Trigger Points – Pain inside shoulder blade when slouching while seated

tags-upper-backPain along the inside of the shoulders is seldom rhomboids. Trigger points in the scalenes, iliocostalis thoracis, infraspinatus and lower trapezius are much more likely. Look closely at the section on “Similar Patterns” to see if they better describe your pattern.

Client’s Description


People complain of aching along the inside of the shoulder blade that is annoying tender when pressed. It bothers then the most when they are slumped forward at a desk so that the shoulder blades are spread and the chest is closed.

These people have shoulder blades that are either close together and wing out or they are spread far apart and lay close to the ribs. Their chest is either tightly closed or very broad and they have difficulty bringing their shoulder together in the front. They shoulder blades are not very mobile from front to back.

The onset is usually slow, over a long period. It may have suddenly gotten worse after an unusual period of reaching up and forward. This might occur while painting  overhead with a short brush or stocking a high shelf.

I have had chronic problems with these trigger points over the years, even though I have very upright posture. They only bother me when a seat presses into them or they are overworked by an inexperienced therapist. These trigger points do produce weakness in back exercises where the shoulder blades are pulled together.

Self Care

breathing on magazines - vid cap high pec stretch

More than anything the exercise of breathing for upper back pain (in this post) offers relief but one has to be patient and consistent with it for lasting results. Stretching your pecs (see this post) in the doorway to release stress on the rhomboids is also essential when they are short and tight.

Stretching your back in the shower or using a heating pad will offer relief but will usually make it worse after a few hours, especially when repeating this over weeks or months.

Therapy Notes

oit-rhomboidsWhen it actually is the rhomboids that produce this pattern, there are achy trigger point just along the border of the scapula. They are often too sensitive to get a good release without ice, heat or working the joints first.

This is one of those life lessons like the one that I talk about in The Godfather of Organized Pain. I’ve witnessed Dr. Pruitt, on others and myself, reach out and press those sensitive rhomboid trigger points, adjust the upper thoracics and then press on the same spots with little or no tenderness. These will not release with any lasting effect unless the facet joints and costovertebral joints along the upper thoracic vertebrae are addressed.

Similar Patterns

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

tags-upper-back tags-shoulder-blade tags-top-of-shoulder


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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