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What causes upper back pain between the shoulder blades? ScanAlign private EOS imaging clinic, Harley Street, London
Thoracic spine

What Causes Upper Back Pain Between the Shoulder Blades?

Pain in the upper back between the shoulder blades usually comes from muscle tension, poor posture or stiff joints in the thoracic spine. The rhomboid and trapezius muscles overwork when the head sits too far forward. Sometimes the pain is referred from the neck. A standing whole-body scan can show the alignment problem behind the symptoms.

Key points

  • Pain between the shoulder blades is common. It is usually muscular or linked to posture.
  • Holding your head forward or having a rounded upper back puts extra strain on the thoracic area.
  • The real cause can sit in the neck or lower spine, not where you feel the pain.
  • Scans taken lying down can miss alignment problems that only show under your full body weight.
  • Sudden chest pain, difficulty breathing or weakness in the arm needs urgent medical attention, not a scan.

What does pain between the shoulder blades feel like?

It can range from a dull, constant ache to a sharp, burning pain between the shoulder blades. Some people describe it as a knot they cannot stretch away. It often gets worse after long hours sitting at a desk or carrying a heavy bag on one shoulder.

Dull ache A heavy, constant soreness across the middle of the back that gets worse as the day goes on.
Burning feeling A burning pain between the shoulder blades, often linked to tense rhomboid or trapezius muscles.
Stiffness when turning Difficulty twisting the upper body or looking fully over one shoulder.
Pain on deep breathing Discomfort when breathing in deeply, which may involve the rib joints where they meet the spine.

When to get urgent help

If your upper back pain comes with chest tightness, difficulty breathing, numbness or weakness in your arms, or loss of bladder or bowel control, contact your doctor or go to the emergency department straight away. These symptoms need urgent medical attention, not a scan.

What are the most common causes of upper back pain?

Most thoracic back pain comes from everyday mechanical problems, not anything serious. The thoracic spine (the twelve vertebrae between your neck and lower back) is built to be fairly stiff because it anchors the ribcage. Because of that stiffness, posture habits can easily overload the muscles and joints around it.

Muscle tension Rhomboid and trapezius muscles overworked by hunching or repeated movement.
Forward-head posture When the head drifts forward, the upper back muscles work harder to hold it up. This creates trigger points.
Desk posture Hours of sitting with rounded shoulders stiffens the costovertebral joints where the ribs meet the spine.
Joint stiffness Wear and tear (spondylosis) in the thoracic facet joints or disc spaces.

Too much rounding of the upper back, sometimes called a dowager's hump, moves your centre of gravity forward. The muscles between your shoulder blades then have to keep contracting to stop you falling forward. Over months or years, this leads to persistent rhomboid pain and tiredness in those muscles.

Can neck problems cause pain between the shoulder blades?

Yes. The lower cervical spine (roughly C5 to C8) shares nerve pathways with the upper back. Conditions such as cervical spondylosis or C8 radiculopathy can send pain, tingling or burning into the area between the shoulder blades, even though the problem sits in the neck. This is called referred pain.

In the same way, thoracic radiculopathy, where a nerve root in the thoracic spine is irritated, can cause a band of pain that wraps around the ribs or settles between the shoulder blades.

What causes upper back pain between the shoulder blades? ScanAlign clinic illustration

The source of the pain can be above or below the spot that hurts. So scanning only the sore area often misses the true cause. This is where whole-body alignment imaging becomes valuable.

How does a standing scan show what lying-down scans miss?

Standard X-rays, CT and MRI are usually taken while you lie down. That position relaxes your muscles and takes the load off your spine. Any tilt, twist or curve that only appears under your own body weight can disappear on a lying-down image.

An EOS scan captures your whole skeleton from head to feet while you stand naturally. It shows how the thoracic spine relates to the neck, lower back and pelvis while carrying your real body weight. Forward-head posture, too much rounding of the upper back and pelvic tilt all show up in one image.

The scan uses about 90% less radiation than a standard X-ray, around ten times less.

Lying-down imaging relaxes the muscles that hold your posture together. A slight curve or twist may flatten out on the table. The image can then look normal even though you feel pain every day when standing or sitting. These scans also capture only one body region at a time, so compensation patterns elsewhere go unseen.

Your body works as a connected chain from your feet to your skull. A tilt in the pelvis or a bigger curve in the lower back can force the upper back to compensate. This overloads the muscles between your shoulder blades. ScanAlign standing imaging captures this full chain in a single, low-dose scan, so your clinician can trace the pain back to its root cause.

What helps with upper back pain?

The right approach depends on the cause. Getting accurate imaging first means any treatment plan is based on what is actually happening in your spine, not guesswork.

  • Posture awareness. Simple changes to your desk setup, screen height and sitting habits can reduce the load on the thoracic area.
  • Targeted exercise. Once the cause is found, a physiotherapist can give you stretches and strengthening work for the rhomboids, trapezius and deep thoracic muscles.
  • Manual therapy. Mobilisation of stiff thoracic and costovertebral joints may help if imaging confirms joint stiffness.
  • Treat the neck. If the pain is referred from the cervical spine, treating only the upper back will not resolve it. Imaging that includes the neck and the full spine is essential.

Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis first. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.

When MRI is the better tool. EOS shows bones, joints and alignment clearly. If your clinician suspects a disc bulge, nerve compression or soft-tissue inflammation, MRI is usually more suitable. The two scans answer different questions, and sometimes you need both.

Not sure whether your upper back pain needs alignment imaging, or whether the trip to London is right for you? A short video call can help you decide.

Book a free video consultation

Frequently asked questions

The most common reason is muscle tension in the rhomboids and trapezius. This is often caused by long hours of sitting, forward-head posture or repeated arm movements. Stiff thoracic joints and pain referred from the neck are also frequent causes.

In most cases it is a mechanical or posture problem and not dangerous. However, if it comes with chest pain, difficulty breathing, arm weakness, or loss of bladder or bowel control, get urgent medical help immediately.

Rhomboid pain is usually felt as a deep ache or burning between the spine and the inner edge of one or both shoulder blades. It often gets worse when you pull your shoulders back or sit for long periods.

Yes. Rounded shoulders and a forward-head position increase the load on the thoracic spine and the muscles around the shoulder blades. Over time this can lead to persistent discomfort and trigger points.

Yes. The lower cervical nerve roots (C5 to C8) can send pain into the area between the shoulder blades. Conditions such as cervical spondylosis or a pinched nerve in the neck are common sources of referred upper back pain.

When you lie down, gravity no longer loads your spine. Posture problems such as too much rounding of the upper back, forward-head position and pelvic tilt relax away on the table. A standing whole-body scan captures your skeleton while it carries your real body weight. This shows alignment problems that lying-down imaging can miss.

An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. This makes it one of the lowest-dose skeletal imaging options available.

No. ScanAlign is a private self-pay clinic. You can refer yourself by booking a free video consultation. If the scan is suitable for you, it is arranged directly.

The price for patients travelling from abroad is confirmed during the free video consultation.

EOS shows bones, joints and overall alignment very clearly, but it is not designed for soft tissue. If a disc bulge, nerve compression or ligament injury is suspected, MRI is usually the better tool. Your clinician can advise which scan you need.

Find out what is really behind your upper back pain

A short video call with a specialist radiographer can help you understand whether standing alignment imaging at our London clinic is right for you. No cost, no pressure.

Book a free video consultation

Written by Abbas Dhami (Specialist Diagnostic Radiographer)

Sources

  1. NHS. "Back pain." nhs.uk, 2023.
  2. Briggs AM, Smith AJ, Straker LM, Bragge P. "Thoracic spine pain in the general population: prevalence, incidence and associated factors." BMC Musculoskeletal Disorders, 2009;10:77.
  3. Illés T, Somoskeöy S. "The EOS imaging system and its uses in daily orthopaedic practice." International Orthopaedics, 2012;36(7):1325-1331.

This page is general information and not a diagnosis.

ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.