Day to day, it’s easy to lose sight of how interconnected our bodies truly are. For example, we rarely consider the position of our feet influencing stress on our knees and hips, and we don’t often think about the control of our arms and legs affecting the load we experience in our spines. Similarly, shoulder pain is rarely just about the shoulder, itself. It often involves surrounding structures like the neck. This article will dive deeper into the relationship between shoulder pain and your neck, as well as the surprising connections between the two.

Anatomical Factors for the Shoulder & Neck 

When considering the relationship between shoulder pain and the neck, we have to ask ourselves what factors bring them together. The main anatomical features to consider include: bones, muscles, and nervous tissue. Let’s take a look at each!

Bones

The skeletal connection between the neck and the shoulder serves as a foundation for how the two regions interact with one another. The cervical spine (neck) has 7 segments that support the skull. At the shoulder, the collarbone and shoulder blade help to form the shoulder joint. You can hopefully then begin to see that the bones of the shoulder joint rely heavily on the stability of the neck. Therefore, things like arthritis, bony abnormalities, or dysfunction at one joint can affect the function of the other.

Muscles

We’re all familiar with several muscles throughout our upper back. Most of us are less knowledgeable about where those muscles attach, their specific functions, and how they can impact our bodies when injured or irritated. Truth be told, many muscles attach from the neck and impact motion and function at the shoulder.

• Trapezius: The trapezius muscle originates from the base of the skull, neck, and upper back, connecting to the shoulder blade and collarbone. Its function is to help move and stabilize the shoulder blades, allowing us to shrug our shoulders and extend our necks.
• Splenius: The splenius muscle starts at the upper back and connects to the base of the skull and the neck. It helps rotate and extend the neck, as well as maintain posture.
• Rhomboids: The rhomboid muscles originate from the upper back/lower neck and attach to the inner edge of the shoulder blade. Their primary function is to pull back and stabilize the shoulder blades, keeping them in line against the ribcage.
• Levator Scapulae: The levator scapulae muscle starts at the neck and connects to the upper corner of the shoulder blade. Its function is to lift the shoulder blade and assist with neck movements like tilting the head to the side.

Understanding where these muscles attach and how they function, it’s clear why tightness, weakness, or injury in one area can impact the other.

Nerves

Nerves act as the body’s communication system, connecting the brain and spinal cord to the rest of the body. Many of these nerves exit the spine near the neck and extend into the shoulder, arm, and hand. This interconnected network allows for coordinated movement and sensation.

 

LISTEN: TREATING NERVE PAIN WITH NEURODYNAMICS

 

However, when a nerve is compressed, irritated, or lacks mobility, it can lead to a range of symptoms, including pain, numbness, or weakness. This is especially common in the cervical spine, where the spaces through which nerves exit can become restricted due to posture, injury, or degenerative changes.

 

Common Conditions Involving The Head and Neck

Now that we know some of the contributing factors that bind the function of the neck and shoulder, let’s talk about some of the most common conditions involving the two regions.

Cervical Radiculopathy, or “a pinched nerve”: As previously mentioned, when the nerves leave the spinal cord near the neck and become compressed, this can lead to irritation. The effects are most commonly felt in the shoulder and potentially even down into the arm. This is such a common phenomenon that it has been described through Clowards Sign, which demonstrates various areas of discomfort along the shoulder and the most likely affected nerve in the neck (1).

 

 

Muscle Strains: We mentioned common muscles between the neck and shoulder previously, now it is time to discuss what happens when injury occurs. A strain occurs when the muscle is overstretched either suddenly or over time. A sudden strain, or “whiplash,” can result from the head being thrust quickly (think car crash or trauma). A more chronic strain can come from poor positioning, such as sitting in the same position for 8-10+ hours daily. In either case, the tension placed on the muscles originating at the neck can lead to discomfort at the shoulder.

 

Improve your Neck and Shoulder Mobility

Looking to jumpstart your journey to a pain-free neck and shoulder region? Get started with our 8-week Neck and Midback Rehab program through the Prehab App! Start with a 7-day free trial today! 

 

Get more information on muscle strains listen to the podcast below!

LISTEN: WHAT IS THE BEST WAY TO TREAT A MUSCLE STRAIN?

 

 

Treatment for the Shoulder and Neck Connection

Understanding the link between shoulder pain and the neck is the first step toward effective treatment. Because the neck and shoulder are so interconnected, treating one area often requires addressing the other. Here are some common approaches to managing and alleviating pain in these regions:

Targeted Exercises: If there is a specific deficit in place or tissue that has a limitation (ie. decreased joint range of motion or weak/painful muscle), it is important to address it promptly. Loss of range of motion of the joints of the neck or loss of strength of the muscles between the neck and shoulder can quickly impact function. If you are dealing with ongoing pain in your shoulder or feel limited in your current motion, having a full assessment from a professional could help you better determine the tissue involved. Try a few of these exercises below to get started on some healthy neck and shoulder mobility exercises!

 

 

Postural Modifications: One of the easiest ways to improve shoulder pain that stems from the neck or vice versa is to address your posture. This doesn’t mean you have to assume a militant position and always have your shoulders pulled back or be stiff and upright. Instead, focus on changing positions or postures frequently throughout the day. I’ll often tell my patients, “the best posture is your next posture.” No one can comfortably sit upright all day, and frankly, it’s not beneficial. Instead, focus on ways you can move positions to give your neck, shoulders, back, etc. a break. The best thing you can do in many cases is to continue to move. If you have a desk job and are able, consider utilizing a standing desk. If this is not a viable option, consider going for a short walk, standing to stretch, or doing some chair yoga every hour or so (2). Get some more ideas for specific postural exercises in the blog below!

 READ: THE BEST POSTURE EXERCISES

 

Manual Therapy:

Sometimes, hands-on techniques can provide significant relief for pain stemming from the neck or shoulder. Manual therapy techniques could include gentle mobilizations of the joints in your neck, stretching of tight muscles, or soft tissue techniques to improve blood flow and tissue mobility. These treatments can help reduce pain and stiffness, allowing you to regain comfortable movement. However, you shouldn’t only rely on these passive treatments. Manual therapy is most effective when combined with exercise to address the root cause of the problem. Think of manual therapy as a tool to help you “unlock” movement, giving you a window of opportunity to strengthen and stabilize the area (3).

 

Nerve Glides:

Nerves need three essential elements to work properly: oxygen, movement, and space. When a nerve becomes compressed, irritated, or restricted, it can lose mobility and start to function poorly. This can lead to symptoms like pain, tingling, numbness, or even weakness in the affected area. To restore full function and mobility, one of the most effective techniques is performing nerve glides, also known as “neural flossing.”

Nerve glides involve carefully moving the nerve through its natural range of motion by repeating specific movements. These exercises are designed to gently stretch and mobilize the nerve, reducing tension and creating more space for it to function.

 

Initially, these movements should be performed within a comfortable range, avoiding pain or irritation. Over time, as the nerve becomes more mobile and symptoms improve, the range of motion and intensity of the exercises can be gradually increased. Consistency is key, and regular practice will help retrain the nerve and surrounding tissues to function optimally.

 

Closing Thoughts:

By now, it should be clear that the shoulder and neck share a unique relationship, where dysfunction in one area can often lead to issues in the other. Understanding this connection is essential for effectively diagnosing and treating pain, as addressing only the shoulder or neck in isolation may leave underlying problems unresolved.

The interplay of bones, muscles, and nerves highlights how our bodies are designed to work as a cohesive unit. This means that improving mobility, strengthening key muscles, and addressing nerve function in both regions can lead to better outcomes, not just for pain relief but also for long-term health.

Remember, the key to lasting relief is recognizing and treating the body as a whole, not just focusing on individual symptoms. Whatever your treatment looks like, make sure you are taking an active approach to address your health, rather than waiting for things to improve on their own. Your neck and shoulders will thank you for it.

See our neck programs through the Prehab App here!

Improve your Neck and Shoulder Mobility

 

Resources:

1. Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011 Oct;7(3):265-72. doi: 10.1007/s11420-011-9218-z. Epub 2011 Sep 9. PMID: 23024624; PMCID: PMC3192889.
2. Ghamkhar L, Kahlaee AH. Is forward head posture relevant to cervical muscles performance and neck pain? A case-control study. Braz J Phys Ther. 2019 Jul-Aug;23(4):346-354. doi: 10.1016/j.bjpt.2018.08.007. Epub 2018 Aug 22. PMID: 30145129; PMCID: PMC6630105. (neck pain and posture)
3. Wilhelm M, Cleland J, Carroll A, Marinch M, Imhoff M, Severini N, Donaldson M. The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis. J Man Manip Ther. 2023 Dec;31(6):393-407. doi: 10.1080/10669817.2023.2202895. Epub 2023 Apr 24. PMID: 37092822; PMCID: PMC10642331. (manual therapy)

 

About The Author

John Schaefer PT, DPT, OCS, CSCS

[P]rehab Writer & Content Creator

John is a native of Rochester, MN and a double graduate of Saint Louis University, where he studied marketing and exercise science before earning his DPT.

Always up for an adventure, John traveled to Boston following graduation to intern at Champion PT and Performance. There he was able to work with high-level high school, college, and professional athletes. Following this experience, he headed south to pursue orthopedic residency training in Houston, TX at Harris Health System, working with a largely underserved and non-English speaking population.

John’s treatment philosophy hinges on empowering movement through extensive education and easy-to-replicate exercises, as well as meeting patients where they are. This perspective is shaped by his personal experiences, including five broken bones and two surgeries, during a multi-sport childhood filled with lots of activity and adventure.

Outside of work, you can find John cycling, attending concerts/festivals, hiking, and traveling!

Follow along on instagram @johnschaefer.dpt

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.