Upper and middle/mid-back pain and/or pain between the shoulder blades is common for individuals who spend long hours sitting or standing. Stress, tension, and repetitive movements can cause middle-back trigger points to develop. Symptoms occur anywhere from the neck’s base to the bottom of the rib cage. Trigger point development and reoccurrence can contribute to chronic upper and middle back pain. Injury Medical Chiropractic and Functional Medicine Clinic can release, relieve and help prevent trigger points through various therapies and treatment plans.

Middle Back Trigger Points

The ribs attach to the sternum and adhere to and wrap around the back. Pain and sensation symptoms can radiate to other places where the nerve travels if a nerve in this area is pinched, irritated, or injured. The muscle groups of the chest region also have a significant role in middle back trigger point development. Tension in the chest muscles can overload the muscles of the mid-back region, causing tightness. This happens to individuals that release the trigger points in the mid-back muscles but fail to address the trigger points in the chest muscles, causing reactivation that could worsen the injury. Three muscle groups can cause trigger point referred pain between the shoulder blades include:

• Rhomboids
• Middle Trapezius
• Pectoralis Major

Rhomboid Trigger Points 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 connect to the inside of the shoulder blade.
• The contraction causes the shoulder blades to retract and rotate.
• Trigger points only cause pain in the region of the muscle group.
• They can cause tenderness in the region and the spinous process or the bony tip extending from the lamina or part that can be felt when touching the back.
• The pain is often described as burning.

Rhomboid Trigger Symptoms

• A common symptom is superficial aching between the shoulder blades that individuals try to rub with their fingers to get relief.
• Intense pain can extend upward to the shoulder area above the blade and into the neck area.
• Individuals may hear or feel a crunching and snapping as they move the shoulder blades.
• The common rounded-shoulder and forward-head hunching posture are nearly always present in individuals with these trigger points.

Middle Trapezius Trigger Points

• The trapezius is the large, diamond-shaped muscle group that forms the base of the neck and upper back.
• It has attachment points at the bottom of the skull, along the spine, collarbone, and shoulder blade.
• When this muscle contracts, it moves the shoulder blade.
• Movements can also affect the neck and head region.
• Trigger points in the middle portion of this muscle refer to pain between the shoulder blades and the spine.
• Trigger points develop for several reasons, including unhealthy postures, stress, injuries, falls, and sleeping positions.
• Additionally, tension and added trigger points in the chest muscles can overload the Trapezius muscle fibers, causing trigger point development.

Trapezius Symptoms

• It can be difficult to distinguish pain from the middle trapezius and rhomboid trigger points.
• Pain in the middle trapezius can have more of a burning sensation and often extends over the thoracic spine.
• The pain referral to the spine can activate secondary trigger points in the surrounding muscles.

Pectoralis Major Trigger Points

• The Pectoralis Major muscle group is the large, flat muscles in the upper chest region.
• The muscle has four overlapping sections that attach to the ribs, collarbone, chest bone, and upper arm at the shoulder.
• The muscle group contracts when pushing with the arms in front of the body and rotating the arms inward towards the trunk.
• Trigger points can radiate pain symptoms to the chest, shoulder, and breast regions.
• Numbness and/or pain can radiate down the inside of the arm and into the fingers.
• Trigger points in this muscle group can activate triggers in the upper back, causing pain symptoms between the shoulder blades.

Pectoralis Major Symptoms

• Individuals will present with chest pain, front shoulder pain, and pain traveling down the inside of the arm to the elbow.
• If referred pain occurs on the person’s left side, it can be similar to cardiac pain.
• Consult a cardiologist to rule out cardiac involvement before investigating trigger points.
• The pain will initially occur on one side of the chest but can spread to the other as it intensifies.
• In many, the pain is only experienced with the movement of the arms and goes away or decreases with rest.
• Simultaneous pain in the mid-back, between the shoulder blades, frequently occurs.
• In women, there may be nipple sensitivity and pain in the breast.
• The breast can become enlarged from the tension causing impaired lymphatic drainage.

Chiropractic Treatment

Chiropractors treat myofascial pain syndromes such as myofascial trigger points or adhesions with various therapies. A chiropractor will locate trigger points by pressing muscle tissue or manipulating the muscle fibers. Once the trigger points have been found, treatment can include:

• Massage.
• Percussive Massage.
• MET techniques.
• Myofascial release techniques.
• Applied pressure to reduce pain gradually.
• Direct pressure upon the trigger point.
• Chiropractic adjustments.
• Targeted stretching.
• Decompression.
• Health coaching.

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References

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Sadria, Golnaz, et al. “A comparison of the effect of the active release and muscle energy techniques on the latent trigger points of the upper trapezius.” Journal of bodywork and movement therapies vol. 21,4 (2017): 920-925. doi:10.1016/j.jbmt.2016.10.005

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