Upper back pain between shoulder blades: 5 common causes (and when to see a physical therapist)

That uncomfortable ache between your shoulder blades can be hard to ignore. Whether it shows up during your workday or after exercising, it can stem from several factors that affect how your body moves. While certain stretches for upper back pain may help, persistent discomfort may point to an underlying issue that deserves a little more attention. 

At Performance Rehab, we evaluate patients with back pain and develop personalized physical therapy plans tailored to their needs. In this article, we'll explore some of the most common reasons for upper back pain, key signs that it's time to see a physical therapist and stretches that might help you feel better.

What causes pain between your shoulder blades?

Not all upper back pain is caused by the same issue. Here are five reasons you might experience pain between your shoulder blades:

Poor posture and prolonged sitting

One of the most common causes of upper back pain is sitting for long periods — especially with poor posture. If you spend hours in front of your laptop, phone or tablet each day, holding your head forward and rounding your shoulders can put extra strain on your upper back.

Common signs of a postural issue may include:

• A dull ache between your shoulder blades

• Muscle tightness after sitting for a long time

• Symptoms that improve when you move around

A physical therapist can help you find ways to create a more ergonomic desk setup, be more mindful of your movement patterns and maintain better posture.

2. Muscle strain or overuse

Repetitive movements and sudden increases in physical activity can strain your upper back muscles. For instance, yard work, moving furniture and playing sports can place extra demands on the muscles that stabilize your shoulder blades.

Symptoms of a muscle strain or an overuse injury may include:

• Localized soreness

• Tenderness to the touch

• Discomfort during specific movements

Most mild muscle strains improve with time and rest, but ongoing symptoms may warrant a professional assessment.

3. Joint stiffness in your spine

The joints in your thoracic spine (upper back area) help you rotate and extend your body. If these joints become stiff, you may experience pain, reduced mobility or a feeling of tightness between your shoulder blades. This discomfort may be associated with:

• Age-related wear and tear on your vertebrae

• Spinal conditions (e.g., arthritis or a herniated disc)

• Previous back injuries that have reduced your mobility

• Tight muscles surrounding your upper back and rib cage

A physical therapist can assess your spine and identify the possible restrictions that could be contributing to your symptoms.

4. Shoulder-related problems

One of your shoulders could be causing the pain you feel between your shoulder blades. Conditions involving your rotator cuff, shoulder joint and surrounding tissues can sometimes cause discomfort that radiates into your upper back. While shoulder pain and upper back pain aren't always connected, they can influence each other.

If it hurts to reach overhead, lift objects or sleep on one side, a shoulder evaluation may be helpful.

5. Stress and muscle tension

Did you know that stress can affect more than just your mood? Many people unconsciously tighten the muscles in their neck, shoulders and upper back during particularly stressful, overwhelming or anxious moments. Left unaddressed, this increased muscle tension may promote prolonged discomfort.

In addition to physical therapy, your provider may recommend mindful movement practices, such as yoga and Pilates, to help maintain your overall well-being.

When to see a physical therapist for your back pain

Many episodes of upper back pain improve with movement, activity modification and time. However, it could be helpful to see a physical therapist if:

• Your pain lasts longer than a few weeks

• Your symptoms keep returning or have become more intense

• Your pain limits your ability to work, exercise or perform everyday activities

• You're not sure what's causing it or what to do about it

A physical therapist can assess your symptoms and help you better understand what might be causing them. From there, they can work with you to develop a treatment plan based on your specific needs and goals.

4 stretches for upper back pain

Gentle stretching may help reduce stiffness and improve mobility in your upper back and other areas. For instance, some of the most commonly recommended stretches for back pain include:

1. Seated thoracic extension

Sit in a chair with a supportive backrest, and place your hands behind your head. Gently lean backward over the top of the chair, feeling the stretch in your upper back and shoulders.

2. Cat-cow stretch

Start on your hands and knees. Within a comfortable range, slowly alternate between rounding and arching your back.

3. Child's pose

Kneel on the floor, and sit back toward your heels. Reach your arms forward, slowly resting your body over your thighs and forehead on the floor, allowing your upper back to relax into the stretch.

4. Thread-the-needle stretch

Begin on your hands and knees. With your palm facing upward, slide one arm underneath your body and feel the stretch through your upper back. Repeat this move with the other arm.

Although these stretches may help improve your comfort and flexibility, they might not fully address what's behind your back pain. If your symptoms continue despite self-care, talk to your healthcare provider.

Get expert help for persistent upper back pain

Occasional soreness between your shoulder blades is common, but ongoing pain deserves attention. Located in the Kansas City area, the team at Performance Rehab can assess your symptoms and offer evidence-based treatments to help address the underlying issue.

Let us help you get back to doing what you love — stronger and more confident than ever. Contact us to learn more or request an appointment today.

FAQs about upper back pain

• What's the most common cause of pain between the shoulder blades?

Poor posture, prolonged sitting and muscle tension are among the most common contributors. However, this symptom can stem from multiple causes, which is why someone with persistent back pain may benefit from professional evaluation.

• Can stretching help relieve the upper back pain between my shoulder blades?

Yes. For some people, gentle stretches may help reduce stiffness and improve mobility. However, the results of this strategy often depend on the underlying cause.

• How long should my upper back pain last before I see a physical therapist?

If your symptoms persist for several weeks, keep returning or interfere with your daily activities, it may be time to schedule an appointment with your physical therapist.

• Can stress cause upper back pain?

Yes, stress can contribute to muscle tension in your neck, shoulders and upper back. However, it's important to consider other possibilities as well.

• Is upper back pain always related to posture?

No, your posture may just be one contributing factor. Upper back pain may also be associated with muscle strain, joint stiffness, shoulder issues and other conditions.

• Why does my upper back hurt when I sit at my desk?

Long periods of sitting can increase stress on the muscles and joints in your upper back. Limited movement throughout the day may also contribute to your discomfort.

• Can certain sleeping positions affect my upper back pain?

Yes, some sleeping positions may place additional stress on your neck, shoulders and upper back. Inadequate mattress and pillow support can also influence your comfort level.

• Is walking good for upper back pain?

For many people, walking and other gentle movements may help with back pain and stiffness. However, the appropriate activity level depends on your symptoms and condition.

• Can physical therapy help with upper back pain?

Yes, physical therapy may help identify movement, mobility and strength factors associated with your upper back pain. Your physical therapist tailors their treatment recommendations to your symptoms, goals and evaluation results.

• What symptoms mean you should seek urgent medical care for upper back pain?

Chest pain, shortness of breath, fever, significant trauma, worsening weakness, unexplained weight loss and other serious symptoms require a prompt evaluation by a medical professional.