Surprisingly, the answer doesn’t involve smashing and massaging your pain into oblivion.
Our spines and magicians have something very important in common…misdirection.
The closer a pathology is to the spine, generally the more difficult it is for our body and brain to understand where the source of the pain is coming from.
To use a very serious and unfortunate example, when individuals are experiencing a heart attack they may feel the symptoms anywhere from their chest to their neck, jaw, shoulder, or even down their arm sometimes.
I see patients with a low back pathology that can lead to pain anywhere in their back, buttock, hamstring, knee, ankle, and big or little toes. Sometimes the pain radiates down their legs from their low back, other times they feel the pain down their leg but not at all in their back.
When the pain source is at the spine in the mid-back, people will often tell me they feel like their pain wraps around their back along one of their ribs, and so they think their rib is to blame. Generally, it’s just our body having a hard time pinpointing the true pain source in our spine!
What about the cervical spine?
The cervical spine, aka the neck, isn’t any different. Patients with neck pain often report pain anywhere from their upper or lower neck to their traps, upper chest, shoulders, elbows, wrists, hands, and fingers.
One of the most common complaints I hear from patients with neck pain: a pain, often sharp and local, right in between their shoulder blades.
Sometimes the pain is near the top of the shoulder blade, sometimes in the middle and sometimes near the bottom. Sometimes they tell me the pain will even shift from the left shoulder blade to the right one, and they think they’re going crazy when that happens!
They’re typically glad to hear that I believe them. This symptom of neck pain is actually common enough that there is a name for it: it’s called the Cloward sign.
Finding the source of the pain between the shoulder blades
Dr. Ralph B. Cloward was a renowned neurosurgeon and he produced seminal research on discogenic cervical pain published in 1959.
He used a small probe to “puncture” different regions of his volunteers’ cervical discs. He found that they regularly reported pain at their shoulder blade when the disc in their neck was poked!
Then he injected anesthetic into the disc that was provoked and the pain at their shoulder blade would immediately resolve. Pretty cool, right? Well, I definitely think so.
This one study alone doesn’t make the proposal absolute truth (that’s for sure!), but I have seen the same pattern repeatedly in my own practice.
I perform the exam and we reproduce the same pain with certain neck movements. Then I use techniques directed to treat discogenic neck pain, and the pain between their shoulder blades improves or resolves completely.
It never gets old and it is incredible every time to see the patient’s reaction. Mystery solved!
What to do about it
First, we would perform a thorough examination to narrow in on the specific pain generator. It can be your neck, or sometimes it can be a high thoracic injury that is producing that sharp pain.
Whether it is your neck or upper back, the best action you can take on your own is a few things we preach non-stop for spine pain: unload your spine a few times during the day by laying down flat, and stop stretching your neck! Stay active and keep moving, but your spine does not respond well to being forcefully cranked around all the time.
The source of this pain is never the muscle where you feel the pain. You can dig into it all you want and ask your massage therapist to drive their elbow through your back, but that pain will come right back. If you’ve had it before, you understand the frustration.
My conclusion here is simple: if you have pain between your shoulder blades, it’s almost surely coming from your spine. If the pain isn’t going away then you need to make some changes. Stop digging at it fruitlessly and treat your spine.
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