"I Cant Get Rid of the Knot Between My Shoulder Blades"

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“I can’t get rid of the knot between my shoulder blades” this is something I hear very commonly at my Camden Chiropractic clinic. Many frustrated patients who have had countless massages, using massage balls, stretching but nothing seems to be getting rid of that “knot” between their shoulder blades.

So what is actually going on? Is it really a knot? Why isn’t the massage and stretching getting rid of the symptoms?

Many times, after examining these patients, the cause of this irritating pain is the costovertebral joint. The costovertebral joint as the name suggests is a joint formed between the ribs (costo) and the spine (vertebral).

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The thoracic spine (mid back) is made up of 12 vertebrae. The body also consist of 12 pairs of ribs which wrap around from the sternum at the front, and attach to each vertebra on either side of the spine. These joints are called the costovertebral joints, and they consist of smooth cartilage which lies between the joint surface, and strong connective tissues called ligaments which wrap around the joints and provide support.

Repetitive or excessively forceful bending, twisting, lifting or arching movements may cause damage to the joint structure. This condition is known as costovertebral joint sprain.

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The pain with costovertebral joint sprain can vary from a mild, niggling/annoying pain on one side between the shoulder blades, to a very sharp, stabbing pain which limits most movements and can be very painful even with breathing. With severe sprains, the pain can wrap around the ribs to the front of the chest.

Many patients with costovertebral joint sprains report that they did something very small such as reaching for a tissue, or bending to pick up their keys and all of a sudden they experienced a pain near the shoulder blade. Generally these patients have very restricted movement through their thoracic spine which leaves the costovertebral joints very unstable and vulnerable to injury. Spending long hours sitting at a computer, driving or on electronic devices can lead to restricted motion of the thoracic spine.

Many of these patients get misdiagnosed as having a “knot in the muscles” and after a few massages start to realise perhaps something else is causing their pain.

Now, when there is a costovertebral joint sprain, the surrounding muscles such as the rhomboids and trapezius will naturally spasm and tighten up to help protect the injured joint. However, it doesn’t matter how much the muscles are rubbed or massaged, if the cause of the muscle spasm isn’t corrected, they will just continue to tighten back up.

So what can we do to get rid of this pain?

At Proactive Chiro & Sports Med, we have helped hundreds of patients with such symptoms. Adjustments/manipulation directed at the costovertebral joints generally gives patients immediate relief. As mentioned prior, most patients with this condition have a very restricted thoracic spine, and so adjustments to help improve function of these joints is imperative.

Other very effective treatment options particularly with very stubborn conditions include Rocktape and dry needling the affected area

As with all conditions, a thorough assessment of the patient's spine and functional movement patterns is very important to pin point what might be causing their pain. Rehabilitative exercises to address any muscle imbalances and ergonomic and postural advice will also help prevent reoccurrence.

By Dr Danny Diab – Camden Chiropractor