We have seen countless cases in our Boulder and Lafayette physical therapy offices of clients presenting with reports of a “knot” next to their shoulder blade that in many cases has often been massaged, needled, scraped or mashed to death with no lasting relief of symptoms.

Scapular or shoulder blade pain is a classic sign of pain referred from the joints and discs of the cervical  spine (neck) and has been well-documented dating back to Cloward’s seminal work in 1959 (Cloward, Annals of Surgery, 1959). It is very common to experience an absence of pain in the neck itself but acute pain in the upper back or shoulder blade area which may or may not progress down the arm. The lack of response to local treatments addressing the painful area are ineffective because they are not targeting the root cause of these symptoms.

There are many potential causes of upper back, thoracic, and shoulder blade region pain. These include both musculoskeletal (bone, muscle, joint, nerve) and concerning non-musculoskeletal conditions (cardiac, respiratory, digestive). For physical therapists with expertise in treating spinal conditions, scapular pain is considered ‘referred from the neck until proven otherwise’. This highlights the importance of seeing a Doctor of Physical Therapy or other licensed medical professional with expertise in treatment in spinal conditions and differential diagnosis to ensure that you are receiving effective and evidence-based care for your shoulder blade knot.

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