Trigger Points – Can’t Reach Pain Under the Shoulder Blade

Client’s Description

referral - serratus posterior superior - posteriorPeople complain of pain under the shoulder blade that can’t be reached. It aches fairly constantly. This pain can become so vague, unreachable and constant that people do not consider it in their pain patterns anymore. When that happens, and this trigger point continues to worsen, people begin to complain about the elbow and wrist pain.

This pattern becomes more active when the person reaches forward, and the shoulder-blade presses into the muscle as when reaching out while using the computer mouse or reaching out for the top of the steering wheel while driving.

People may primarily complain about the wrist pain as it bothers them when they use the computer mouse. They almost always admit to the shoulder pain when asked. They have concerns about carpal tunnel as this often bothers them more when they are reaching for a mouse. (there are a number of more common causes of wrist pain).

People seldom primarily complain of the elbow pain. I remember a few of these cases when I thought that it was so unusual that elbow pain was relieved by working this trigger point when they never complained of shoulder pain.

Self Care

There aren’t any easy stretches that you can do to for this muscle. It tightens because the upper ribs have become chronically elevated. There are some things that you can to to help.

Sit up straight. BPostures that bend forward, like working on your laptop, compresses your abdomen and force you to breathe by pulling up on your ribs with these muscles.

Start with gentle shoulder exercises 2-3 times a week. That means things that drive your elbow up toward your head. Those exercises may make this a little less comfortable for about two weeks and then begin to feel noticeably better in about three weeks.

Here is a post on how to release these rib heads, which usually releases the trigger points in this muscle. This exercise works well for aches and pain along the upper back, especially stuck rib heads that produce sharp pain while inhaling.

breathing on magazines - vid cap

Releasing Rib Heads with Breathing Exercise

This pattern not usually addressed until the rib heads have become chronically fixated. They can be difficult to release with lasting results without correcting structural issues like forward head posture. See your trigger point specialist for lasting relief.


Therapy Notes

Serratus posterior superior straps the ribs onto the vertebrae like a 5th scalene muscle. Like the scalenes, it is used to raise the ribs while breathing when the diaphragm is inhibited by compressing the abdomen. It is the breathing while slouched forward that perpetuates the constant pain generated in this pattern.

It is hard to get a sustained release of this muscle unless you can free up the displaced rib heads with lamina groove work or some other soft joint mobilization. Clients also need help with posture so that they do not naturally slouch while seated.

Similar Patterns

Click on these categories to see if there is a referral pattern that better describes your concerns.

tags-upper-back tags-shoulder tags-shoulder-blade tags-shoulder-joint tags-elbow tags-wrist  



Tony Preston has a practice in Atlanta, Georgia where he sees clients.

He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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