Pain in the back, lower back, between the shoulder blades: causes, which doctor to see

People complain of pain between the shoulder blades much less often than discomfort in the lower back and neck, however, they also occur and can indicate a variety of diseases. Moreover, if pain in the lower back or neck can occur as a result of muscle strain, then discomfort between the shoulder blades is almost never of such a harmless nature, i.e. its appearance should be regarded as an unambiguous sign of the occurrence of disorders in the spine or internal organs and a reason for treatment to the doctor.

Types of back pain depending on the cause

Pain sensations are primary and secondary; each of these types can be caused by a wide range of conditions and diseases.
In this article we will try to consider only the most basic ones. 1. Nonspecific (primary). This type of pain has a direct connection with problems in the spine and surrounding tissues.

Causes of back pain associated with the spine:

Scoliosis. Poor posture, leading to gradual curvature of the spine, displacement of the vertebrae and muscle strain.
Osteochondrosis. The cause of the development of the disease is a decrease in the shock-absorbing capacity of the spine: damage to the intervertebral discs, rupture of the fibrous ring and, as a consequence, infringement of the disc nucleus. Pain sensations are localized in the area of the spine in which there are pathological changes. So, with osteochondrosis of the thoracic spine, back pain is localized in the thoracic region (the back hurts between the shoulder blades and under the ribs); with osteochondrosis of the lumbar spine, a person experiences pain in the lumbar region.
Intervertebral hernia. Due to damage to the intervertebral disc, protrusion of the soft structures of the vertebrae occurs with the possibility of strangulation (regular and strangulated hernia). The pain is localized at the site of the hernia.
Ankylosing spondylitis. It is characterized by back pain and limited mobility in the spine, which leads to a forced “leaning forward” posture in the patient.
Osteomyelitis. The cause of the disease is an infectious process that has developed in the spinal column. The patient feels that the pain affects not only the spine, but also the back muscles.
Spinal injuries. In this case, the cause of back pain is injury and its accompanying complications. The intensity of pain and its location are directly related to the type of injury and the affected part of the spinal column.

In 40–50% of cases, the causes of back pain are damage to the joints and ligaments of the spine (skeletal pain). Another 3–5% of severe back pain is associated with damage to the roots of the spinal cord (radicular pain).

Back pain associated with pathological changes in muscles:

Fibromyalgia. The inflammatory process develops in the muscles surrounding the spine, is characterized by symmetry and can be chronic. In this case, the back muscles along the entire spine hurt. The important point is that peak pain occurs when certain areas are pressed.
Polymyositis. Hypothermia can trigger the disease. As a result of the development of the disease, the patient experiences muscle weakness and pain, which intensifies when trying to make a turn.
Polymyalgia rheumatica. The etiology of the disease is not clear. Infectious diseases that lower immunity can serve as a trigger. It manifests itself as pain that increases as the disease progresses and can cover all areas of the back. Severe back pain impairs mobility to such an extent that the patient is unable to move independently. A clear asymmetry is visualized in the back.
Charcot's disease. Symptoms are caused by inflammation in the peripheral nerves along the spinal column. As a result of the pathological process, in addition to fairly intense pain, there is a change in the person’s gait.

In 50–60% of cases of nonspecific back pain, their localization is in the muscles.

2. Specific (secondary pain). This type of pain, despite its localization in the back, is often not directly related to diseases of the spinal column or the surrounding muscular skeleton. The causes of specific pain are extremely varied, but the most dangerous are cancer. Thus, pain radiating to the back can be caused by a malignant neoplasm in the area of the mammary glands, lungs or prostate, which provokes metastasis of the spine.

Diseases that cause specific pain include:

Pinched nerve roots in the chest. Most often this leads to the development of intercostal neuralgia. The pain in this case is localized at the pinched site. Thus, intercostal neuralgia can manifest itself: pain under the shoulder blades, pain in the back under the ribs (on the side where the pinching occurred). Soreness has varying degrees - from aching to sharp, shooting. Most often, pain occurs when moving or pressing on the affected area. This fact is the main difference between intercostal neuralgia and diseases of the heart and lungs, which can also manifest as pain under the left (or right) shoulder blade from the back.
Diseases of the gastrointestinal tract. Pain is most often provoked on the right side; in some cases, it can spread to the left side of the body. For the most part, pain is localized in the lumbar and sacrolumbar regions. Quite strong pain is characteristic of pathologies associated with manifestations of diseases of the pancreas, colon diverticulum, intestinal obstruction, retrocecal appendicitis, etc.
Ulcerative lesions. Ulcerative lesions of the organs of the upper abdominal cavity (peptic ulcer of the duodenum and stomach) can manifest themselves in the form of pain in the thoracic and lower lumbar back. If the lower part of the abdominal cavity is affected (ulcerative colitis), pain is localized in the lumbar region. The severity of pain may vary, but most often reaches its peak at night.
Appendicitis. In acute appendicitis, in cases where the vermiform appendix (appendix) is located behind the cecum, the back hurts in the lumbar region. The pain is alternating in nature and can vary from aching, mild to acute, intense.
Kidney diseases. Quite often they manifest themselves as pain in the lumbar region. This type of manifestation is characteristic of pyelonephritis and chronic glomerulonephritis. Differentiation from pathologies that have a direct connection with the spinal column occurs based on the analysis of other clinical manifestations and research results.
Urolithiasis disease. With renal colic, the back hurts in the lumbar region. The pain is pronounced, intense, occurs suddenly and does not depend on the position of the body. Back pain in the lower back and with coral nephrolithiasis. Manifestations of the pain syndrome are low-intensity, the pain is rather aching in nature.
Diseases of the female reproductive system and menstrual pain. In these cases, the pain is most often localized in the lower back.
Neoplasms in the pulmonary system. In this case, pain appears at the stage when the lungs undergo germination of peripheral tumor elements (metastases) into the pleural area and chest wall. The nature of the pain is intense and debilitating.
Cardiovascular diseases. The most common causes of pain localized in the thoracic back are myocardial infarction and stroke. As a rule, these diseases are accompanied by pain between the shoulder blades.
Inflammatory processes in the joints. Infectious arthritis can cause pain to radiate from the affected joint to nearby areas, including back pain.

For the most part, the causes of pain in the back are identical for representatives of both sexes, but it is necessary to identify a number of diseases that differ in gender predisposition.

Treatment

Help before diagnosis

Most non-drug measures are aimed at preventing pain between the shoulder blades: developing and maintaining correct posture, eating a balanced diet without harmful foods, leading an active lifestyle and playing sports. In case of severe pain during the diagnostic search, the doctor prescribes non-narcotic analgesics, recommends limiting mobility, and, if necessary, prescribes strict bed rest.

Conservative therapy

In the treatment of back pain between the shoulder blades, a differentiated approach is used - the therapeutic regimen is selected individually, taking into account the leading disease that caused the symptoms and concomitant pathologies. In case of orthopedic problems, posture correction with the help of corsets and other orthoses comes to the fore. The following groups of medications are used to treat the causes of pain:

Nonsteroidal anti-inflammatory drugs
. Prescribed to relieve discomfort in diseases of the osteoarticular system, as well as to eliminate inflammation and speed up recovery. NSAIDs are also effective for diseases of the respiratory organs and mediastinitis.
Antisecretory drugs
. Proton pump inhibitors and H2-histamine blockers are the basis for the treatment of GERD and achalasia cardia. The drugs reduce damage to the esophagus from acidic stomach contents and relieve pain. To quickly relieve the burning sensation, non-absorbable antacids are taken.
Antibiotics
. Massive antimicrobial therapy is indicated for acute forms of mediastinitis to destroy pathogens and prevent bacterial complications. Medicines are selected empirically. A combination of 2-3 agents is introduced to act on all possible types of microbes.
Cytostatics
. Polychemotherapy is selected for some forms of mediastinal cancer as preparation for surgery or as palliative care. Immunosuppressants are sometimes recommended for patients with severe forms of ankylosing spondylitis.

Patients with acute conditions (aortic dissection, fulminant mediastinitis) are hospitalized in the intensive care unit. The goal of treatment is to get rid of the state of shock: for this purpose, cardiotropic medications, infusion solutions are used, and oxygen support is provided. To relieve pain, narcotic analgesics and tranquilizers are administered.

Non-drug methods play an important role in the treatment of musculoskeletal diseases. Special exercise therapy complexes are prescribed to strengthen the muscle corset and form an even posture. Manual manipulation, kinesiotherapy, orthopedic massage of the chest, back, and lower back show good results. A number of physiotherapeutic methods are used: electrical stimulation of the back muscles, peloid therapy, general ultraviolet radiation.

Surgery

For persistent deformities of the spinal column, surgical correction of scoliosis is recommended. Surgical treatment for osteochondrosis is resorted to in the case of spinal compression: the intervertebral hernia is removed and the spinal canal is decompressed. As a rule, minimally invasive techniques are used: puncture vaporization of the disc, microdiscectomy.

Surgical interventions are indicated for complicated forms of diaphragmatic hernia and severe stenosis of the esophagus. The hernial orifice is sutured with crurorrhaphy, gastropexy or fundoplication, resection and plasty of the esophagus. Emergency surgery is the only treatment for a dissecting aneurysm. Vascular surgeons perform resection of the damaged area with reconstruction of the aorta.

Back pain in men

Although the causes of back pain are mostly the same for both sexes, there are a number of diseases that men are more susceptible to due to their lifestyle.

Such predisposing factors include:

work that involves lifting and carrying heavy objects;
strength sports (including various martial arts, powerlifting, etc.);
bad habits.

As a result, diseases of the musculoskeletal and cardiovascular systems may occur more often in men than in women.

Specific “male” diseases that can cause back pain are various prostate pathologies.

Prostatitis is an inflammatory disease of the prostate gland. At the beginning of the disease, the pain syndrome is localized in the groin, scrotum and lower abdomen, but in the second stage and in cases where the disease has become chronic, the pain spreads to the back.

The localization of pain in this case can either be concentrated in the lumbosacral region or spread to the entire back. This is due to the fact that the inflammatory process affects the nerve endings, which envelop this organ in large quantities. The intensity of pain is directly related to the stage of the disease. Thus, in the acute phase, pain is characterized as acute and short-term. In the chronic form, the pain syndrome is not very pronounced and is often permanent.

In this case, a urologist makes a diagnosis and prescribes treatment.

Symptoms accompanying painful manifestations

Using additional signs, you can quickly identify the cause of pain between the shoulder blades.

A feeling of numbness in the back appears against the background of:

osteochondrosis;
curvature of the spinal column;
humeroscapular periarthritis;
pleurisy;
cardiac ischemia;
biliary dyskinesia.

The appearance of itching in the back area is characteristic of diseases such as herpes zoster and biliary colic. If a feeling of chills occurs, we can talk about an exacerbation of pyelonephritis or infringement of nerve receptors in the spinal canal.

High temperature is characteristic of pathologies of internal organs:

pancreatitis;
pneumonia;
tuberculosis;
hepatitis;
cholecystitis;
jade.

Cough syndrome in combination with pain in the interscapular area appears against the background of problems with the lungs and bronchi. A typical symptom of impaired pulmonary function is difficulty breathing.

The appearance of vomiting is characteristic of peptic ulcers in the stomach, liver and kidney diseases, and myocardial infarction. The appearance of belching may indicate damage to the upper digestive tract.

Pain in the interscapular region is only a symptom. To achieve positive results and eliminate discomfort, you need to begin treating the underlying disease.

Back pain in women

In some cases, back pain in women may have a specific nature associated with the characteristics of the body and the processes occurring in it. We are talking primarily about the reproductive sphere.

As a rule, pain associated with gynecological diseases is localized in the thoracic and lumbosacral regions. The most common reasons include:

1. Menstrual cycle. During menstruation, a woman's hormonal background changes, which leads to a number of negative manifestations. This is primarily due to a decrease in the level of progesterone, which is responsible for the intensity of the pain threshold. A decrease in the pain threshold leads to the fact that even minor pain sensations become more pronounced. Also, hormonal changes lead to irritation of the intestinal walls and fluid retention, which provokes an increase in the volume of some organs and, as a result, compression of the nerve endings of the lumbar spine. The combination of these factors provokes the occurrence of back pain.

2. Pregnancy. Lower back pain in this case can be divided into two groups:

– First trimester pain. If painful sensations are accompanied by additional symptoms (bloody discharge, increased body temperature, etc.), we may be talking about the risks of miscarriage. – Pain in the second half of pregnancy. Most often, such pain is associated with physiological changes, namely: active growth of the fetus, provoking a change in the center of gravity in the position of the body, and preparation of the pelvis for the upcoming labor. 3. Diseases of the reproductive system. Most of the pain is concentrated in the lumbar region, which is explained by the topography of the female reproductive organs. The most common causes of this manifestation of pain are ovarian cysts, adnexitis, ectopic pregnancy, endometriosis, etc. 4. Menopause. During menopause, powerful changes and fluctuations in hormonal levels occur. Such a restructuring of the body leaves its mark on many systems of the female body. First of all, the skeletal system suffers, which, under the influence of hormonal changes, becomes more fragile and susceptible to various kinds of diseases. 5. Large breasts. A large bust size in combination with poorly supporting underwear creates additional stress on the spinal column, and, as a result, a woman has back pain in the area of the shoulder blades and lower back. 6. High heels. Wearing high-heeled shoes leads to the development of a number of diseases associated with pathological changes in the musculoskeletal system and back pain.

Factors contributing to pain between the shoulder blades

Painful sensations in the interscapular area can occur against the background of some vertebral pathologies:

osteochondrosis of the thoracic region;
problems with posture (kyphosis, scoliosis, kyphoscoliosis);
spondyloarthrosis;
humeroscapular periarthrosis;
protrusion and intervertebral hernia in the thoracic region;
intercostal neuralgia;
radiculitis;
spinal column injuries.

Problems in the functions of the spine can develop:

during sedentary work;
in the absence of sports;
under significant loads for which the body is not ready.

More than one spine may be the source of the problem. Painful manifestations may occur against the background of disturbances in the functioning of internal organs. For example, the presence of cardiac pathologies: angina pectoris, coronary artery disease.

In addition, pain syndrome can develop against the background of:

hepatitis A;
cholecystitis;
peptic ulcer in the stomach;
pulmonary diseases;
infectious pathologies.

Often, people who move little due to the specific nature of their work activity have to face a similar problem, since their muscular and ligamentous systems are weakened, and the muscle fibers in the shoulder girdle are tense for a long time. Such pain often bothers drivers, garment factory workers, etc.

Back pain due to coronavirus

Coronavirus infection leads to damage to many organs, but the lungs are primarily affected. Therefore, pain between the shoulder blades or under them is often a manifestation of inflammation that has developed in the lung tissue. Depending on which lung is more affected, the patient will feel pain under the left or right shoulder blade.

In addition to damage to the lung tissue, there is general intoxication of the body and an increase in temperature, which can also cause pain (ache) in the back and limbs.

Back pain after coronavirus is explained by the fact that the disease can not only damage the nervous system, but also, against the background of a general decrease in immunity, chronic diseases, including internal organs and the musculoskeletal system, worsen.

III. Is it necessary to conduct additional research methods?

At the appointment, the doctor, after assessing your condition (clinical picture) and medical history, makes a conclusion about the need or lack thereof for additional research methods. In most cases, if the pain syndrome is benign, the diagnosis is made based on the patient’s clinical picture. If there are “red flags”, depending on the conditions that the doctor wants to exclude, additional research methods may be prescribed, such as a blood test for inflammatory markers, tumor markers, MRI, computed tomography, radiography, or referred for consultation to a specialized specialist.

Back pain after sleep

The reasons why your back hurts after sleep can be:

work involving physical activity and heavy lifting;
low back muscle tone;
history of intervertebral hernia and osteochondrosis;
prolonged hypothermia of the back;
curvature of the spine, leading to muscle strain and uneven contraction;
excess body weight, resulting in increased load on the back area;
stressful situations;
uncomfortable sleeping place.

Unpleasant sensations can have varying intensity and appear under the ribs, in the lower back, between and under the shoulder blades.

To eliminate pain that occurs after sleep, it is necessary to exclude all provoking factors and consult a doctor to prescribe treatment.

Application therapy Lyapko

Lyapko applicators in various modifications (plates, rollers, application belts, application tapes) are an original, powerful device with many health-improving therapeutic capabilities.

Their action is based on the principles of traditional Chinese medicine - superficial multi-needle acupuncture, as well as on the general physiological mechanisms of life.

Mechanisms of action of the applicator.

The high healing effect of Lyapko applicators is due to a combination of intense reactions:

reflex-mechanical;
galvano-electric;
immunological.

Application therapy has a pronounced analgesic and antispasmodic effect. Improves blood circulation, lymph flow, microcirculation, reduces tissue swelling. Activates tissue mechanisms of immune defense, increases the level of its own opiate peptides and anti-stress hormones in the blood, reduces the level of sensitivity of pain receptors, has a positive psycho-emotional effect and, as a result, stimulates general human adaptation mechanisms. In contact with the skin, the applicator needles stimulate the release of a person’s internal medicines, engaging his “inner doctor” in the work.

It is important to note that local (local) improvement of blood circulation during application therapy occurs without additional stress on the heart, since the work of peripheral circulation increases and the heart rests at this time. This is very important for all categories of patients and, especially, with coronary heart disease, circulatory failure of 1-2 degrees, and elderly people.

For back pain, many patients experience positive dynamics from Lyapko application therapy. It is combined with all types of medication and physiotherapeutic treatment. The ease of use of Lyapko application devices and their safety make it possible to carry out such procedures at home.

After removing the applicator at the site of its application, all pores are open for 10 minutes, so to improve the healing effect, you can apply ointments and creams that have an analgesic and anti-inflammatory effect.

Back pain - which doctor should I contact?

The primary diagnosis of pain in the back area is carried out by a general practitioner. If necessary, a number of additional examinations and consultation with highly specialized specialists may be prescribed:

neurologist;
gastroenterologist;
gynecologist;
urologist;
pulmonologist.

To make an accurate diagnosis, it is necessary to conduct a detailed analysis of the patient's condition. For these purposes, the doctor may prescribe a number of additional studies:

Lab tests. Most often, this list includes general and biochemical blood tests, urine and stool tests, and in some cases, analysis of hormone levels. These studies help identify possible inflammatory processes and infections. If certain diseases or an oncological component are suspected, the doctor may prescribe a number of specific studies (biopsy, tumor markers, etc.).
Hardware research. They help to obtain a more clear picture of the course of the disease, which cannot be achieved with visual examination and palpation. The most commonly prescribed are radiography, MRI, and ultrasound.

How to use the applicator, application zones

In 90% of cases it is necessary to act on the pain zone, and to increase efficiency on additional and auxiliary zones. The general formulation should always include the core area (spine area).

The main zones are located on the back surface of the torso, head, and neck.

They are named the main ones due to the fact that the areas of skin on both sides of the spine and directly above the spine are closest to the exits of the roots of the cranial and spinal nerves and other structures.

Very important meridians also pass here, which influence all organs and systems of the body in the area in which they pass, control a person’s protective energy, and influence his resistance to diseases.

Thus, multi-needle multi-metallic exposure is desirable and most effective on the area of the skin surface above the spine to the right and left of the spinal column and on the back surface of the torso, head and neck. You can apply it to the spine itself.

The choice of the most important area (zone, strip, segment) of the skin on the posterior surface of the body will depend on the main diagnosis, pathology, area of damage to certain organs, and the level of segmental innervation of these organs.

In the methodological recommendations for the use of Lyapko's application therapy, a schematic drawing is always given for each disease indicating the required areas of application.

Auxiliary zones are the anterior surface of the torso, head and neck. Due to the fact that the internal organs and endocrine glands are located directly under the anterior abdominal wall, under the chest, in the neck, face, exposure to them or to individual skin areas (metameres) in these areas using different metal needle applicators helps regulate, normalization, restoration, improvement and activation of the activities of these bodies. The result is achieved faster when using auxiliary zones simultaneously with the main and additional zones.

Accessory zones: zones of the skin of the lower and upper extremities, which are secondary (peripheral) in relation to the (central) structures of the spinal cord and brain.

On the inner and outer surfaces of the arms and legs there are zones of “Yin” (female) and “Yang” (male) groups of channels - meridians of organs located on a certain surface of the arms and legs, and having different groups of points that differ in purpose.

Using for applications and influencing various groups of points of certain meridian channels, we have the opportunity to further regulate (change, enhance or decrease) the activity of certain organs and systems (general action). Thus, we intensify the work when applying Lyapko applicators to the main and auxiliary zones and additionally provide a therapeutic effect.

Additional (zones of the skin of the lower and upper extremities) and auxiliary zones (the anterior surface of the torso, head and neck) should also be used in cases where, for a number of reasons, it is impossible to influence the main zone (plaster applied, wound surface). To enhance the therapeutic effect, it is advisable to include in the formulation an effect on symmetrical areas of the healthy side.

Thus, the result is achieved faster when using the main zones simultaneously with additional and auxiliary zones, or if this is not possible, then alternately.

It is recommended to use flat applicators of large sizes on the back area: Applicator “Large Mat”, “Large Needle Massage Mat”, “Chance 6.2x4”, “People’s”.

“Chamomile M”, “Quadro”, “Duet”. The larger the impact area, the better the effect.

It is also possible to use flat applicators of smaller sizes: “Needle massage pillow”, “Insoles plus”, “Chance”, “Sputnik plus”, which are placed on the pain area. In addition to the back area, to enhance the effect, it is recommended to use applicators on auxiliary zones on the front surface of the body, in the area of pain projection. For example: pain in the thoracic spine - place the applicator on the sternum. The exposure time is 20–30 minutes, the course of treatment is 10–14 days, which can be repeated after a break after 1–2 weeks. Such procedures can be used in courses for a long time.

It is better to complete the session by treating the feet using the Insole Plus applicator, which can also be used on all parts of the body.

In addition to flat applicators, you can roll the area of the back, front surface of the body, arms, legs with the “Large Roller M” or “Universal Roller M” until the skin becomes uniformly pink in color. They can also be used to warm up the body before a massage.

First, roll along the spine, along the intercostal spaces on one side, until a uniform pink color appears. Then, we roll the second side in the same way. Exposure time is 3–7–10 minutes depending on the individual skin reaction.

Belt “Baby”, Belt “Universal M” is attached across and along the spine to areas of pain or applied in a lying position, like a regular applicator.

You can also wrap the pain area with the “Health Magic Tape”.

The “Speck” applicator can be fixed on the pain area. Considering the small area of influence, wearing is long - 1 - 3 hours.

You can use either a manual back massage or a massage using the Pharaoh massager, which can be used through thin fabric or over the body lubricated with oil or cream. The duration of the massage and its intensity determines the desired effect. Long lasting, up to 15 minutes. and more, massage promotes complete relaxation of muscles and creates a sedative (calming) effect. A short massage, 3–5–7 minutes, has a tonic (stimulating) effect. During the session, you should perform circular movements clockwise or longitudinal movements up and down.

After the massage, we recommend laying on a flat applicator for rest and relaxation.

Points on additional areas (lower and upper limbs) to relieve back pain. A small “Speck” applicator and application belts can be attached to the dot area (Fig. 1)

Fig.1