Is Your Shoulder Pain Actually From Your Neck? A Physio's Guide

As physiotherapists, we regularly see patients who have been treating their shoulder for months with limited results, only to discover the root cause was in their cervical spine. Identifying whether your pain stems from shoulder-specific tissue dysfunction or referred pain from your neck is crucial for developing an effective treatment plan.

After all, there's little point in obsessing over shoulder-specific rehab if hidden neck dysfunction is the true source of your pain.

What Is Neck-Related Shoulder Pain?

When we discuss referred pain from the neck, many people imagine a severely pinched nerve with dramatic symptoms. In reality, neck-related shoulder pain is often much more subtle.

You don't necessarily need a disc bulge compressing a nerve or advanced arthritis to experience referred pain. More commonly, neck-related shoulder pain results from relatively hidden joint or tissue restrictions that have reached a "referral threshold" - the point where overloaded cervical tissues generate pain signals in other areas, like your shoulder.

Symptoms of Neck-Related Shoulder Pain

Recognising the characteristic symptoms of cervical referral can help identify the true source of your shoulder pain:

• Vague, hard-to-localise ache: Unlike specific shoulder tendon pain that you can pinpoint, neck-referred pain often feels "deep" or spreads across a generalized area.
• Pain that moves or changes: The location or intensity might vary throughout the day without clear shoulder movement triggers.
• Associated neck stiffness: You might notice limited neck mobility, even without direct neck pain.
• Neurological symptoms: While pins and needles, numbness, or burning sensations more commonly extend down the arm to hands and fingers, they can occasionally manifest around the shoulder area with cervical issues.

Where Does Neck-Related Shoulder Pain Come From?

To understand cervical referral patterns, we need to explore dermatomes - sensory patterns on the skin linked to specific spinal nerve roots. These dermatomal distributions form during fetal development and provide crucial diagnostic clues.

As the dermatome map illustrates, the lower spinal levels of the neck (those beginning with 'c') most commonly refer pain to the shoulder region. When patients present with unexplained shoulder pain, these cervical levels are our primary investigation targets. Please note, the distribution may be slightly different for each person.

How to Self-Assess for Neck-Related Shoulder Pain

While professional assessment is always recommended, these simple tests can help identify potential cervical involvement in your shoulder pain:

Neck Movement Test

Slowly and gently move your neck through its full range of motion:

• Turn your head right and left
• Tilt your head toward each shoulder
• Look up and down

Note if any of these movements reproduce, increase, or decrease your shoulder symptoms. Even without symptom changes, significant stiffness or restriction in any direction suggests your neck warrants further investigation.

Deeper Jont Assessment

Using a tennis ball or lacrosse ball against a wall or on the floor, apply gentle pressure to different areas of your neck:

• Start just below your skull and work down to the base of your neck
• Focus on areas just beside the bony bumps (spinous processes)
• Compare both sides, noting any significant differences in tenderness or tightness

How to Self-Treat Neck-Related Shoulder Pain

If your self-assessment suggests cervical involvement, these strategies may help:

Targeted Release Work

Using a tennis or lacrosse ball against a wall or floor:

1. Position the ball on tight areas identified during your assessment
2. Apply gentle, sustained pressure for 30-60 seconds
3. Breathe deeply and allow the tissue to relax
4. Move to adjacent tight areas

Gentle Mobility Exercises

After release work, perform slow, controlled neck movements through all ranges of motion to maintain the newly gained mobility.

When to Seek Professional Help

While self-management can be effective for mild cases, professional assessment is recommended if:

• Your pain persists despite self-treatment
• You experience neurological symptoms (numbness, tingling, weakness)
• Your symptoms worsen
• You're uncertain about the cause of your pain

Conclusion

Your neck has significant potential to cause or contribute to shoulder pain. Taking time to assess cervical involvement - either through professional evaluation or careful self-assessment - can be the key to resolving persistent shoulder issues that haven't responded to conventional shoulder treatments.

Addressing hidden cervical restrictions often provides the breakthrough needed for complete and lasting shoulder pain resolution. Once identified and treated, the focus can shift to preventing recurrence by addressing the underlying factors that caused your neck issues in the first place.