“I hold most of my stress between my shoulder blades.” Or I’ll hear “The pain is pretty constant and it never seems to go away, even after deep tissue massage.” The story of pain between the shoulder blades is fairly common. In fact, after sciatic pain and lumbar pain, this is the 3rd most common musculoskeletal pain situation that I encounter in my clinic.
The patient usually points to a location between the shoulder blades. This part of the back contains two important muscles involved in stabilization and movement of the scapula, the trapezius muscle and the rhomboids (major and minor). Upon palpation, the acupuncturist or massage therapist usually finds an “ah shi” point or tender area on the patient that feels knotted and ropy. Therefore, it’s fair to assess that this is the source of the problem, right? So this muscle knot gets treated, either by acupuncture, massage, or chiropractic means and provide some instant relief. A day or so later, the patient complains that the pain returned full strength. If this situation sounds familiar to you, then only side of the problem is being treated…the back. So, what’s missing? The chest.
Let’s call a muscle that moves, an agonist. This agonist usually has one or more muscles that oppose the action of the agonist. This opposing muscle, or muscles, will be called the antagonist. For a nice, easy example: Let’s look at the action of the knee joint. If we call your quadriceps the agonist, we can call your hamstrings the antagonist. The quadriceps will straighten the knee, while the hamstrings bend the knee. The quadriceps and hamstrings form an agonist-antagonist pair. A slightly more complicated joint such as the shoulder has muscles that can perform an agonist or antagonist function depending on direction of shoulder movement.
The trapezius and rhomboids together aid in retracting the scapula, or pulling your shoulders back and upward. The opposing muscles, or antagonist to this movement, are the pectoralis minor, which protract the scapula, or pull your shoulders forward and downward. (There are more actions of both the trapezius and rhomboid muscles, but they will be excluded for sake of simplicity.)
Tight pectoralis minor muscles can pull the shoulders forward. Localized back pain is felt when the rhomboids and trapezius muscles revolt against the pectoralis minor by having to expend so much energy to pull your shoulders back. The rhomboids and trapezius eventually fatigue and finally spasm. When they finally scream out in anguish from the tension, you have a knot of pain between the shoulder blades. Of course, this is an oversimplification of the whole scenario, but for a lot of folks, it is true. The agonist muscles and antagonist muscles play a game of tug-of-war with your body. In the end,one muscle wins and one muscle loses. To avoid this scenario, have both agonist muscles and their antagonist muscles treated.
To get great relief, we suggest getting a massage or sports acupuncture session with focus on the back muscles that are tight and painful. You will also have the pectoralis minor treated on the ipsilateral, or same side of the body. This is a thorough treatment plan that may have the pain between your shoulder blades abate quickly and take much longer to return.
We think it’s a great idea to manage your pain between visits to your healthcare provider. We suggest our very own Sciaticare Ball. On our website, we have detailed instructions on how to massage out your pectoralis minor pain as well as rhomboid and upper back pain. We’ve said it before, and we’ll say it again. It’s the best $20 that you’ll ever spend on you healthcare. Now on Amazon.com. Additionally, learn to stretch these muscles to keep the qi and blood flowing. Good luck!