Shoulder Blade Pain: Why It Keeps Coming Back (and What’s Often Missed)
- Dr. Natalie Grohmann, DC, CCSP®
- Oct 13
- 2 min read
Shoulder blade pain is something many people deal with. That nagging tightness or pulling between the shoulder blades that never seems to go away. You stretch it, massage it, maybe even get the ribs adjusted, and it feels better for a bit, but then it comes right back.
Have you ever thought that the pain might not be coming from the shoulder blade?
Shoulder blade pain is often caused by nerves from the neck. Nerves come out of our spine (in this case, the cervical spine) and travel throughout the body, including down to the shoulder blade, where they innervate the muscles in that region. If one of these nerves becomes irritated, it can cause the muscles around the shoulder blade to reactively tighten as a way to protect the area. This protective tension can feel like a constant knot or pulling between the shoulder blades, but the neck is often driving the response.
It’s important to note that shoulder blade pain isn’t always caused by the neck. It can come from the shoulder itself, or referred pain from other internal organs or illnesses (why it's important to get it checked out if you've had it for while). However, the neck is a commonly overlooked source.
That’s why focusing only on the upper back with rib adjustments or soft tissue work can feel good temporarily but rarely leads to lasting relief. The key is identifying and addressing where that irritation is coming from in the first place.
A Better Way to Approach Shoulder Blade Pain
Lasting relief starts with understanding where the pain is coming from, not just where it’s felt. When someone comes in with shoulder blade pain, we assess not only the area of discomfort but also the neck, shoulder, and upper back. A key part of this process is a neurologic exam to evaluate how the nerves that supply the shoulder blade and arm are functioning. If a nerve in the neck is irritated, it can alter muscle tone, create protective tension, and refer pain down into the shoulder blade, so identifying that early is essential.
Once the source is identified, care typically involves several components:
Soft tissue therapy to reduce tension and calm symptoms in the short term. This helps improve movement, makes rehab a little easier when you're in pain, and allows you to sleep better (an important part of recovery!).
Joint mobilization or chiropractic adjustments to help where range of motion is limited, often in the neck or mid-back.
Rehab exercises and stretches to strengthen the muscles that support the neck, mid-back, and scapula, and take pressure off the nerve. Building stability through these areas improves mechanics, reduces nerve irritation, and creates lasting relief.
By improving mobility, restoring normal nerve function, and strengthening the muscles around the neck and shoulder blade, we’re not just chasing symptoms. We’re helping the body move and heal so pain is less likely to return.
In summary
Persistent shoulder blade pain usually isn’t just a “tight muscle.” It’s your body signaling that something deeper needs attention, often in the neck. When we address the whole picture- the neck, upper back, and how the nerves and muscles work together -we can create lasting relief and keep you moving without that constant nagging ache.