This case looks at the link between shoulder blade pain and breathing.
Presentation
A woman attended with severe shoulder blade pain. Over time, she had also developed chest tightness and episodes of breathlessness. She had already been assessed in emergency care and had received several other treatments before attending.
During the conversation, one phrase stood out: “I can’t catch my breath.” This shifted the focus of the assessment from the shoulder blade itself to how she was breathing.
Assessing shoulder blade pain and breathing
Functional testing suggested that the serratus anterior, a muscle along the side of the ribs that helps control the shoulder blade, was not activating well. Her breathing pattern also appeared restricted.
Approach
Sessions focused on breathing control and serratus anterior function rather than on the painful area. No hands-on work was applied directly to the shoulder blade. She was also shown simple self-management strategies to practise at home.
What the client reported
Over the course of her care, she reported that her shoulder blade pain had eased considerably and that she felt comfortable standing, sitting and lying down. She was surprised that working away from the painful area had made a difference for her.
These observations reflect one person’s experience, and the reasons for these changes are not fully known.
Reflection on shoulder blade pain and breathing
The serratus anterior attaches to the upper ribs and runs underneath the shoulder blade to its inner edge. It helps hold the shoulder blade against the rib cage and move it when you reach forward or overhead. Because it sits directly on the ribs, it is one reason shoulder blade pain and breathing are sometimes worth looking at together in a movement assessment.
This case was a reminder that the place where pain is felt is not always the whole story, and that listening closely to how someone describes their symptoms can change the direction of an assessment.
However, shoulder blade pain and breathing difficulty, especially with chest tightness, must always be checked by a doctor first, because it can be a sign of a heart or lung problem. Movement-based care is only appropriate once serious causes have been ruled out, and it should sit alongside medical guidance.
Related case reflections
- Case 19: Unexplained Limb Weakness and Breathing Restriction
- Case 37: Long-Standing Breathing Restriction and the Ribs
- Browse all case reflections
