Trigger Points – Sharp Pain Between the Shoulder Blades

Client Description

People complain of pain along the spine between the shoulder blades. This can vary a great deal in intensity. It can be nagging and achy or sharp in a deep breath. There are a number of patterns between the shoulder blades but this one is right along the spine and described like a bone is out-of-place. People complain more about their movement of the trunk and breathing than pain in their arms and neck.

This illustration shows a focus of pain along the thoracic spine where this often occurs. It may also occur above and below this spot along the spine and ribs. Cervical multifidi produce different referral patterns and are discussed in this post.

When it is more severe and creates a sharp pain on breathing it is often described as a rib head that is out. There is some truth to that. This pain is often associated with a vertebra that is twisted. The rib head is not seated well on the side of the vertebra that has rotated back. It can be felt like a more prominent bump there.


Self Care

The breathing exercise in this post is usually great for this. I will sometimes use it as the fastest and least painful way of releasing this in session. Walking through this with clients helps them to see that this process works best when it is not rushed.

If you are in a spot and don’t have the magazines, do this on a rolled towel. In some cases, where the client is unusually thin or sensitive on the back of their ribs, it is better to do this exercise face down with a towel along the sternum. Breathing in and out deeply, to the point of tension and for about 10 minutes.

Therapy Notes

Although there are some muscles that connect vertebrae to each other these pain patterns are largely attributed to the multifidi. 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.

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.

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.

Similar Patterns

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

tags-upper-back tags-base-of-neck tags-stiff-back 


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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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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