Mid-Back Pain Trigger Points
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Trigger Point Therapy for Mid-back Pain or Pain Between the Shoulder Blades
Mid-back pain, or pain between the shoulder blades, is a commonly experienced pain disorder by people who spend long hours at a computer or desk. This pain disorder is perpetuated by a sunken chest-head forward posture.
What is interesting about mid-back pain is that the muscle groups of the chest region play an such an important role in the development (and re-development) of this pain disorder. The tension in the chest muscles overload the muscles of the mid-back region, causing them to develop trigger points. This occurs so often that, even if you release the trigger points in the mid-back muscles, if you fail to address the trigger points in the chest muscles, the mid-back trigger points will be quickly reactivated.
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Three muscle groups can contain trigger points that refer pain to the region in between the shoulder blades:
The Rhomboid Trigger Points that Cause Pain Between the Shoulder Blades
The Rhomboid muscle group is found in the mid-back region, between the shoulder blades. These muscles attach along the spine and run diagonally downward to attach to the inside edge of the shoulder blade.
Contraction of this muscles causes the shoulder blades to retract and rotate.
There are three trigger points that develop in this muscle group. Unlike most trigger points, these trigger points refer pain only only locally in the region of the muscle group. They will often make the region and tips of the spine very tender, and the pain might be described as a burning sensation at times.
Rhomboid Trigger Point Symptoms
My patients with active Rhomboid trigger points complain of a superficial aching pain between the shoulder blades that they will try to rub with their hand to get relief.
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If the pain is intense it may extend upward to the shoulder area above the shoulder blade. The patient may hear (or feel) crunching and snapping sounds as they move their shoulder blades.
The common “rounded-shoulder and sunken-chest” posture (that your mother warned you about) is nearly always present in patients with these trigger points.
The Middle Trapezius Trigger Point that Causes Pain Between the Shoulder Blades
The Trapezius is the large, diamond shaped muscle group that forms the base of the neck and upper back region. It has attachment points at the base of the skull, along the spine, on the shoulder blade, and on the collar bone.
When this muscle contracts it typically moves the shoulder blade, but it also plays a part in moving the neck and head.
Trigger points in the middle portion of this muscle refer pain between the shoulder blades and to the spine. Trigger points in this muscle develop for a number of reasons, including poor posture, emotional stress, whiplash injuries, falls, and sleeping positions (or sleeping under a ceiling fan).
Additionally, tension and trigger points in the chest muscles will easily overload the middle Trapezius muscle fibers, and activate trigger points in it. (Note: Trigger points can develop in any of the middle Trapezius muscle fibers, and may or may not be located as depicted in the picture.)
Trapezius Trigger Point Symptoms
It can be difficult to distinguish pain from the middle trapezius trigger point and that from the rhomboid trigger points. The pain from the middle trapezius trigger point can have more of a burning quality to it and will often extend over the thoracic spine.
This pain referral to the spine will often activate satellite trigger points in the thoracic multifidi muscles (see below).
The Pectoralis Major Trigger Points that Cause Mid-back Pain
The Pectoralis Major muscle group is the large, flat muscles found in the upper chest region. The muscle has four overlapping sections that attach to the ribs, collarbone, chest bone, and upper arm bone at the shoulder.
This muscle group contracts as you push with your arms in front of you (e.i. the bench press) and when you rotate your arms inward towards your trunk. The Pectoralis Major can contain up to five different trigger points that refer pain in the chest, shoulder, and breast regions.
Additionally, pain or numbness may radiate down the inside of the arm and into the fingers. Trigger points in this muscle group tend to activate trigger points in the upper back muscles that produce pain between the shoulder blades.
Pectoralis Major Trigger Point Symptoms
Patients with active pectoralis major trigger points will present with chest pain, front shoulder pain, and pain traveling down the inside of the arm to the elbow. If this referred pain occurs on the person’s left side, it can be confusingly similar to cardiac pain. Important Note: If you have chest pain please see a cardiologist to rule out cardiac involvement before investigating trigger points as the source.
The pain from the pectoralis major trigger points initially will occur on one side of the chest but will spread to the trigger points on the other side as it intensifies.
In woman, pain in the breast and nipple sensitivity will often occur with these trigger points. The breast may also be enlarged because the tension in this muscle can impair normal lymphatic drainage.
A simultaneous pain in the mid-back, between the shoulder blades, frequently occurs with these trigger points. Sometimes this back pain component is the only symptom from these trigger points.
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In most patients, the pain from the pectoralis major trigger points is only experienced with movement of the arms and is absent or minimized at rest.
Secondary Trigger Points that Cause Mid-back Pain
Trigger points in two other muscle groups can contribute to mid-back complaints. Watch the videos for more information on these trigger points.
The first is the Scalene trigger points which create a plethora of symptoms in the upper body including chest pain, mid and upper back pain, radiating arm pain, and wrist and hand pain. A pretty common trigger point in the anterior branch of the scalene muscle group is responsible for the pain between the shoulder blades referral.
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The second is the Thoracic Multifidi trigger points. These are very small muscles that attach between the vertebrae of the spine. These trigger points are often activated by the referred pain from other trigger points, such as the middle trapezius. They refer pain and tenderness to the spine itself.
Related Instructional Videos from Dr. Perry
While the videos below were created to teach therapists how to locate and release these trigger points, many non-professionals have used them to learn these techniques successfully.
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If you have a partner, a little time, you can use these videos to learn how to treat your own trigger points.
Related Articles from Dr. Perry
More extensive articles on these muscles and trigger points are available from Dr. Perry on our sister website TriggerPointTherapist.com. Click on the titles below to read them:
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