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Sharp Pain Between the Shoulder Blades – Massage Therapy Notes

The active trigger points in the small, deep interspinal muscles tend to produce sharp pain between the shoulder blades. This grabbing upper back pain is usually caused by binding in spinal joints. There are interspinous muscles, that connect a vertebra to other vertebrae. In this area, they are in several layers:

  • Rotatores lie deepest in the lamina groove and connect a vertebra to the 2 above it
  • Mutlifidi lie over rotatores and connect a vertebra to the vertebrae that are 3-5 segments above it
  • Levator costae connect the transverse process of a vertebra to the rib on the vertebra (or 2) below it.

Start by Understanding the Anatomy.
About the coloring of the illustrations…

Multifidi and rotatores are interspinous muscles that manage tension and balance between vertebrae.

The semispinalis capitis, semispinalis cervicis, and semispinalis thoracis are interspinous muscles that lay on top of this but are associated with different referral patterns. This sharp pain near the center of the back that is especially sharp on quick movements or sneezing comes from the muscles underneath.

Other muscles that bind the axial skeleton, like erectors and levator costae lay over the interspinous muscles.

Either of these two muscles could be responsible for creating displacements in facet joints by twisting vertebrae. When the multifidus has trigger points, it is easily palpated as a swollen strand deep in the lamina groove that spans several vertebrae.

These trigger points become less active as the joint fixations in the facet joints of the local vertebrae are freed.  Thoracic dysfunctions are often accessories of greater postural patterns that originate in the cranium, upper cervicals, and pelvis. Work those areas before gently working up and down the lamina groove for easier releases and longer-lasting results.


Treatment Sequencing

Taking Care of Big Patterns

If you’re having trouble getting lasting results with direct work, look at the big patterns. Forward head posture tends to complicate and perpetuate facet joints in this area. The semispinalis and erectors extend from the cervical vertebrae into the thoracic vertebrae and ribs. These thoracic structures act as an anchor and are stresses as that weight moves forward.

This Collection has a list of patterns, therapy notes, and self-care posts to help you identify and correct FHP.

Direct Work Usually Does the Trick Here

This protocol is probably the most useful for the direct release of the facet joints and interspinous muscles. It is an easy, relaxing routine that drives people parasympathetic dominant and releases the entire spine without popping or sudden movement. Good results are all about taking the time to run multiple passes.

Unless there is a strongly flexed torso, complications from a recent accident, or other factors perpetuating spinal distortions, this is typically an easy, one treatment release.

Follow Up Smoothes and Stabilizes

This protocol does a nice job of smoothing out irregularities and tension in the paraspinal muscles that may perpetuate the binding of the facet joints.

This site is undergoing changes. Starting in early 2020, we began improving the format. We are also adding more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We appreciate your input and feedback. You will see us adding posts and updating older posts as time permits.



Weekly Featured Post

This patient had recovered from a frozen shoulder but developed shoulder pain at the end of his golf swing. More traditional neuromuscular techniques weren’t working. Chiropractic wasn’t working. Integrative Craniosacral was the right solution for lasting relief.

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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*This site is undergoing major changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistency in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.