Your Shoulder Blade Pain Could Be A Rib Or Thoracic Spine Problem
You wake up and feel a sudden, sharp pain near your shoulder blade. Maybe it stabs when you twist or hurts when you take a deep breath. You try to stretch, roll it out, or rest, but it keeps coming back. This kind of pain can feel like a pulled muscle or even a pinched nerve. But, as an Austin, TX manual physical therapist would ask, what if the problem isn’t a muscle at all?
Many people are surprised to learn that pain near the shoulder blade often comes from the thoracic spine or the ribs. These parts of the body don’t get much attention, but they do a lot of work. When something in this area gets stuck or irritated, it can lead to pain that’s sharp, deep, or hard to pin down. If you’ve been struggling with this kind of pain and nothing seems to work, keep reading. You might finally get the answers you’ve been looking for.
What’s Happening Under the Skin with Thoracic Spine and Rib Anatomy
The thoracic spine is the middle part of your back. It includes 12 vertebrae, labeled T1 through T12, that run from the base of your neck to the bottom of your ribcage. These bones form joints not only with each other, but also with your ribs.
Each rib connects to the spine at two points: the costovertebral joint (where the rib meets the vertebral body) and the costotransverse joint (where it connects to a small bony part called the transverse process). These joints are small, but they allow the ribs to move slightly every time you breathe, twist, or reach. That movement is important. It helps your lungs expand and keeps your upper body flexible.
When one of these joints stops moving well, either because it’s stiff, misaligned, or irritated, it can cause pain. The pain might not feel like it’s in the rib itself. Instead, it often shows up as referred pain near the shoulder blade or wraps around the side of the body. That’s why it can be tricky to figure out what’s really going on.
What Is Rib Dysfunction?
Rib dysfunction happens when a rib joint doesn’t move like it should. This might mean the rib gets “stuck” and doesn’t glide smoothly. It might shift slightly out of position too far forward, too far back, or too high or low compared to the ribs around it.
There are a few types of rib dysfunction:
- A posterior rib subluxation happens when the rib gets pushed backward.
- An anterior rib dysfunction is when the rib gets stuck forward.
- An elevated rib can occur when the rib is pulled upward, often by tight muscles.
- A depressed rib is one that doesn’t rise as it should during breathing.
Even small changes like these can put pressure on surrounding joints and soft tissue. The rib joints are located right next to muscles like the rhomboids, trapezius, serratus anterior, and intercostals (the muscles between your ribs). If a rib is stiff or misaligned, it can irritate those muscles, limit movement, and create pain that feels like it’s in your back or shoulder blade even though the true problem is at the rib joint.
Rib dysfunction is often caused by everyday things: poor posture, lifting something awkwardly, sleeping in a twisted position, or even sneezing hard. In other words, it’s easy to end up with this problem without knowing it.
How Rib Dysfunction Feels
Shoulder blade pain from rib dysfunction can feel sharp, aching, or like a deep pinch. It may start suddenly or build up over time. People often describe it as:
- A stabbing or burning pain right under or beside the shoulder blade
- A sharp pain when taking a deep breath, yawning, coughing, or laughing
- A sensation that something is “caught” or “stuck” in the back
- Pain that worsens with twisting, reaching, or lifting one arm
- Tenderness when you press on the ribs near the spine
This kind of pain usually doesn’t spread down the arm like a nerve problem from the neck would. Instead, it stays close to the spine and shoulder blade. It might also wrap around the side of the chest but rarely below the ribcage.
One of the most frustrating things about rib dysfunction is that stretching or massage may feel good for a few hours but doesn’t fix the problem. That’s because the real issue is joint movement, not just muscle tightness.
Common Triggers and Causes
You don’t have to be injured to end up with rib or thoracic spine dysfunction. Here are some common ways it happens:
Sleeping in a twisted position for example, with your top arm thrown overhead or your upper body rotated to one side. This can compress or torque a rib joint.
Reaching or twisting suddenly like grabbing something from the back seat of your car or swinging a golf club. These motions can overstress a rib joint that’s already stiff.
Sitting with poor posture through slouching, especially for long periods at a desk or while using a phone, reduces thoracic mobility and increases rib stress.
Repetitive strain activities that involve repeated upper body movement (lifting, pulling, pushing) can irritate the ribs if the spine isn’t moving well.
Shallow or chest-dominant breathing is when you breathe more with your upper chest than your diaphragm, the upper ribs and surrounding muscles get overloaded.
Weak core or mid-back muscles without support from strong postural muscles, ribs can shift more easily out of alignment.
Why It Doesn’t Go Away on Its Own
You might think a little pain near your shoulder blade will ease up with rest or some massage. And sometimes it does for a while. But rib dysfunction often returns because the joint doesn’t fix itself. The rib stays stiff or out of place, and the surrounding muscles tighten up to protect it.
Every breath you take moves your ribs slightly. So if one joint isn’t working right, that tiny irritation adds up day after day. Over time, it can lead to more pain, reduced range of motion, and even nerve irritation.
Massage and foam rolling might help loosen tight muscles around the area. But unless the rib joint itself moves normally again, the pain is likely to return. That’s why hands-on treatment and guided movement from a physical therapist are so effective at Move Empower Concierge Physical Therapy.
Physical Therapy Treats the Real Cause
At Move Empower, we don’t just look at where the pain is, we figure out where it’s coming from. If your pain is caused by rib or thoracic dysfunction, we’ll find the exact joint that’s restricted and work to restore its motion.
The evaluation starts with testing your posture and spinal alignment. We feel how your ribs move during breathing. We check for joint stiffness along the spine and test how your shoulders and mid-back move. We also look at your core strength and how you breathe since poor breathing patterns often go hand-in-hand with rib pain.
Once we identify the source of your pain, we use hands-on therapy to restore movement. That might include:
- Gentle rib mobilization
- Thoracic joint mobilization or manipulation
- Soft tissue release for tight muscles like the rhomboids or intercostals
- Breathing retraining to get your diaphragm working again
We’ll also teach you exercises that strengthen the muscles supporting your ribs and spine. These include the mid-back, scapular stabilizers, and core. These exercises are key to helping you feel better long term.
We show you how to adjust your posture, how to move more efficiently, and how to sleep in ways that reduce rib stress. Most people feel better within just a few visits and can get back to work, exercise, and daily life without pain.
How Move Empower Helps with Personalized, Hands-On Care
Our physical therapy team specializes in treating pain that doesn’t always have a clear cause. We take the time to listen, assess, and explain what’s happening in your body. Every treatment is one-on-one and based on your exact needs.
We don’t just treat the pain, we help you move better, breathe better, and live without fear of the next flare-up. Whether you’ve had shoulder blade pain for days or months, we can help you get to the root of the issue.
No generic stretches. No quick fixes. Just skilled hands, clear guidance, and real results.
You Don’t Have to Live with Shoulder Blade Pain
Shoulder blade pain that comes and goes or sticks around no matter what you do can be incredibly frustrating. It’s easy to blame stress, posture, or a pulled muscle. But sometimes, the problem is deeper. A rib that’s not moving right or a stiff thoracic spine can create pain that lingers and won’t respond to simple stretching or massage.
The good news is, this pain is treatable. With the right care, you can feel better, breathe easier, and get back to moving freely.
If you’ve been wondering why your shoulder blade hurts and nothing seems to work, let us help. At Move Empower Concierge Physical Therapy, we’ll work with you to uncover the cause, fix it, and keep it from coming back. Schedule a FREE discovery session today.