At a recent active release technique seminar I attended, an interesting study was discussed. A 2013 paper published in the Archives of Physical Medicine and Rehabilitation investigated the nature of upper back pain (between the shoulder blades) and nerve entrapment. For many people, muscular pain and spasm located between the shoulder blades is an unrelenting problem. This recent publication may assist in the treatment of this condition…
As mentioned, many people experience pain in the yellow area highlighted in the picture. Usually, the area implicates the rhomboid muscle, which extends from the inner border of the shoulder blade to the spine. Treatment for this area often consists of active release technique, graston technique, acupuncture, massage therapy and laser therapy. The pain is often a constant, nagging sensation that is aggravated with prolonged use of the upper extremity. This includes sitting in front of a computer for long periods, day after day!
The aforementioned study investigated whether a nerve entrapment was responsible for the pain between the shoulder blades and the spasm that occurs in the muscle. The authors looked at 55 patients and compared them with healthy control subjects. Among other things, they performed an electrophysiologic test of the dorsal scapular nerve, the rhomboid major and the levator scapula. In other words, they looked at the nerve that services the muscles in the painful area as well as the muscles themselves. Perhaps their most interesting finding is that 29 patients (52.7%) had entrapment of the dorsal scapular nerve!
Yes, this week’s blog is a little technical for most of our readers. The important point to take out of it is that the nagging, unrelenting pain between your shoulder blades might not be fundamentally a “tight muscle”. As this study suggests, entrapment of the nerve may be the cause of the problem. Treatment targeted at the entrapment site (which can occur higher up in the neck near the 5th cervical vertebrae and the scalene muscles – the black star in the picture) may be a necessary part of the treatment!
Sultan HE et al. Role of dorsal scapular nerve entrapment in unilateral interscapular pain. Arch Phys Med Rehabil 2013; 94(6): 1118-25.