Mary's right shoulder blade sits a little differently than her left but the real problem is the fact that it often aches or even burns. She's tried rubbing it, moving it around, applying heat and ice, but nothing seems to help except briefly. She saw her doc recently but he didn't think it was anything to worry about and gave her something for the pain. The prescription helped but Mary's not much of a pill taker and stopped using them.
Mary is probably suffering from irritation or injury of one of several nerves that service the shoulder blade region. The fact that the right shoulder blade flares outward a little suggests that the muscle assigned to hold the blade against the ribcage isn't doing a great job, which allows the whole shoulder to sag forward a little, thus adding compression to the very nerves, arteries, and veins that lie beneath the collarbone and feed the shoulder blade area. What began as a strain or overuse injury appears now to be spiraling into a greater problem.
Since her physician found nothing serious, it's reasonable to assume the cause is mechanical and to apply mechanical solutions. For six weeks, Mary should protect the right shoulder from mechanical insult of any kind. She should avoid carrying items that feel heavy, should limit or avoid the use of shoulder bags or backpacks, and should use bra strap pads or sports bras to minimize forces that dig into the muscles and nerves of the neck and shoulder.
In addition, Mary must do all in her power to decompress the areas where these nerves are being squeezed. She must restore and maintain optimal ribcage positioning by consistently stretching chest muscles and routinely strengthening upper back muscles using isometrics (see Blog #10). She must also improve upright posturing while sitting, standing, walking, working or playing and must avoid sleeping in the fetal position or on a saggy mattress or both.
Heavy exercising and/or weightlifting are not appropriate during this trial period because they may inflict additional pressure or friction on the aggravated nerves that will likely complicate recovery. Even swimming, biking, ellipticals, and jogging may provoke or at least retard recovery. So a smooth, well-postured, walking program makes more sense for aerobic conditioning, which is important to nerve recovery.
Shoulder blade nerves know how to heal and will do exactly that if Mary will stop insulting them. Healing of a severely injured nerve is a slow process and usually takes many months, even a year. Healing of a mildly injured nerve can occur in four to six weeks, hence the need for a six-week trial program. Chances are very good that Mary will notice some improvement during this period and it is hoped she will decide to make some or all of these corrective measures a permanent part of her life. Most people recover and can avoid further problems if they will simply maintain a spine-healthy lifestyle.