Therapy Notes – Sharp Pain Between the Shoulder Blades

Effective relief starts with an understanding of the anatomy.

About the coloring of the illustrations…

There are interspinous muscles, that connect vertebrae to other vertebrae. There are two other significant groups of interspinous muscles in this area; semspinalis muscles and levator costae.

Rotatores and semispinalis thoracis also attach the transverse process of one vertebra and to the spinous processes of other vertebrae in this area. They are rich in proprioceptors, indicating that they are key in positioning vertebrae in relation to each other. The rotatores lay deepest in the lamina groove, Multifidi lays on top of the rotatores. All layers of the semispinalis muscles lay on top of the multifidi.

Other muscles that bind the axial skeleton, like erectors and levator costae attach above this.

The levator costae muscles seem indicated here as they would develop trigger points when the costovertebral joint is normalized.

Any of them could be responsible for creating displacements in facet joints between vertebrae. The multifidus is easily palpated as a swollen strand deep in the lamina groove that spans several vertebrae. And the sharp pain is relieved as the multifidi relaxes.

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.

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. This 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.

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.

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.

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.


This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


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Can’t Reach the Pain
Under the Shoulder Blade

This pain and tension under the shoulder blade may be the most common pain pattern that I see. It isn’t always the primary complaint as people have gotten used to the constant ache.

It is usually combined with this pattern in the upper neck, which creates upper neck tension to go with the shoulder blade pain.

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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