Deep shoulder blade knots are best treated by a combination of muscle activation (strengthening) work and stretching for short-term relief. 

Knots between the shoulder blades are incredibly annoying and they seem to come from out of nowhere, last forever and can become significantly painful. 

Most people, and you might be in this boat, endlessly try to stretch, massage, or mash the pain away, only to be disappointed when you only get short-term relief. 

It feels good for a little while and then it comes back. This is a common sentiment among my clients. 

In this article, I’m going to share the most effective strategy I’ve seen work with my clients so that you can do the same. I also wrote this article about shoulder blade long-term fixes that I’d recommend reading after you complete this one. You might also benefit from reading this one about how to get faster relief if possible.

For a downloadable DIY rehab plan click the button below.

Let’s dive in!

Table of Contents

    Key Takeaways

    • Strength exercises seem to be more effective in the long term than stretching
    • Poor posture likely doesn’t cause deep shoulder blade knots as pain is multi-faceted
    • Muscle weakness likely is not a cause either
    • Shoulder blade knots are the same thing as trigger points
    • Massage can be used as a short-term relief tool but likely won’t provide long-term relief and won’t help prevent this from occurring in the future

    What’s the most effective way to get rid of shoulder blade knots in the long term?

    Based on my work with dozens of clients with this issue (and several family members), my advice is to do the following:

    Prone swimmers

    This exercise is the most effective (in my opinion), because it allows your shoulder blades to go through their full range of motion of upward and downward rotation. And due to the position that you are in, it is working fully against gravity so that your rhomboids and mid traps are getting worked pretty hard. 

    Try to complete 3 sets of 10 reps slowly, counting 3 seconds up and 3 seconds down. If this is too easy, add weight or increase the number of reps. Similarly, if this is too hard, reduce the number of reps. 

    Bent over rows

    I like bent-over rows for this issue too because it directly works your mid-back muscles. There is something about getting the “pump,” in the mid-back muscles that seems to help increase blood flow and thereby reducing sensitivity of the sore spots. 

    Bent over rows are a movement I recommend to people even without trigger points in their mid back as it’s a great way to keep your body (and back) used to tolerating higher levels of stress which will inevitably come at random times in life. 

    Complete 3 sets of 10. 


    I generally don’t give many stretches as they don’t have great long-term effects for things like this however I think it is valuable to give you some short-term relief. You can do many different types of stretches, it won’t hurt you, however, I’d start with this one and then explore different ones. 

    Remember, stretching mainly gives you short-term relief and is not a long-term solution to the problem you’re having. 

    Complete 3 sets of 10. 

    For more exercises and stretches check out this article.

    What causes shoulder blade knots?

    There is not a known cause of shoulder blade knots. 

    Proposed causes have been suggested from the following list:

    • Poor posture
    • Weak mid-back muscles
    • Muscle strain and scar tissue formation

    I want to talk a bit about each of these and see if they are actually plausible or not.

    Poor posture

    It is true that if you stay in one posture for a long period of time that things can start to hurt. A perfect example of this is if I lay in bed for longer than 10 hours my back starts to hurt. This is my cue that it’s time to get up! (ha.) 

    Now, similarly, if you are sitting at a desk for several hours (and you’re not used to it), or you’re standing all day, bending forward and reaching while cleaning all day, these are all things that put you in one position, all day. 

    When you repetitively stress your body by doing the same motion or posture over and over again it’s not uncommon to experience pain. 

    It might be that we experience pain from this due to our body tissues (muscle, ligament, bone, nerve, tendon), are not accustomed to this level of activity and thereby produce pain as a byproduct. That is just a theory as there are many other theories of why pain occurs, which, is too complex of a topic to go into in this blog post. 

    You’ve probably heard that poor posture is a cause of so many bad things, however, I want to give you a slightly different perspective if you’re open to it. 

    Okay, ready?

    You can have pain regardless of whether you have “good” or “bad” posture. There is no difference. 

    I’ve worked with hundreds of people at this point, some who have great posture, some who have bad posture. It’s a wash. Several studies support this position, as well. 

    So what does this mean for shoulder blade knots? Are they not caused by poor posture?

    Well, it could be that they are, however it could also be that they’re not. Poor posture for most people is not actually poor. It’s just a different posture. If you find that you’re constantly having symptoms and you change your posture and it helps, great! It could be that this was a contributing factor, however, just realize that it could also be from a slew of other potential causative factors. 

    Okay, so what’s the actual answer, stop the rambling, you say…

    The answer is, posture might be a contributory factor, sometimes, but no one really knows. 

    I know… it’s that such an unsatisfying answer?

    As I’ve gotten deeper into studying pain and helping people get better I’ve grown to accept the gray; meaning that we likely won’t know the exact cause of the issue, however, we can definitely come up with a plan to make it feel better.

    Weak Mid-Back Muscles

    You might think that these knots are due to weak mid-back muscles and that the trigger points are forming to try to hold everything together. 

    While this thought does seem logical there is not a tremendous amount of evidence for it. 

    While it’s true that stronger people generally have less disabling pain, there is not any clear evidence that weakness is a causative factor. 

    Why muscle strengthening exercises work is likely due to expectation biases (you expect it to work so it does), increasing pain-free or reduced pain movement, increasing blood flow and internal temperature of the muscle, and a variety of other factors. 

    You really can’t go wrong getting strong just remember that weak muscles are not often the cause of these types of issues. 

    Muscle strain and scar tissue formation

    It’s possible that a muscles strain could then cause a scar tissue formation and then this could produce a trigger point. I think this is a logical progression. 

    The only problem is that this is very difficult to test and often times people didn’t do anything to strain their muscle prior to getting a knot between the shoulder blades

    Ultimately, this is as good as any guess as to what the specific cause is. 

    As I shared above and i’ll mention below, the cause (as long as it’s not something sinister like cancer), is unimportant. What’s more important is how to make it feel better so you can get on with your life.


    Are shoulder blade knots different from trigger points?

    Shoulder blade knots are the same thing as trigger points. 

    Knots and trigger points are used interchangeably and trigger points themselves are defined as a “knotted,” or tight band of tissue that is sensitive to external pressure. 

    There are also what’s called “latent,” trigger points that produce no pain whatsoever but still feel “taut” or tight to the touch. 

    Is massaging out a knot the most effective method?

    Massaging out a knot is not the most effective method. As I suggested above you should focus on both strengthening or muscle activation for long-term relief as this actually increases your tissue’s capacity for stress and then combine that with some sort of massage or stretching for short-term relief. 

    I think that short-term relief is beneficial as it helps you stay consistent and not become discouraged when you don’t get complete relief, immediately. 

    Are shoulder blade knots serious, should you be concerned?

    Shoulder blade knots are not serious. While it is possible to have a lump that is a cyst or tumor, these generally feel much different than a trigger point, and often come with other symptoms. 

    If you have had cancer before and are concerned that this nodule could be cancerous, please stop reading my blog and schedule an appointment with your doctor. 

    If it’s primarily painful and feels better when you press it and exercise it, chances are it’s musculoskeletal and that you’ll be able to fix it right up!

    I hope that helps!

    I’m also going to link to this article about shoulder blade anatomy and why it’s so difficult to know what’s causing pain, if you’re interested. It’s a pretty short one!