Between The Shoulder Pain
Pain between the shoulder blades, a constant ache in the upper back and pain referring to the inside or under the shoulder blade is a complaint which is commonly seen in clinic. Clients will often report a constant dull ache or sometimes a sharp stabbing pain which never seems to ease. As you would expect, a large number of clients presenting with these symptoms are those who spend long hours sat in front of a computer screen, usually resulting in neck and back pain.
What you may be surprised to hear is there seems to be another section of society who repeatedly seem to visit the clinic for help with this problem – cyclists!
Now, cyclists are usually a healthy bunch, known for their fitness and high levels of endurance and not someone you would expect to be suffering from the everyday aches and pains us mere mortals suffer from! The reality is I see more cyclists with pain in the upper back, neck and pain along the inside of the shoulder blades more than almost anyone else – but why is this?
The main reason is the riding position cyclists have to hold themselves in as they spend hour upon hour on the road. Sitting in a high seated position, the cyclist will often arch their upper back as reach down towards the handlebars. This arching of the upper back will lead to stiffness, aching…and pain.
As you can see here the riders upper back (known as the thoracic) is arching in order to reach the grip. Prolonged riding in this position can potentially cause stiffness or ‘locking’ of the joints in the area.
Many a cyclist will testify to having had various treatments in order to relieve the discomfort in the upper back. Deep tissue massage may help but for others the pain never really goes away leaving them in a constant pain spasm cycle – but why is this?
Why Does This Cause Pain?
The source of the pain in this instance is not usually coming from the muscles themselves but from the joints of the spine and ribs. As a result of the cyclist holding themselves in the fixed position we mentioned earlier, the joints can become stiff and immobile which can eventually result in a locking of the joint, or as it is more commonly known, a fixation.
When a fixation occurs, receptors within the joint – known as mechanoreceptors – signal to the brain there is a potential injury. The brain responds to these messages by attempting to protect and stabilize the area. One of the ways the body will do this is to layer the tissues surrounding the joint with a protective muscle spasm, causing the muscles in the area to become stiff and tight. This muscle spasm acts almost like a splint to the area, attempting to stabilize what the brain perceives as an unstable or injured joint.
To compound the problem, as the joints of the mid spine become fixated, the ribs, which attach to the mid spine, can also become fixated, creating further muscle spasm! The referred pain will normally produce the stabbing pain felt to the inside of the shoulder blades.
Thoracic spine or mid back. As you can see the ribs attach to the joints of the mid back. If the joints become fixated then this can also lead to the ribs becoming stuck, leading to further referred pain.
I’m sure many a cyclist has had some well meaning massage to the mid back and shoulder blades with little or no long term relief. The reason for this is the pain may not actually be caused by the muscles themselves but originating from the spine and ribs which have become fixated and causing the muscles to contract in an attempt stabilize and protect the area.
How Can This Be Fixed?
In this instance the first part of the treatment should be to release the stuck spinal segments and the associated rib fixations prior to any massage to the area. Once this has been achieved, any massage or soft tissue treatment is much more successful in relieving the mid back pain.
Due to the head position some cyclists ride with, issues can also arise in the neck, causing pain and stiffness, headaches and TMJ (jaw pain). The treatment for these clients is generally the same; release the fixated facet joints to reduce protective muscle spasm and then apply soft tissue massage to relieve the tension.
There are various ways of releasing the spine including the use of adjustments and mobilisations. At our clinic we use a specialised soft tissue technique called myofascial release in order to gently free the joints and return the movement to the spine.
Of course there are other factors to take into account, riding position being one of them, so getting a good bike fit and appropriate advice on riding position is also important in preventing the condition from returning, along with a home retraining programme.
The complaint of pain between the shoulder blades is a very common one for most therapists to treat. Many clients will come to us having suffered with the pain for many years. If you are one of these people then I hope this blog has given you a little insight into where the pain may be coming from and what can be done to alleviate your symptoms.
If you have the problem yourself and need some help then get in touch to see how we can help.