Determining the Causes of Upper Back Pain Between Shoulder Blades

A woman in a blue shirt sits on a bed wanting to know the causes of upper back pain between the shoulder blades.

The upper back, also called the thoracic spine, refers to a large area in the back within the neck and ribs. Because this area is heavily involved in the lifting and moving of objects, upper back pain between the shoulder blades is very common. In fact, studies have shown that 1 in 5 women and 1 in 10 men deal with upper back pain. 

This article will detail the causes of upper back pain between the shoulder blades as well as detail the best treatment options.

What Are the Causes of Upper Back Pain Between the Shoulder Blades?

Upper back pain can manifest in many areas within the thoracic spine—one of the most common areas is between the shoulder blades. Pain in this area can be acute or chronic, varying in intensity—from dull aches to sharp pains. 

Because this region—much like the rest of the back—is made up of a complex array of muscles, ligaments, and tendons, there are many potential causes of upper back pain between the shoulder blades.

Some of the causes of upper back pain between the shoulder blade include:

  • Muscle Strains: Because muscles in the back stabilize your spine and assist in motor functions, the common cause of this pain is strain within the muscles. Lifting too much weight or engaging in repetitive activities that require a range of motion can increase your chances of straining muscles. Poor posture is another common cause of chronic “knots” and strains.
  • Joint Issues: The spine is made up of a series of bones called vertebrae that are connected via facet joints. Vertebrae give your spine and back the ability to bend and twist, and when they become inflamed or irritated, they can cause pain between the shoulder blades. 
  • Disc Issues: Between your vertebrae are small, fluid-filled discs that separate the vertebrae and act as shock absorbers. If these discs bulge or become herniated, they can cause pain in the upper back.
  • Rib Issues: Because your ribs are connected to your spine, issues such as fractures or inflammation of the cartilage that connect the two regions can cause pain in this area.
  • Hypokyphosis: This occurs when there is too little natural curvature of the spine. This can cause muscles such as the rhomboids and traps to become too tight and lead to pain in the region. This underdeveloped musculature can also result in more compression on the joints because the muscles are too short.
  • Hyperkyphosis: Conversely, with hyperkyphosis, the curvature of the spine is overdeveloped and can result in the spine humping over. Even with slight humps, the muscles in the shoulder and upper back region can become overstretched and cause compression that can irritate the joints between the shoulder blades. 
  • Lateral Shoulder Flexion Posture: This occurs when one shoulder is higher than the other. It compresses one side and pulls the muscles on the opposite side tightly, causing irritation and pain.  
  • Rotated or Twisted Rib Cage: Unnatural positioning of the rib cage can cause irritation and pain in the area. This is often caused by the rib cage compensating for a twist in the pelvis or from one leg being shorter than the other.
  • Pain Referral: Because of interconnected tissues in this region, pain can often be “referred” to other regions from a different source. For example, the actual region with issues may be the neck but the irritation in the neck facets could refer to the pain down into the back. This kind of pain will typically be diffused and feel more like an “achy area” than a pinpoint location.

It’s crucial to understand that it’s possible to have more than one of these causes and they can often be mutually reinforcing. Furthermore, many of these causes can be the result of an underlying condition such as postural issues or irregularities in leg length. 

How To Treat Upper Back Pain Between the Shoulder Blades

Since the muscles in this region are used a lot in daily activities, pain and discomfort can be very inconvenient and detrimental to one’s quality of life. Luckily, there are treatment options that can offer immediate and long-term pain relief.

  • Stretching: Gentle stretches to loosen up the muscles and relieve tension can help alleviate pain and stiffness. Certain yoga exercises can also promote a healthy back. 
  • Heat therapy: Heat from a heating pad or hot water bottle can help relieve pain and tightness in the muscles. 
  • Over-the-counter pain medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen (Tylenol) can help relieve pain and reduce inflammation. Though you may feel pain relief, it’s important not to overexert yourself as you may further irritate or injure the region. There are also many side effects to regular NSAID use, ranging from gut problems to memory issues, so this is not a great option.
  • Rest: If you’re experiencing pain or discomfort in the upper back, be sure to allow the muscles in the area to heal by getting enough sleep and limiting their use.

When the pain has become chronic and inhibits daily activities, it may be time to seek care from a medical professional. Chiropractic care can offer long-term relief for upper back pain between the shoulder blades because it is designed to treat the symptoms at the root, such as if the cause is a postural issue.

Chiropractic care could include the following:

  • Massage therapy: Massaging the muscles in the upper back can reduce tightness and help with blood flow to promote healing in the area. 
  • Chiropractic adjustment: Having a chiropractor use their hands or instruments to apply controlled force to the spinal joints can reduce pain and restore range of motion.
  • Postural exercises: A chiropractic professional may recommend a series of exercises designed to increase the strength of muscles that are weak and cause poor posture which could be the cause of upper back pain between the shoulder blades. For example:
    • If there is a loss of curvature in the mid back, exercises such as crunches can help.
    • If there is too much curvature in the mid back, superman exercises can help restore proper posture.
  • Spinal Traction: Only used in chiropractic offices that boast advanced education in spinal rehabilitation. If the above treatments had short-term or limited benefits, then the problem is likely structural in nature and will require deep precise stretching of the spinal ligaments  When the ligaments shorten and develop adhesions due to prolonged poor posture or past trauma, spinal traction is the only current method shown to improve spinal alignment and is especially important for long-term relief of upper back pain.

As with any medical treatment, it’s important to ensure that your condition is properly assessed to receive the most accurate treatment. 

Chiropractic BioPhysics® Treats the Causes of Upper Back Pain Between the Shoulder Blades

If you’re experiencing upper back pain between the shoulder blades, there may be more than one cause. The team at PostureWorks uses Chiropractic BioPhysics® to properly assess our patients and craft solutions for long-term pain relief and prevention.

Chiropractic BioPhysics® is an advanced technique that utilizes an in-depth analysis of your spine’s curvature to isolate the causes of your back pain such as structural abnormalities and postural issues to create a comprehensive, non-invasive treatment plan uniquely tailored to you.

Contact us today to learn more about the causes of upper back pain between the shoulder blades or to schedule your appointment with PostureWorks.

Chiropractic BioPhysics®, or CBP, is a deeply researched and results-oriented corrective care technique. CBP-trained chiropractors aim to realign the spine back to health and optimal function. As with all chiropractic care, CBP is conservative, painless, and non-invasive.

Let’s Get Started

We are excited to help you reach your health goals! Please fill out the form below and we’ll reach out as soon as possible to confirm your appointment time.
  • San Francisco, California
  • Lakewood, Colorado

San Francisco Clinic Hours


10:00 AM - 1:30 PM

3:30 PM - 6:30 PM


3:30 PM - 6:30 PM


10:00 AM - 1:30 PM

3:30 PM - 6:30 PM


11:00 AM - 1:30 PM

3:30 PM - 6:30 PM


10:00 AM - 1:30 PM





Map Facet