Your shoulder pain could be coming from your neck

Many patients come to physical therapy looking for help with their shoulder pain. While there are many diagnoses of the shoulder that could be causing your pain, one commonly overlooked cause of shoulder pain is the neck. This is called “referred pain,” which means that impairments or injuries in one part of the body cause pain in a different area.

How does this happen?
All of the bones and muscles in the body are somehow connected to each other, so a change in one part of the body can have effects on the others. There are a few muscles that connect the 7 neck bones to your shoulder blades. If the bones in your neck becomes stiff, or the natural curve in your neck bones is changed by poor posture, this can cause an extra pull on or increased stress in these connector muscles. Since these muscles are connected to your neck and your shoulder, you may feel the pain from the muscle near the shoulder, even though the original problem (stiffness or posture) is in the neck! There are also 8 different nerves that come out of the spine from your neck, which branch out into even more nerves (just like a tree), and go around your shoulder and down your arm. Nerves send a signal from the muscles and joints to the brain when they’re hurt, and then the brain lets you know that something isn’t right by making you feel pain. Since the nerves of the neck and shoulder are so close together & connected, sometimes the brain has a hard time figuring out if the signal is coming from the shoulder or the neck, and sends you the wrong message. While it might be difficult for you to figure this out on your own, physical therapists know what questions to ask and what special tests to do to help figure this out.

Signs and symptoms:

  • Pain- While you may be feeling the pain in your shoulder, your pain usually will not change when you move your shoulder, such as when you reach overhead or you lift something. However, your pain might increase when you do things that move your neck such as turning your head, looking down, or looking up. Additionally, you may feel pain on the back of your shoulders, in the shoulder blades, or close to your neck.
  • Numbness and tingling: Numbness or tingling, or feeling “pins and needles” in the hands or fingers are usually a sign that the neck is the reason for pain, not your shoulder.
  • Stiffness: You may feel stiff in the neck and upper shoulder areas.

Physical therapy:
The overall prognosis for treating this type of pain with physical therapy is very good! Physical therapists are masters of muscles & joints, and know how to figure out if your shoulder pain is actually coming from your neck. The goal for our treatment is to move the pain away from the shoulder towards the neck, and then get rid of it all together!

  • Manual therapy: Physical therapists can use a variety of hands-on techniques that to help improve your signs and symptoms. Based on what we find during our evaluation we can develop a plan that will get at the root of your problem. These manual therapy techniques can include massage, trigger points, joint mobilizations, and manual stretching.
  • Stretching: Stretching of tight muscles around the neck & shoulder (such as the upper trapezius, suboccipital, scalene, and paraspinal muscles) can help. Physical therapists can do this manually as well as give you instructions for how to stretch these muscles at home.
  • Strengthening: Many patients who experience this type of pain will have decreased strength in the deep muscles of your neck. We will give you exercises to help strengthen your neck, scapular, and postural muscles to help alleviate your pain and improve your overall function.
  • Improving posture: Sitting with a forward neck, rounded or slumped shoulders, and improper alignment of your spine can play a major role in neck & shoulder pain. Physical therapists can evaluate your posture and give you strategies to improve it over time.
  • Movement!: This is very important. Although the neck may be the source of your pain, you should not stop moving your neck all together. For this reason we DO NOT recommend bracing and collars- they will likely do more harm than good, and exercise is the best medicine! Movement of the neck helps improve blood flow to the joints helping them to move better and also helps your bodies self-made healing-agents get to the site of the injury.
  • Education: A big part of what we do is teaching you how to manage this condition after you finish your physical therapy. We want to help give you the tools to maintain the progress you make during your time with us, as well as the ability to recognize the signs and symptoms that mean you should give us another visit.

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