Thoracic spine pain: 5 reasons you may be feeling pain between your shoulder blades

Thoracic spine pain can make sitting, working, exercising and even taking a deep breath uncomfortable. You may feel a dull ache between your shoulder blades, a sharp pain when you twist or a tight spot that never seems to relax.

Your thoracic spine is the middle and upper part of your back. It begins below your neck and extends to the bottom of your rib cage. This area includes 12 vertebrae, along with muscles, joints, discs, nerves and the places where your ribs connect to your spine.

Because so many structures work together in this area, pain between your shoulder blades has multiple possible origins. Some problems begin after a sudden injury. Others develop slowly because of your posture, work habits or repeated movements. Physical therapy at KC Rehab may help you recover.

Common causes include:

1. Poor posture and prolonged sitting

Poor posture is one of the most common causes of ongoing upper and middle back discomfort. You may spend hours leaning toward a computer, looking down at your phone or sitting without enough back support.

When your head moves forward and your shoulders round, the muscles around your shoulder blades must work harder to hold you upright. Over time, some muscles can become tight while others become weak or tired.

You may notice:

• An aching or burning feeling between your shoulder blades

• Tightness across your chest and shoulders

• Pain that gets worse later in the workday

• Temporary relief when you stand, stretch or change positions

There is no single “perfect” posture that you must hold all day. Moving regularly is often more helpful than trying to remain in one fixed position. Your desk setup, chair height and screen position may also affect how your back feels.

2. A muscle strain or overuse injury

You can strain the muscles in your upper back through a sudden movement or repeated activity. This type of thoracic spine pain may begin after lifting a heavy object, completing a hard workout or doing more yardwork than usual.

You can also irritate these muscles through repetitive tasks, including:

• Reaching overhead

• Carrying a heavy bag on one side

• Rowing, swimming or throwing

• Lifting with poor body mechanics

• Repeating the same work movement for several hours

A muscle strain often causes soreness in one focused area. The pain may increase when you move your arm, rotate your trunk or press on the affected muscle. You may also experience stiffness or muscle spasms.

Most mild strains improve with time and gradual movement. However, continuing to push through significant pain can delay your recovery. A physical therapist can help you identify which movements are irritating your back and show you how to return to activity safely.

3. Stiff or irritated spinal and rib joints

Your thoracic spine is designed to provide stability, but it still needs to bend and rotate. Small joints connect each vertebra, while other joints connect your ribs to your spine.

These joints can become stiff or irritated after an injury, a long period of limited movement or repeated stress. When one area does not move well, nearby muscles and joints may have to work harder.

Joint-related thoracic spine pain may feel like:

• A deep ache near one side of your spine

• Sharp pain when you twist or reach

• Stiffness after sitting or sleeping

• Discomfort when you take a deep breath

• A feeling that your upper back needs to “pop”

Your symptoms alone cannot confirm which joint is involved. A physical therapist can evaluate your posture, spinal movement, shoulder mobility and breathing mechanics to determine what may be contributing to the pain.

4. A disc or nerve problem

Discs sit between the vertebrae and help absorb force. Although disc problems occur less often in the thoracic spine than in the neck or lower back, a disc can become irritated or place pressure on a nearby nerve.

Nerve irritation may cause symptoms that feel different from a basic muscle ache. You may experience:

• Burning, shooting or electric pain

• Pain that wraps around your ribs or chest

• Numbness or tingling

• Unusual sensitivity in part of your back or torso

• Weakness or changes in coordination

These symptoms should be evaluated by a qualified health care provider. Your provider can determine whether you need further testing or whether conservative treatment, such as physical therapy, is appropriate.

The presence of thoracic spine pain does not automatically mean that you need an X-ray or MRI. Imaging is not usually required for uncomplicated, recent thoracic back pain, but it may be considered when symptoms persist or warning signs are present.  

5. A fracture or another medical condition

Less commonly, pain between your shoulder blades may be related to a vertebral fracture, inflammatory condition, infection or problem involving an internal organ. A fracture can occur after a fall, sports collision or car accident. If you have osteoporosis, even a smaller force may injure a vertebra.

Seek prompt medical care if your pain:

• Begins after a serious accident or fall

• Is severe, constant or rapidly worsening

• Occurs with chest pain or trouble breathing

• Comes with a fever or unexplained weight loss

• Wakes you regularly during the night

• Occurs with weakness, numbness or difficulty walking

• Is accompanied by a loss of bladder or bowel control

These symptoms might not always mean that you have a serious condition, but they should not be ignored. They can signal medical emergencies.

How physical therapy may address thoracic spine pain

Your treatment should be based on the reason for your pain, not just the location of your symptoms. During a physical therapy evaluation, your therapist may assess your spinal mobility, strength, posture, shoulder movement and daily activities.

Your care plan may include:

• Gentle mobility exercises

• Strengthening for your back, shoulders and core

• Hands-on techniques to address stiff joints or soft tissue

• Guidance on your workstation and lifting technique

• A gradual plan for returning to work, exercise or sports

Thoracic spine pain can be frustrating, but you do not have to guess what is causing it. A personalized evaluation can help you understand your symptoms and take practical steps toward moving with less pain.

Schedule an initial appointment here or contact our team for more information.

Frequently asked questions

What is thoracic spine pain?

Thoracic spine pain is discomfort in the middle or upper part of your back. You may feel pain between your shoulder blades, along your ribs or around the middle of your spine. The pain may feel dull, sharp, tight, burning or achy depending on what is causing it.

What causes pain between your shoulder blades?

Pain between your shoulder blades can have several possible causes. Common reasons include prolonged sitting, posture-related strain, muscle overuse, stiff or irritated spinal or rib joints, and disc or nerve problems. Less commonly, pain in this area may be related to a fracture or another medical condition.

Can poor posture cause thoracic spine pain?

Your posture may contribute to thoracic spine pain, especially if you spend long periods sitting, looking down or leaning toward a computer. These positions can make the muscles around your shoulders and upper back work harder. However, you do not need to maintain one “perfect” posture all day. Changing positions and moving regularly may be more helpful.

Can sitting for a long time cause pain between your shoulder blades?

Yes, prolonged sitting can contribute to discomfort between your shoulder blades. You may notice pain getting worse later in the workday, especially if you remain in one position for several hours. Standing, stretching and changing positions regularly may help reduce some of the strain.

How do you know if thoracic spine pain is caused by a muscle strain?

A muscle strain may cause soreness in one focused area of your upper or middle back. Your pain may increase when you move your arm, twist your trunk or press on the affected muscle. You may also experience stiffness or muscle spasms, especially after lifting, exercise or repeated activity.

Can a stiff rib joint cause upper back pain?

A stiff or irritated rib joint may contribute to pain near your thoracic spine. You may experience a deep ache, pain when twisting or reaching, stiffness after sitting or sleeping, or discomfort when taking a deep breath. Because other problems can cause similar symptoms, an evaluation can help determine what may be involved.

Can a thoracic disc problem cause pain between your shoulder blades?

Yes. Although disc problems occur less often in the thoracic spine than in the neck or lower back, a thoracic disc can become irritated or affect a nearby nerve. You may notice burning or shooting pain, numbness, tingling, pain that wraps around your ribs or changes in strength or coordination.

When should you be concerned about thoracic spine pain?

You should seek prompt medical care if your pain begins after a serious accident or fall, becomes severe or rapidly worse, or occurs with symptoms such as chest pain, trouble breathing, fever, unexplained weight loss, weakness or difficulty walking. Loss of bladder or bowel control also requires prompt medical attention.

Do you need an X-ray or MRI for thoracic spine pain?

Not always. Imaging is not usually needed for uncomplicated, recent thoracic spine pain. Your health care provider may consider an X-ray, MRI or other testing if your symptoms continue, your examination suggests another problem or you have warning signs that need further evaluation.

How can physical therapy help with thoracic spine pain?

A physical therapist can evaluate your spinal mobility, strength, posture, shoulder movement and daily activities to determine what may be contributing to your pain. Your treatment plan may include mobility exercises, strengthening, hands-on techniques, workstation or lifting guidance and a gradual return to work, exercise or sports.