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Pain between the shoulder blades is the worst. I’ve worked with dozens of patients who have had this problem, I’ve experienced it several times, and my wife has also experienced it. There are a few different causes of this issue and there are also many different solutions too. In most cases this sharp, sometimes dull, and achy pain under the right shoulder pain, sometimes left, is due to an overstretched or overused muscle.
An overstretched or overused muscle is the most common reason for sharp and stabbing pain between the shoulder blades. This can happen when you are reaching forward and excessively protracting the shoulder blade. Exercises that target the rhomboids and middle traps are generally very effective at reducing symptoms and preventing this from happening again.
It’s also possible that if it is muscular in nature it could be that segment of the erector spinae muscle group as that also travels along that region.
In this article I’m going to teach you how to differentiate why you’re having sharp stabbing pain under your right shoulder blade and then once we’ve narrowed down why it’s happening, I’ll show you how to improve your symptoms so that you’re not experiencing that sharp, sometimes dull and achy shoulder blade pain. As an aside, if you’re a parent, particularly a mom, I wrote a shorter article about shoulder blade pain for moms.
The only equipment you will need for this would be some dumbbells. There are many different types that you can find on amazon. The ones I recommend the most (and that I personally use) are powerblocks (amazon affiliate link). They are adjustable and barely take up any space. You can of course get some cheaper ones, but these ones are my top pick and are very durable
Let’s dive in!
Table of contents
- What potentially causes sharp stabbing pain under your right shoulder blade?
- Most common
- Least common
- What probably doesn’t contribute to the pain
- Upper right back pain when breathing
- How to tell if the pain between my shoulder blades is muscular or not?
- If the pain between my shoulder blades is muscular, what can I do to fix it?
- Exercises for sharp pain under the right shoulder blade and pain between the shoulder blades
- How long should I expect the pain between my shoulder blades to last?
- What else helps pain between the shoulder blades?
- Summary
What potentially causes sharp stabbing pain under your right shoulder blade?
I’m going to separate this by “most likely,” to “least likely.” I’d rather you not freak out about something that is a low-likelihood event.
Most common
- Rhomboid, middle trapezius, or erector spinae muscle strain
- Shoulder blade knots
Least common
- Costochondritis. Inflammation of the costovertebral joint (where the rib meets the spine)
- Gallbladder issue. You will often have other symptoms associated with this which you can read about here.
- Vertebral fractures.
- Thoracic osteoarthritis. Though most people don’t experience these symptoms here, usually lumbar and cervical.
- Thoracic intervertebral disc herniation. Also very rare. I usually only see these in severe trauma like a fall from a height or in a major car accident.
- Spinal infection. This is possible but of all back pain, only ~ 0.5-1% is related to an infection. You can read this article to see what the signs of infection are.
- Lung conditions. You can read this article to see if your symptoms match these.
Feel free to share this infographic with the link, to your website!
What probably doesn’t contribute to the pain
- Poor posture. If you stay in one posture for a long period of time, it is possible that this could lead to more pain. However, this does not always happen. Changing postures throughout the day is likely the past strategy to distribute mechanical stress over the course of a day and will give you the best chance at preventing something like this. As the saying goes, your next posture is your best posture.
In my mind, there isn’t really “poor posture,” just a sustained posture that your body may not tolerate all that well. I’ve seen patients who have “perfect posture” who have terrible pain, and patients who slouch all the time and have no pain.
- Cervical disc herniation. It’s very unlikely that a cervical disc herniation would radiate down to the thoracic region unless it was causing central cord compression due to a direct posterior herniation (herniation) moving backward directly towards the spinal cord.
- Subluxed rib. This doesn’t happen. Ribs don’t sublux, this is pseudoscience. It is true that you can have a dislocated rib, shoulder, ankle, etc. but this is only as a result of severe trauma, or if someone on the rare occasion has Ehler’s Danlos Syndrome.
Upper right back pain when breathing
If you have severe pain and also difficulty breathing this could be a medical emergency. You will want to contact your doctor or 911 right away.
- sudden onset of shortness of breath
- coughing up of blood
- rapid heartbeat or sudden onset of irregular heartbeat
- sudden onset of severe chest pain
- fainting or sudden onset of dizziness or weakness
- sudden spike in temperature above 100°F (37°C).
How to tell if the pain between my shoulder blades is muscular or not?
- No problem or very minimal problems breathing
- Feels sharp, but also dull and achy at times.
- Can’t seem to get comfortable in any position.
- Feels like it needs to be stretched.
- In the past two days did more manual labor than usual.
- In the past two days was sitting hunched forward more than usual.
- Feels better once it’s been warmed up with exercise.
If you checked most of those boxes, it’s most likely muscular. Remember, if you are exhibiting any of the red flags that were mentioned above reach out to your doctor immediately as this could be a medical emergency.
If the pain between my shoulder blades is muscular, what can I do to fix it?
Great question! I thought you’d never ask.
I’ve had this issue myself, my wife has had it, and I’ve had dozens of patients who’ve had this issue. This is the protocol I put them through that has been the most helpful.
For each of these exercises, I would test one at a time. If you test the first one and it feels fine and is not further aggravating symptoms, move onto the next one. Complete all three for 2-3 sets of 10 to start with, 3x/week.
You could also break it up where you are doing one of the exercises for 3 sets every day and just do a different exercise each day.
Do these exercises for about 2-3 weeks. If you noticed your symptoms are getting worse and not better it’s likely that an adjustment needs to be made in your routine, either using less weight, decreasing reps, changing the type of exercise, or slowing down the movement.
The last rep should be challenging and you should struggle a bit to perform the movement.
Here’s that link again for dumbbells (amazon link) if you don’t have any or were looking to upgrade from your current set. These will last you quite literally, forever.
Exercises for shoulder blade pain
Prone swimmers (prone ‘lying on belly’)
Reverse Flyes (seated or standing)
Bent Over Rows (standing)
If you need dumbbells, I’d recommend getting adjustable dumbbells, like the PowerBlock, that I shared in that link as they take up a very small footprint in your home, and if you or one other person are the only ones using them they should last for years.
The cool thing about PowerBlocks is that you can buy the lighter version and then add more to it as you get stronger. That’s very unique with adjustable dumbbells.
I haven’t had as much success with having people implement a stretching routine so I like to start with some basic strength training exercises.
If you want to and enjoy stretching you can also try:
- Cross body stretch
- Scapular protraction/retraction
How long should I expect the pain between my shoulder blades to last?
Usually, when people implement the above routine they see resolution within 5 days to a few weeks.
It’s possible that this can last longer and if that’s the case and you aren’t sure what to do, that’s beyond the scope of this article.
What else helps pain between the shoulder blades?
- Icing. If icing feels good, feel free to do it. Ice for 20 mins on, 20 mins off.
- Heat. If heat feels good feel free to do this as well. 20 mins on, 20 mins off, just make sure to use adequate layers so you don’t burn yourself.
- NSAIDs. Non-steroidal anti-inflammatory drugs can be used if you have been cleared by your doctor to take them. Always check with your doctor before taking medication.
- Massage. This is an option as well, however, for long-term results, I always recommend including strength training into your normal routine and not only doing more passive activities such as stretching and massage.
If you’re in the market for a new ice pack or heat pack, check this one out as it does both and is reusable. There is also a strap to help keep it in place.
Summary
If you’ve decided or discovered that the pain between your shoulder blades or under your right shoulder blade is indeed muscular, a combination of strength training exercises coupled with some ice, heat, massage, and NSAID use (as approved by your doctor), is the best way forward to resolve symptoms.
Once symptoms are resolved I highly recommend continuing at least 2x/week lifting weights as this will potentially help to reduce the recurrence of this issue.
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