Pain between the shoulder blades

Pain between the shoulder blades is one of the most common complaints among people who spend their working day at a screen. It usually sits in the upper back, between the spine and the inner edge of one or both shoulder blades, and it tends to build as the day goes on. Most of the time it comes from the muscles and joints of the upper back and neck. This is also a spot where a few problems that have nothing to do with muscles can make themselves felt, so it is worth knowing which signs need a doctor rather than a stretch.

What pain between the shoulder blades feels like

People describe it in very different ways: a dull ache, a burning patch, a knot that never quite lets go, or a sharp catch when they turn or breathe in deeply. It is often on one side, though not always. When it is linked to desk work, it tends to follow a pattern:

• It builds over hours of sitting and is often worst late in the afternoon.
• It eases when you get up, move around or change position.
• It changes when you move your neck, shoulders or upper back.
• It often comes together with stiffness or pain in the neck.

The area involved is the thoracic spine, the middle section of the back where the ribs attach, and the muscles that hold and steer the shoulder blades, such as the rhomboids and the middle part of the trapezius.

If your pain does not fit this pattern, for example if it has nothing to do with how you sit or move, read the section on when to see a doctor before anything else.

How common is upper back pain?

The upper back gets far less research attention than the neck or the lower back, but pain here is not rare. A review of 52 studies covering 65 groups of workers, from office staff and drivers to health professionals and military personnel, found that the share of people who had thoracic spine pain over a year ranged from 3% to 55%. Most occupational groups sat at a median of around 30% (Briggs et al., 2009). A companion review of the general population found figures that varied widely, largely because studies defined the pain in different ways (Briggs et al., 2009).

The thoracic area has also been largely neglected in research compared with the neck and lower back, and no clinical practice guideline has been written for non-specific thoracic spine pain (Risetti et al., 2023). Keep that in mind when you read confident claims online. Much of what follows draws on studies of the neck and shoulders, and we say so where that is the case.

What usually causes it at a desk

When no specific cause is found, clinicians call it non-specific thoracic spine pain. That does not mean the pain is imagined. It means the usual checks do not point to one damaged part. A few likely sources come up again and again.

The muscles that hold the shoulder blades

A common explanation for desk-related upper back pain, though one with little direct research behind it, is that the muscles around the shoulder blades, along with the levator scapulae and upper trapezius further up, are kept working in much the same position for hours. The studies of workers do link this kind of pain with heavy, intense workloads (see the risk factors below), but they describe associations and cannot prove that one causes the other.

The small joints of the upper back

Each vertebra of the thoracic spine connects to the next through small facet joints. Studies that numb these joints with diagnostic injections show that they can be a source of upper back pain in some people (Manchikanti et al., 2023).

Pain that starts in the neck

A nerve root that is irritated or compressed in the neck can produce pain around or between the shoulder blades, sometimes well before any pain reaches the arm.

In a study of 50 people who had surgery to free a single compressed nerve root in the neck, 70% had pain in the neck or shoulder blade region before they noticed symptoms in the arm or fingers. In 92% of them that pain eased soon after surgery. The authors concluded that pain in the region above, between or over the shoulder blades can come directly from the compressed root (Tanaka et al., 2006). A 2025 review of 86 studies found pain around the shoulder blade described in 72% of the studies that mapped where people felt it, and noted it may come weeks before pain in the arm (Carmichael et al., 2025).

In that review neck pain was described in 88% of the studies, so this pattern usually comes with a sore neck too. If your upper back pain comes with neck pain, pain spreading down an arm, or pins and needles or weakness in the hand, a doctor or physiotherapist should check your neck.

What about posture?

A rounded upper back and a head that drifts forward are often blamed. The research linking any specific posture to spinal pain is weaker than the posture industry suggests (Slater et al., 2019). Posture may still matter for some people, but it is more useful to think about how long you stay in one position than about finding a perfect one. For the neck side of this story, see forward head posture.

What raises the risk

The review of working adults listed a wide spread of factors that went together with upper back pain in at least one study (Briggs et al., 2009):

• Personal factors: being female and already having pain elsewhere in the muscles and joints.
• Work in general: a high workload, high work intensity, feeling that the workplace has ergonomic problems, boring or tedious tasks, and longer time in the job.
• Psychological factors: high mental pressure and a sense of being at risk of injury.

Two things stand out in that list. Mental pressure sits alongside the physical factors, so stress deserves attention alongside the chair and the screen. And these are associations, not proof of cause. The authors called for studies that follow people over time to work out what comes first.

Sitting itself is part of the picture. In a 2021 review, people who reported sitting a lot at work had 1.73 times the odds of neck and shoulder pain. That figure came from cross-sectional studies, which take a snapshot at one point in time, and the authors noted they could not rule out that pain leads some people to sit more rather than the other way round. In the intervention studies they reviewed, reducing workplace sitting went together with less neck and shoulder pain (Dzakpasu et al., 2021). More on how researchers think about sedentary behaviour in our glossary.

What the research says helps

Because there is so little research on the upper back alone, the best guide comes from studies of office workers with neck and shoulder pain, which often overlaps with pain between the shoulder blades.

• Strengthening has the best evidence. A review of 27 trials in office workers found moderate-quality evidence that strengthening exercises for the neck and shoulders, and general fitness training, reduced neck pain in people who already had it. The effect was larger for targeted strengthening, and greater participation brought greater effects (Chen et al., 2018).
• The certainty is not high. A later review of eight trials in office workers with long-term neck pain found that strengthening of the neck, shoulder and shoulder blade muscles reduced pain and disability, but rated the certainty of that evidence as low because all the trials had a high risk of bias (Jones et al., 2024).
• Small doses can count. In a trial of 198 working adults with frequent neck and shoulder pain, two minutes of strengthening with elastic tubing, five days a week for ten weeks, lowered pain by 1.4 points on a 10-point scale compared with a group that received health information only (Andersen et al., 2011). We look at what that trial does and does not show in Is two minutes of exercise enough?
• Staying active. For back pain in general, the NHS advises keeping up your daily activities, avoiding long periods in bed and trying back exercises and stretches, stopping if the pain gets worse. It suggests heat for stiffness and ice for swelling, and notes that walking, swimming, yoga and pilates may also help (NHS).

What these studies have in common is regular movement that loads the muscles over weeks, rather than one-off fixes. The specific exercises used in trials vary, and this page does not describe them. Choosing and dosing them is what a physiotherapist does.

Desk habits and workstation changes

In the same review of 27 trials, ergonomic changes to the workstation were supported only by low-quality evidence (Chen et al., 2018). That does not make them pointless. A screen that is too low, or a chair that forces you to reach, can add strain for hours every day, and fixing it is cheap. Just do not expect a new chair to do the job of exercise.

The changes worth checking first:

• Screen height and distance. If the screen sits low, you spend the day looking down. See how to set up your monitor.
• Laptop work. Working on a laptop alone almost guarantees looking down. See working on a laptop without straining your neck.
• Desk and chair height. If your shoulders creep up to reach the keyboard, the desk or chair is probably at the wrong height. The desk height calculator gives a starting point from your body height.
• Breaks. In one study included in a Cochrane review, short breaks of one to two minutes every half hour cut sitting time by about 40 minutes a day compared with two long breaks. The evidence was rated low quality (Shrestha et al., 2018). Read more on microbreaks and how often to move.

When to see a doctor about pain between the shoulder blades

The NHS lists back pain that is felt between your shoulder blades, rather than in your lower back, as one of the reasons to see a GP (NHS). That is not because it is usually serious. It is because a few conditions involving the heart, lungs, major blood vessels or organs in the abdomen can show up here.

Call an ambulance (999 in the UK, 911 in the US and Canada, 000 in Australia) if

• You have chest pain or pressure, especially if pain spreads to your arm, neck, jaw or upper back, or you feel sick, sweaty, light-headed or short of breath. The British Heart Foundation notes that heart attack pain can spread to the upper back, that it can feel uncomfortable rather than very painful, and that not everyone has every symptom (BHF).
• You have sudden, severe pain in the chest or upper back that feels tearing or ripping, which may spread to the neck or down the back. This is the main symptom of an aortic dissection, a tear in the body’s main artery, and it is a medical emergency (HSE; healthdirect).
• You suddenly find it hard to breathe, or you have pain in your chest or upper back, or a very fast heartbeat. These can be signs of a pulmonary embolism, a blood clot in the lung. The NHS advises an urgent GP appointment or a call to 111 if you are coughing up blood (NHS).
• Your back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or bottom, or changes in bladder or bowel control (NHS).

Do not drive yourself to hospital.

Get urgent advice the same day if

• You have pain in the upper tummy or under the right ribs that may spread to the shoulder blade. That can be gallstones. The HSE advises contacting your GP urgently if the pain lasts more than eight hours or is so intense that no position helps, or if you have a high temperature with chills or yellowing of the skin or eyes (HSE).
• You feel hot, cold, shivery or generally unwell with your back pain, or the pain started suddenly and is severe or getting worse quickly (NHS).
• You have a tingling or painful patch of skin on one side, followed a few days later by a rash. This is how shingles usually starts, and it often appears on the chest and tummy. For adults, the NHS recommends seeing a pharmacist within three days of the rash appearing (NHS).
• You have, or have had, cancer and develop back pain that is severe, getting steadily worse or waking you at night. NICE guidance asks clinicians to get specialist advice within 24 hours in this situation (NICE NG234).

See a GP if

• the pain has not improved after a few weeks, stops you doing everyday things or worries you
• it is worse at night or does not ease with rest
• it gets worse when you cough, sneeze or open your bowels
• you have unexplained weight loss, a lump or swelling, or a change in the shape of your back (NHS)
• the pain spreads down an arm, or comes with numbness, tingling or weakness in the arm or hand

None of these lists replaces a doctor’s judgement. If something feels different from your usual desk ache, get it checked.

How Bavelu fits

Bavelu is an iPhone app with sessions for the neck, shoulders and upper back, designed and filmed by physiotherapists led by Mgr. Lukáš Kučera. Desk routines take two to four minutes and are guided by your AirPods, and there is a daily session in a short and a full version for days with more time. It is exercise guidance, not a diagnosis or a treatment, so if any of the warning signs above apply, see a doctor first.