The shoulder blade, or scapula, is a flat triangular bone in the middle of your back. It’s supported by a network of muscles that help you move your arms. When these muscles are tight or strained, it can cause pain between the shoulder blades. The most common reason for back shoulder blade pain is a tense muscle or “muscle knot.” This can be caused by an injury, lifting something heavy, or even bad posture. The knot may feel tender to touch, and the area around it may be difficult to move.

A herniated spinal disc in the neck may also cause pain between your shoulder blades. This occurs when the soft, gel-like center of a spinal disc pushes through a crack in the tough outer layer of the disk. The pressure on the nerves in this area can cause numbness or tingling in your arms or hands.

Other causes of pain between the shoulder blades include a heart attack, acid reflux, gallstones, and pancreatitis. Symptoms of a heart attack, such as chest pain and shortness of breath, are often the same as those of a herniated disc.

Most types of back shoulder blade pain are treated with over-the-counter (OTC) pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Cold therapy—using an ice pack for up to 20 minutes every few hours—and gentle stretching exercises can also reduce the pain and stiffness. If your pain gets worse or you’re experiencing other red flag symptoms, such as numbness or tingling in the arms or legs, seek emergency medical attention right away.