The prevalence of shoulder pain tends to increase and become more severe as we age – especially for folks in their 50’s and beyond.

When people complain of shoulder pain – it can manifest in a lot of different ways. Sometimes pain appears in the front, sometimes on the very top of your shoulder, sometimes deep inside your joint… But probably the most annoying and uncomfortable type of shoulder pain I hear about is the one that occurs deep inside your shoulder blade.

It’s tough to get to, tough to pinpoint, and even harder to make go away.

It kind of feels like middle back pain – but also feels like shoulder pain – so which is it? And more importantly… Why isn’t it going away?

There are many reasons why we get shoulder pain and there’s a good explanation why it can move around and appear in so many places. It’s the most mobile joint in your body, which lends itself to lots of ways to get injured. And to add even more confusion – 47% of all shoulder pain originates from a source in your spine (neck) – even when you don’t have any neck pain.

Therefore, misdiagnosis of shoulder pain is very common and it’s probably the most common reason I see for that nagging shoulder blade pain not going away – no matter how many times you massage it, stretch it, or “thera-gun” it.

If you’ve had nagging shoulder blade pain for a while now and it’s not going away – there’s a really good chance it’s not actually a shoulder problem and you’ve been misdiagnosed.

Let’s look at a few key signs and considerations to help you figure out if that nagging pain in the middle of your shoulder blade has been misdiagnosed:

1. Location of your pain?

When your pain is coming from a source within your shoulder, the pain will be localized to your shoulder joint. “True” shoulder pain is typically felt directly in front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm. But the pain will never radiate below your elbow. If the nagging pain in your shoulder blade ever causes pain past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area) – odds are pretty good that you’re dealing with a spine problem and not a shoulder problem.

2. Do you experience numbness, tingling or burning?

If the nagging pain in your shoulder blade is ever associated with numbness, tingling, or burning – these are signs of nerve irritation, or perhaps nerve compression. If that’s happening – the problem is almost certainly coming from your neck. It’s very common for things like bulging discs to compress nerves, or limit movement, which can irritate nerves in your neck. The nerves in your neck will commonly refer symptoms into your upper shoulder/upper trap area, down your arm, and… you guessed it… right into the middle of your shoulder blade. And remember – you could be experiencing the referred symptoms without much (or any) pain in your neck. If you’ve got symptoms of numbness, burning, or tingling in your arm or shoulder along with nagging shoulder blade pain – and you haven’t yet gotten your neck examined by a mechanical pain specialist – there is a good chance you’ve been misdiagnosed.

3. Does posture affect your pain?

Do you notice that your shoulder blade pain changes depending on your posture? This is another telltale sign that your shoulder blade pain is likely coming from your neck. Our heads are inclined to remain upright on top of our shoulders to look ahead at what’s in front of us. So when you slouch your middle back – your neck will always compensate so your head can look forward. Ever hear of the term “forward head posture”? That’s what we call the compensation your neck makes for curved, slouchy posture in your middle back. And in forward head posture, you will stretch out and eventually irritate the nerves in your lower neck. The nerves in your lower neck – particularly the areas of your C6 and C7 vertebrae – refer right into the middle of your shoulder blade. So if you notice the pain easing when you sit upright or lie down, and increasing with long car rides or sitting at a computer (when your back tends to be slouched) – there’s a very good chance the pain in your shoulder blade is coming from your neck.

The good news is that even if you’ve been misdiagnosed for some time, nagging pain in your shoulder blade is typically a mechanical problem and can be fixed naturally with a corrective movement prescription, postural training and education, and strengthening the areas around your neck and middle back. You don’t need to resort to injections or pain killers. Do me a favor though – don’t try and fix this problem yourself or by looking up exercises on YouTube. We call it a movement prescription for a reason – and it should be prescribed to you by a physical therapy specialist who has a deep understanding of the intricacies of mechanical pain and how it all works. If you want help finding someone like this in your area – get in touch – I’m happy to help.

Local to the DMV area? Looking for movement experts or a mechanical pain specialist to help you with lingering shoulder pain and unsure where it’s coming from and how to make it go away? Schedule a free discovery visit with us today

---

CLICK HERE to request a Back Pain Strategy Session from a back pain specialist at my clinic, or email at trupti@mmsspt.com, or CALL (202) 670 8874 for a FREE telephone consultation so we can ask you some questions and help you better.

Trupti Mehta PT, MS, OCSManual Medicine, Spine & Sports Physical Therapy, Washington DC

Knee pain can be stubborn. If you’ve tried stretching, strengthening, injections, or even surgery with little to no relief – it might be time to consider looking beyond your knee. Many people are told their pain is due to “wear and tear,” arthritis, or simply aging. But here’s the thing… There are plenty of people out there with these very same conditions who have no knee pain at all.

So, what gives?

It turns out that knee pain isn’t always a knee problem.
If you’re still dealing with persistent discomfort despite following every piece of conventional advice, one of these four lesser-known culprits might be the real reason behind your lingering knee pain.

1. It’s Not Your Knee—It’s Your Back

Did you know that nearly 40% of extremity pain actually originates from the spine – even if you don’t have back pain? The nerves that control your knee function start in your lower back. If they’re irritated, compressed, or not functioning properly, your knee could suffer the consequences.

A key sign that your knee pain is actually coming from your back is if your pain moves around, travels up or down your leg, or worsens when you sit for long periods. If your knee treatments aren’t working, it’s worth investigating whether your back is the real issue by talking to a mechanical back pain specialist.

2. Your Core is Weaker Than You Think

When people hear “core strength,” they usually think about back pain or six-pack abs – but your core plays a massive role in knee health, too. Your core, hips, and glutes work together to stabilize your lower body. If these muscles are weak, your knees pick up the slack, leading to unnecessary strain and chronic discomfort.

Signs of a weak core affecting your knees include feeling unstable on one leg, difficulty maintaining good posture, or knee pain that worsens after prolonged activity. The solution? Strengthening your core and hips can take the pressure off your knees and keep them moving the way they should.

3. Your Ankles Might Be the Problem

Your ankles act as the foundation for your entire lower body. If they lack mobility or stability – your knees will compensate – leading to stiffness, pain, and dysfunction. Poor ankle mobility can make everyday movements like walking, running, and squatting much harder on your knees.

If you struggle with ankle flexibility or feel unsteady during activities like hiking, running, or sports – your knee pain may actually stem from weak or restricted ankles. Addressing ankle stability and mobility could be the missing link to finally getting relief.

4. Your Knee Isn’t Moving the Way It Should

One of the most overlooked aspects of knee pain is mobility. There might actually be nothing at all wrong with your knee – but if it doesn’t move as well as it should – structures within and around your knee joint will slowly start to get irritated. Most rehab programs focus on bending the knee – but proper knee function also requires slight hyperextension – and this is where I see a lot of problems for people. If your knee stops at “just straight,” it may still be restricted, causing long-term dysfunction and discomfort.

Pro-tip: This is especially common after surgery, where full mobility isn’t always restored. If one knee doesn’t move like the other, it’s time to work with a mechanical knee pain specialist who can prescribe corrective movements to help you regain that lost range of motion.

What to Do Next

If you’ve been dealing with knee pain that just won’t go away – there’s a good chance you either have the wrong diagnosis – or the wrong treatment plan. You may need to stop focusing on the knee and start to look elsewhere in your body. The real problem might be coming from your back, core, ankles, or mobility restrictions somewhere leading to secondary stress on your knee joint.

A mechanical pain specialist who understands the bigger picture can help pinpoint the true cause of your pain and create a plan that actually works to finally get your knee pain resolved.

---

CLICK HERE to request a Back Pain Strategy Session from a back pain specialist at my clinic, or email at trupti@mmsspt.com, or CALL (202) 670 8874 for a FREE telephone consultation so we can ask you some questions and help you better.

Trupti Mehta PT, MS, OCSManual Medicine, Spine & Sports Physical Therapy, Washington DC