Landreneau Physiotherapy, LLC
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Why Your Neck Pain Can Be The Result of a Shoulder Problem

It is not uncommon for a client to present to us with complaints of chronic neck pain and also demonstrate a same sided shoulder mobility deficit (aka tightness) . It’s also not that uncommon for that person to look at us like we are crazy when we explain to them that in order to help the neck we must also address the shoulder. The shoulder-neck relationship is often overlooked by many medical professionals. As a result, many individuals find themselves with persisting neck pain even after spending countless dollars on unsuccessful doctor visits, chiropractor and physical therapy visits, oils and muscle rubs, medications, and worst of all unnecessary surgeries. Undoubtedly, most of these individuals do have a diagnosed neck dysfunction backed up by MRI or XRAY which causes both the patient and the practitioner to zero in on the neck and ignore all associated joints. What people often fail to realize, however, is that the neck dysfunction can very likely be the direct result of a compensation made repeatedly over time secondary to a lack of adequate shoulder mobility. I would like to also add that the opposite can also be true. Meaning, that we do also see shoulder problems that are a direct result of cervical or thoracic hypomobility. For the purpose of this blog we are going to focus solely on neck pain caused by shoulder tightness.

In order to better demonstrate the shoulder-neck relationship let us examine a real life example. Earlier this week we had a client present to use with complaints of right sided neck pain. This particular client is young and active and she has been noticing this pain for a while with any over head activity and recently she is starting to feel the pain even at rest. A few weeks ago she went for a deep tissue massage hoping that this may take care of the issue. She reports that she did feel some relief initially but the pain returned. Upon examination the client was found to have decreased range of motion ( ROM ) of the right shoulder compared to the left (most significant flexion, abduction, external rotation and horizontal adduction with scapula stabilized). Another significant finding was that her neck ROM was minimally impaired.

So what does this tell us and how does this relate to the client’s neck pain? As we mentioned earlier, the client initially had complaints of neck pain with any overhead movement. Due to the lack of mobility in her right shoulder she must over compensate with excessive upward rotation of the scapula and lateral neck flexion which occurs by reflexive contraction of the upper trapezius and levator scapulae muscles which also attach to the vertebrae of the neck. This over engagement of the Upper Trapezius and Levator Scapulae musculature results in abnormal pulling on the spine as well as over-straining of the involved muscles resulting in pain. As she continues to abnormally stress these muscles she begins to notice the pain even at rest. This relationship between lack of shoulder motion and neck compensation is why the deep tissue massage of the neck and upper back musculature only relieved the clients pain temporarily. If the cause of the dysfunction is not addressed the compensation pattern will continue to occur causing the pain to return time and again.

I should also mention that for simplicity sake I am not diving deep into the other less significant findings that were addressed in this patient’s treatment including: hypomobility of the thoracic spine, costovertebral joints, and cervico-thoracic junction, and tightness of the lats and the subscapularis muscles.

This client is just one of many clients we have seen who exhibits shoulder stiffness with associated neck pain. The body functions as a unit and it is absolutely crucial that we look at the whole picture when it comes to examining and treating musculoskeletal pain and dysfunction.

Featured Below: Four part video series capturing our most recommended exercises for shoulder pain/mobility management