Upper Back Pain

Pain along Shoulder Blade when Reaching Up or Back

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How People Describe This Pain Pattern

People complain of pain along the inside of their shoulder blade when reaching high above the head. They also get pain while reaching to the back seat of the car or adjusting clothing behind the back.  Often, they have usually adapted their movements to avoid taking that arm too far back. To avoid the pain, they will insert that arm first into a coat. They will avoid having to tuck in their shirt by putting the pants on over the shirt. They will fasten the bra in front, turn it around, and then carefully insert the painful arm under the strap first.

These same movements, which involve the infraspinatus muscle, may produce shoulder pain, as described in this post. Those shoulder pain patterns are more likely to bother people when sleeping on the shoulder than reaching overhead.

The tests to see if this muscle is the problem involve those movements. The first one involves placing the forearm across the low back. The second one involves reaching around the back of your head to place your palm on your opposite ear. Restriction and pain in either of those activities indicate a problem. A few other muscles, especially the coracobrachialis, may create pain and restriction in these movements. In that case, the pain pattern will be different.

Testing to Assess the Trigger Point

These tests will produce pain and restricted motion when the trigger points in the infraspinatus are active.

The first test involves placing the forearm across the low back. It usually produces pain in the shoulder. Pain worsens as you reach up the middle of the back. Notably, this may also indicate trigger points in the coracobrachialis with a different pain pattern.

In the second test, reach around the back of your head like the pic. When the trigger points are active, it is restricted and painful. Also, you cannot contact the edge of your mouth without pain and stiffness.

How You Activate and Intensify This Pain Pattern

You can activate this pain pattern in several ways.


This trigger point usually involves a severe or sudden jerk of the shoulder. A dog that jerks on the leash is a common irritant, especially when it jerks the arm across the body. In other words, it would be more likely if the dog in this photo was running toward the grass, twisting her shoulder across her chest. People may also overstretch this muscle when they fall forward, landing with the arm in front of them.

Falling back while holding onto a bar also strains this muscle. Again, when the arm crosses the body, it is more likely to activate this trigger point.

Sleeping position

Another common cause is that you sleep on that shoulder at night. Although, that is usually associated with this pattern in the shoulder joint.

Blunt Trauma

A blow to the back of the shoulder can strain the joint, overstretch the tendon and activate this trigger point as well. Research says this might happen when someone is caught off guard while standing on a moving bus or train. One case fell and landed on his shoulder.

Once its activated, activities that reach behind the body intensify the condition. Many clients have complained about reaching to the back seat to deal with a child or get a bag out of the floorboard. Reaching back to the end table by the bed, fastening a bra, or tucking in a shirt are also common irritants.

The Musculoskeletal Anatomy Behind Your Pain

Musculoskeletal Anatomy

About these Illustrations…

This post on anatomy contains standard information about the origin, insertion, function, and innervation of muscles. It also includes information on functional considerations and anomalies.

Find Related Posts

Anatomy posts have a grid of all related posts. This includes posts on pain patterns, self-care, therapy notes, NMT protocols, cranial techniques, and cases.

Getting Relief on Your Own

Clinically Proven
Self-Care Strategies

This post has strategies for getting relief on your own. Explore how to change your activities, stretch, and other strategies that relieve the pain associated with this trigger point.

Therapy Notes for Massage and Bodywork

Better Bodywork
Through Shared Expertise

This post has techniques, tips, treatment routines, and anatomy illustrations to improve the bodyworker’s approach.

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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written materials and instructed classes since the mid-90s. This includes anatomy, trigger points, cranial, and neuromuscular.

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

Tony Preston

Tony Preston, LMT has been treating adults and children since the early 90s. He has authored a number of texts on neuromuscular and craniosacral techniques. He has taught Neuromuscular Therapy for ASHA School of Massage and craniosacral the National Institute of Craniosacral Studies. He currently teaches seminars in Integrative Craniosacral techniques at The Body Guild.

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