Trigger Points – Nagging Pain Inside The Bottom of the Shoulder Blade

Client Description

People complain of nagging pain in the upper or mid back, just inside the base of the shoulder blade. They have trouble determining what causes it or what to do for relief. They may also complain of sore ribs on that side, just under the armpit or fibrocystic breasts. They usually have a straighter upper back with shoulder blades that wing out instead of laying flatly against the back.

Often, they have tried many things to take care of it but have not figured out to get relief because the trigger point is not near the site of pain and in a muscle that is seldom addressed.

This problem is ordinarily caused by forceful or prolonged retraction of the shoulder blade. The most common cause is resting on the elbows while working on a laptop, especially when bent forward or laying on the floor. People get this from a new routine of push-ups or planks during exercise. One client said this started after more vigorous tennis. Another client fell while mountain biking and landed on her shoulder.


Self Care


This pain is more likely to be caused by a weak and overstretched muscle instead of a short-tight one. If your shoulders hunch forward, this stretch will help. A vapocoolant like Icy-Hot on the tender ribs under the arm usually offers relief. Reducing the activities of onset, listed above, helps. It can be hard to get people to stop leaning on their elbows while using their laptop.

plank pose from

This muscle supports the ribs in a posture that faces down like a plank. In this picture, you can see how the ribs drop between the shoulder blades as the serratus anterior does not support the torso. Pressing the torso up through the shoulder blades strengthens the serratus anterior. Wall push-ups are a less difficult way to build this muscle.

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Therapy Notes

Therapists often work other muscles in the area which produce similar pain patterns. These patterns include scalenes, rhomboids, erectors, and multifidi because there are a number of trigger points that create nagging or sharp pain in this area. See the related posts below.

Serratus anterior is often overlooked and can be hard to resolve. It requires balancing the shoulder girdle, which is more difficult in people with a large gut.

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Related Posts…






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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The Body

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