotating your trunk, with your eyes following your hand. 8 repetitions per side, once a day.
- Shoulder blade squeeze. Sitting or standing, draw your shoulder blades back and slightly down, and hold for 5 seconds. 10 repetitions, 3–4 times a day.
If the pain gets worse or spreads, stop the exercise and consult a physiotherapist.
How does a physiotherapist help with pain between the shoulder blades?
With pain between the shoulder blades, the physiotherapist first checks whether the pain is mechanical, i.e. changes with movement, and refers you to a doctor if in doubt. They assess the thoracic spine, cervical spine and ribs, then use manual therapy, mobility exercises and exercises strengthening the shoulder blade muscles, as well as advice on your workstation. The number of visits is decided individually.
At the clinic you can also have a spinal massage as an addition to exercise. A gentle alternative for people who do not tolerate stronger techniques can be the Dorn method, although the evidence for its effectiveness is limited.
Physiotherapy consultationassessment of the source of pain, exercise plan180 PLNManual therapymobilisation of the thoracic spine, ribs and soft tissues180 PLNBack massagefor increased muscle tension, as an addition to exercise140 PLNPrices valid from 08.2026 (price list as of October 2026).
Good to know: If you are not sure whether the pain is coming from your back or your chest, it is better to have an ECG first and consult a doctor. Physiotherapy is safe once serious causes have been ruled out.
Summary
Pain between the shoulder blades most often comes from the muscles and joints of the thoracic or cervical spine, and movement, breaks from work and exercise help with it. Pain with breathlessness, sweating, pressure in the chest, or sudden and very severe pain requires calling for help. We write more about back pain in our guide back pain.
Frequently asked questions
Can pain between the shoulder blades be a sign of a heart attack?
Yes, pain between the shoulder blades can be a symptom of a heart attack, especially in women, older people and people with diabetes. Worrying accompanying signs are breathlessness, pressure in the chest, sweating, nausea, weakness and pain spreading to the jaw or arm. In this situation call 112 immediately.
Can pain between the shoulder blades come from the neck?
Yes, the cervical spine is often the source of pain felt between the shoulder blades, even when the neck itself does not hurt. A clue is symptoms getting worse with head movements or long periods of bending forward, or numbness in the arm. During the examination the physiotherapist checks whether neck movements reproduce the pain and chooses the therapy on this basis.
What does pain between the shoulder blades that gets worse when breathing mean?
Pain that gets worse with a deep breath in may come from the costovertebral joints or muscles, but it can also be a symptom of pneumonia, pleurisy or a pulmonary embolism. If it comes with breathlessness, fever, a cough or palpitations, it needs urgent medical assessment. Physiotherapy should only be started once these causes have been ruled out.
Can pain between the shoulder blades come from the stomach or gallbladder?
Yes, diseases of the abdominal organs can cause pain that spreads to the back. Gallstones usually cause pain under the right shoulder blade, often after a fatty meal, while a peptic ulcer or pancreatitis can cause pain between the shoulder blades. A link between the pain and eating is a sign to see a doctor first.
How should I sleep with pain between the shoulder blades?
With muscular pain between the shoulder blades, sleeping on your side or on your back with a pillow filling the space between your shoulder and head usually works best. Sleeping on your front with your head turned to the side usually makes the symptoms worse. In the morning, a few slow trunk rotations and a warm shower on your back help.
Does massage help with pain between the shoulder blades?
Massage can temporarily reduce muscle tension and pain between the shoulder blades, and many people feel relief afterwards. However, the effect is short-lived if it is not combined with exercise and a change of habits. A spinal massage at the clinic costs PLN 140, and whether it is appropriate is decided after the consultation.
Sources
- Finucane L.M. et al. International framework for red flags for potential serious spinal pathologies. JOSPT, 2020.
- Cloward R.B. Cervical diskography: a contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg, 1959 – interscapular pain of cervical origin.
- ESC. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J, 2023 – atypical symptoms of a heart attack.
- Blanpied P.R. et al. Neck Pain: Revision 2017. JOSPT, 2017.
About the author: Tatiana Grabowska, MSc – master’s degree in physiotherapy, PWZFz 11646 (Polish licence to practise as a physiotherapist). Since 2013 she has run the “W zdrowym ciele” physiotherapy and rehabilitation clinic in Rydułtowy (about 12 years of practice).. Physiotherapist’s profile
- Consultation180 PLN
- Referralnot needed
- ReceptionMon–Fri: 7.00–20.00
