07922 884 788

Upper back

Upper back and shoulder blade pain

The burning ache between the shoulder blades that builds through the afternoon and eases the moment you stand up.

What it typically feels like

  • A burning or gnawing ache between the shoulder blades
  • Building through the day, worst by mid-afternoon
  • Relief from standing, stretching or pressing on it
  • A stiff mid-back that will not rotate or extend

This is the most common complaint among people who sit for a living, and it is almost never a back injury. It is a postural endurance problem: the muscles holding your shoulder blades in place get asked to work statically for eight hours, and they fatigue.

What usually causes it

  • Static loading. The muscles are not moving; they are holding. That is far more fatiguing than movement.
  • A stiff thoracic spine. If the mid-back does not rotate or extend, the surrounding muscles take the strain instead.
  • Rounded shoulders, which lengthen and weaken the muscles between the shoulder blades while the chest tightens and pulls forward.
  • Screen and desk setup — laptop too low, monitor off to one side, chair too far from the desk.

The chest connection

Counter-intuitively, tight pectorals at the front are frequently what makes the upper back ache at the back. They pull the shoulders forward, leaving the mid-back muscles permanently over-stretched and working against them. Treating only the sore side of the body misses half the problem.

What treatment involves

Releasing the tight structures front and back, mobilising a stiff mid-back, and settling the trigger points — which usually gives immediate relief.

Then the boring, effective part: strengthening the mid-back, and fixing the setup that caused it. Otherwise it returns by the following week.

What is actually in the upper back

The stiffest part of the spine by design — twelve vertebrae anchored to the rib cage, built for protection rather than movement, with the shoulder blades floating over the top of it on muscle alone.

Thoracic spine
Joined to the ribs at every level, so it trades range of movement for stability. It should still rotate and extend, and when it stops doing either, the neck and shoulder pick up the slack.
Rhomboids
Between the spine and the inner edge of the shoulder blade. The classic site of the burning ache between the shoulder blades that builds through an afternoon at a screen.
Mid and lower trapezius
Hold the shoulder blade down and back. They lengthen and weaken in a rounded posture, which leaves the upper trapezius doing a job it was never meant to do alone.
Costovertebral joints
Where each rib meets the spine. Stiffness here can produce a sharp, catching pain on a deep breath that feels far more alarming than it is.

Why it goes wrong

This is a region that suffers from immobility rather than injury. Long hours in one position stiffen the thoracic spine and lengthen the muscles that should be holding the shoulder blades in place, so they ache from being held on stretch rather than from being overworked. It responds well, and quickly, to getting movement back into the area.

3D anatomy See the structures involved on the interactive model

The honest next step

This page describes what is common, not what you have. The only way to know is to have it assessed — and your first session includes a full assessment, so you leave knowing what is actually going on.

Book an assessment Call 07922 884 788