Pain under left shoulder blade with exercise - does this happen to you?

July 10, 2017 9:12 AM

I get pain under my left shoulder blade with exercise. I've had an EKG - normal! - and the doctor does not feel that I need further heart workup right now. I know she'll do it if I press for it, though, so I'm trying to decide. Does this pain happen to others? What could cause it?

I've talked to my doctor and a PA pretty extensively about this; based on the EKG and my medical history, neither feels that it is an emergency. But it's weird, man.

So I've always had muscle knots in one place under my left shoulder blade. When I'm weightlifting regularly, they are under control, but they are never entirely gone. They always hurt when pressed and I get a lot of associated back/neck symptoms. I also seem to get costochondritis-like soreness in my ribs, although I've never bothered to talk to the doctor about this since it hurts, I rub and stretch and it resolves. Lately, life has meant that I'm not weightlifting as much, although that should change soon.

For many years, I've had occasional pain under my left shoulder blade during strenuous biking - like when I'm climbing a hill. It goes away after I crest the hill.

It is a localized pain, a few inches long and not wide - like a line of pain right under the shoulder blade.

Lately it's been worse, but only sometimes. Sometimes I'll do a whole bike ride with hills and have no pain at all, but on one occasion it hurt so badly that I felt like I could not continue biking. I went on and it went away.

I have high cholesterol. I'm working on this with the doctor, who wants me to try losing weight before taking medication. My parents, who are retired, have super ridiculously healthy hearts, but my dad's father died of a heart attack at 53.

I am good at somatizing - I get anxiety but don't feel anxious, I just get symptoms. So if I start thinking about heart attacks, my heart rate picks up and my left arm feels funny - but this never happens if I don't think about them.

Anyway - given that my doctor feels that this is not an emergency and I have not had a heart attack: does this ever happen to you? Ought I to press for a full heart workup? What could be causing it if not heart?

posted by Frowner to Health & Fitness (12 answers total)

They always hurt when pressed [...] For many years, [...] Sometimes I'll do a whole bike ride with hills and have no pain at all

This is likely why they aren't worried. I'd generally follow your doctor's recommendations, since this is a long-term issue for you and testing shows that this hasn't made any immediately-visible impact on your cardiac health.

If further testing would make you feel better, go for it.
posted by flibbertigibbet at 9:27 AM on July 10, 2017

I am an emergency physician. The pain you describe would be very atypical for cardiac-related discomfort, but that does not mean there is zero possibility of a cardiac cause. I don't know how old you are, or what your other risk factors for coronary disease are. Regardless, referral to a cardiologist for evaluation (likely to include an exercise stress test) would be very appropriate in this situation, if for no other reason than to reassure you. I would ask your PCP about this and I'm sure they will be happy to oblige.
posted by killdevil at 9:31 AM on July 10, 2017 [2 favorites]

That said, I'm only recommending that you follow your doctor's advice. If anything changes, let your doctor know, and if anyone else has this issue, they should speak to a doctor.
posted by flibbertigibbet at 9:34 AM on July 10, 2017

Insist on a full work-up with a cardiologist. It's getting worse and it's worth identifying a problem early if there is one. If there's no problem found, great, you can avoid the anxiety cycle about it.
posted by quince at 10:00 AM on July 10, 2017

If you suspect it's muscular and weightlifting helps control it . . . IANAD, but this sounds like the pain I get under my right shoulder blade, which is associated with my arm, shoulder, and back muscles misbehaving due to an injury. Weightlifting and working out keep it under control, but my trainer is also a physical therapist, and he's helped me a lot with workout stuff *specifically* to help my arm, shoulder, and back.

Food for thought.
posted by Medieval Maven at 10:26 AM on July 10, 2017 [1 favorite]

Obviously you should see about the possible cardiac issues, I don't know anything at all about that, so don't let this comment dissuade you from getting that fully and completely checked out to your own satisfaction.

But I have minor scoliosis, and used to get a pain under my right shoulder blade that sounds quite similar. It got quite bad when I was a student (under extra stress and extra backpack), so I went in to see what could be done. I went to PT for a while, and the root cause turned out to be all sorts of little imbalances due to the scoliosis, but they could have come up for other asymmetry reasons (I used to ice skate and always landed on the same foot! I'm strongly right handed and do most tasks with that hand!). Anyhow the PT was able to find some exercises that eventually reduced the pain. I also stopped wearing any backpack without a sternum strap, and adjusted my working space to stop exacerbating it. It has been quite some time since it came back, but when it used to I would do the PT exercises again and it would resolve.

So in sum, if it doesn't seem to be cardiac, still might be treatable. A good PT is very useful.
posted by nat at 10:43 AM on July 10, 2017

I think it's muscular as well. There's a lot going on in that area.
I'm throwing a dart to say it starts with your spine and ribs.

Might be worth it to see a really skilled chiro or massage therapist.
posted by littlewater at 10:46 AM on July 10, 2017

I realize I'm saying this as a massage therapist (and thus see muscle problems every day), but it sounds muscular. There's probably a trigger point (or several) in the muscles around your shoulder blade (rhomboid, trap, etc), and while it isn't always hurting, activity can inflame and irritate it.

I would see a PT or a massage therapist who specializes in trigger point therapy. Is the pain underneath the shoulder blade, or is it between the shoulder blade and spine? If you can, trying positioning a tennis ball on the problem area (as you stand against the wall), and see if that pressure helps to relieve it.
posted by hopeless romantique at 10:46 AM on July 10, 2017 [3 favorites]

I had a similar knot around the shoulder blade arise from competing in judo, and it's stunning how much better I felt after self-massaging it with a tennis ball. Lacrosse balls and foam rollers work too. You lay on the floor with the tennis ball (or whatever) underneath the muscle around your shoulder blade, and slowly gently roll around until you find the spot with the ball. You relax into it, you roll around it, you put more and less weight on it, and so on. It's vaguely like Kelly Starrett shows here, with both the ball and the band, though it's important to add to what he shows some "hugging myself, rolling back and forth", "rolling up and down over the ball", and "expanding chest, arms spread wide" movements to the overhead one he does.
posted by daveliepmann at 1:09 PM on July 10, 2017

Oh hey, I had a similar symptom for the longest time. I too was worried it was cardiovascular; for me it ended up resolving after some sessions of massage and acupuncture, and being more mindful of ergonomics. It got worse with stress.
Sometimes mild discomfort or pain will re-emerge now if I'm stressed or doing dumb body shit for a while but not in the same way. Check out a massage therapist if you can.
posted by nixon's meatloaf at 2:57 PM on July 10, 2017

Could it be heartburn? I had a similar pain recently that no amount of stretching seemed to fix; turned out that's what it was.
posted by exceptinsects at 8:08 AM on July 11, 2017

Could be your scalenes. Have had more than a few clients describe similar pains and then get it diagnosed as a scalene issue. There are plenty of good videos for trigger points, SMF, stretching, self massage etc. I'm not your doctor, but would be worth looking into.

The scalene pain often occurs along the inferior, medial area of the shoulder blade. That's the bottom corner of your shoulder blade, towards your midline/spine.
posted by Telf at 6:37 AM on July 16, 2017