Services · Upper back & shoulder
Upper back and shoulder pain
The short answer
Pain between the shoulder blades usually comes from the thoracic spine and the muscles working around it; pain in the shoulder itself is more often a tendon under more load than it is currently prepared for. The two are treated differently, so the examination matters. If an approach is not helping, we will say so and change it or refer you on, rather than keep booking you in.
Two different problems on one page
Between the shoulder blades. Typically thoracic joints that have stopped moving well, with the surrounding muscle working overtime to compensate. We use articulation and soft tissue work.
In the shoulder itself. Usually rotator cuff related, a tendon asked to do more than it was ready for, whether that is a new gym programme, a weekend of painting, or a job that changed. Hands-on work has a place, but the main job is graded loading.
Why this one takes longer
Tendon adapts slowly. What we can do is keep you moving and progressing load while it happens. We would rather tell you that at the first appointment than leave you wondering later why it isn't finished.
How many visits will I need?
We give the number of visits at the start. Not at the end, and not one visit at a time. Where we can't estimate it honestly, and sometimes we can't, we say that instead of picking a figure.
When this is not a job for an osteopath
Please book with a GP, or go to an emergency department, rather than with us, if any of the following apply:
- Shoulder or arm pain with chest tightness, breathlessness, nausea or sweating. Call 000.
- A shoulder that cannot be actively lifted at all after an injury, which may indicate a significant tear.
- Obvious deformity, or an injury following a fall onto an outstretched hand.
- Weakness travelling into the hand.
- Night pain that is unrelated to position, with fever or unexplained weight loss.
If any of these apply, see a GP or go to an emergency department first. The symptom check asks about the most serious warning signs, but it does not cover everything.
Exercises we commonly prescribe for this
Pulled from the library. Which of these you get, at what dose and in what order depends on your assessment, this is what the shortlist usually looks like, not a plan for you.
Common questions
Do I need a scan for a shoulder?
Usually not initially. Ultrasound and MRI find rotator cuff changes in a large proportion of people with no symptoms at all, so a positive finding does not necessarily explain your pain. If you fail to progress, or if the examination suggests a significant tear, we will refer you for imaging.
Is it a frozen shoulder?
Frozen shoulder has a distinctive pattern, a marked loss of external rotation, both actively and passively, and it behaves quite differently from a rotator cuff problem. If that is what you have, we will tell you plainly and plan accordingly.
Can I keep training?
Almost always, with modification. Complete rest is rarely the answer for a tendon. We will work out what you can keep doing rather than simply telling you to stop.
Why does it hurt more at night?
Shoulders are commonly worse lying down because the position loads the tendon and reduces blood flow. It is a normal feature rather than a warning sign, unless the pain is unrelated to position, which is different and worth mentioning.