Could The Neck Have Caused Your Frozen Shoulder?
Key insights: 60-second read
- I often find neck dysfunction alongside frozen shoulder - In my clinical assessments, stiffness and restriction around the mid-to-lower cervical spine are a recurring finding in people with frozen shoulder.
- The shoulder and neck are neurologically connected - Important nerves supplying the shoulder joint have contributions from the cervical roots, particularly C5 and C6.
- Test and retest rather than simply assuming - One of the most useful parts of this approach is seeing whether improving neck movement actually changes your shoulder movement or symptoms.
- Try two different shoulder mobility approaches - One uses compression, and one uses band-assisted distraction, with the response helping determine which approach is more useful for you.
- This is a clinical finding, not established consensus - I don't claim that neck dysfunction causes every frozen shoulder. I am explaining a connection I repeatedly find clinically and believe is very much worth assessing.
Frozen shoulder can be one of the most frustrating shoulder problems to deal with. Movement gradually becomes restricted, everyday activities become difficult, and progress can feel painfully slow.
After more than 20 years working as a musculoskeletal physiotherapist, I've developed a particular clinical interest in something that I believe is often overlooked: the neck in people with frozen shoulder.
This approach is based on what I find clinically. When I assess people with frozen shoulder, I very frequently find stiffness, restriction and changes in the tissues around the mid-to-lower cervical spine. I don't believe this means the neck is the cause of every frozen shoulder, and it isn't currently established medical consensus. But I believe it's an important area to assess rather than automatically treating the shoulder in isolation.
The key clinical idea: We can't just treat a frozen shoulder as an isolated shoulder issue. Rather than assuming that everything needs to be treated at the painful shoulder, I like to assess the neck, make a change where appropriate, and then test and retest the shoulder again to see whether anything actually changes.
On this page
The Neck-Shoulder Connection I Find Clinically
Frozen shoulder, also called adhesive capsulitis, involves pain and restriction of movement around the shoulder. The capsule surrounding the glenohumeral joint becomes painful and stiff, particularly affecting movements like rotation and elevation.
The shoulder joint is also closely connected to the nervous system. Articular branches supplying the glenohumeral joint include contributions from the suprascapular, axillary and lateral pectoral nerves. Several of the important neural contributions to the shoulder arise from the brachial plexus, which includes the C5 and C6 nerve roots.
What I find clinically: A large percentage of the people I see with frozen shoulder also have noticeable stiffness, restriction, tightness or altered tissue quality around the mid-to-lower cervical spine.
That observation has made the neck something I routinely assess when someone presents with a frozen shoulder.
At this stage, its important to note that current clinical guidelines for frozen shoulder haven't established this relationship as an accepted cause. Not because they've considered it and found it unhelpful, but because I don't think we've explored this connection enough, yet. However, if my clinical findings are anything to go by, I'd hope we can broaden our thinking on this as soon as possible.
Until then, it's best to think of this as something to try for yourself to see what impact, if any, it has for you and your symptoms.
Test and Retest: The Most Important Part
One of the principles I use throughout my clinical practice is simple: don't just hope that an intervention is helping. Test it and figure it out definitively for yourself.
Before doing anything to your neck, establish a simple baseline for your shoulder.
How to Test
- Check your neck: Turn your head comfortably to each side and compare the movement.
- Check your shoulder: Assess how far you can lift your arm and how much internal and external rotation you have.
- Notice the symptoms: Pay attention to pain, stiffness, restriction and the quality of the movement.
- Remember the baseline: You are going to repeat the same movements after the neck exercise.
The purpose isn't to prove that the neck is the cause of your frozen shoulder. It's simply to see whether changing the neck produces any immediate change in the shoulder.
If nothing changes, that's useful information too.
Neck Mobility Exercise
The first exercise is designed to explore and gently mobilise areas of restriction around the mid-to-lower cervical region.
Ball-Assisted Neck Release
- Setup: Use a small tennis ball or similarly soft ball. Position it against the muscular area beside the cervical spine rather than directly over the front or side of the neck.
- Position: Lie down or lean against a wall so that the ball applies gentle pressure to the tissues.
- Explore: Slowly move the ball a small distance at a time and compare one side with the other.
- Find restrictions: Look for areas that feel noticeably stiffer, thicker or more restricted than the opposite side.
- Hold gently: Spend around 30-60 seconds on an area if the pressure feels comfortable and non-threatening.
- Retest: Recheck your neck movement and then immediately repeat the shoulder movement you tested earlier.
Safety: Do not press directly onto the front of your neck, throat, carotid area or other sensitive structures. Stop if you experience dizziness, visual symptoms, nausea, numbness, weakness, headache or unusual pain. If you're unsure where or how to perform this technique, have it assessed by a physiotherapist.
Now comes the important part: retest your shoulder.
If your shoulder suddenly moves a little further, feels less painful, or feels different in some other meaningful way, you may have found a meaningful connection.
Shoulder Capsule Mobility: Compression
While hunting around for the root cause of your frozen shoulder, we still need to try to free things up at the shoulder. This first exercise uses a position of controlled compression and loading around the shoulder.
Compression-Based Shoulder Stretch
- Setup: Start on all fours with your hands beneath your shoulders.
- Position: Gently move your body towards the side you're working on while keeping the movement controlled.
- Find the range: Explore the position until you feel a gentle stretch or pressure around the shoulder without sharp pain.
- Progress if appropriate: You can lower onto your elbows and allow the chest to move between the shoulders if this creates a useful, comfortable stretch.
- Hold: Start around 20-30 seconds and gradually build the duration if your shoulder responds well.
Then retest the shoulder.
If your range improves without provoking a flare-up, that gives you another useful piece of information about how your shoulder responds to this particular movement.
Banded Shoulder Capsule Stretch: Distraction
The second shoulder-specific exercise takes a different approach, using a resistance band to create a gentle distraction force around the shoulder.
How to Perform the Banded Distraction Stretch
- Setup: Attach a suitable resistance band above shoulder height and place it around your wrist.
- Create tension: Step backwards until you feel a comfortable, controlled pull through the shoulder.
- Position the shoulder: Gradually move into the available external rotation range without forcing it.
- Lean into the movement: Allow the band to create a gentle distraction while you explore the available range.
- Hold and breathe: Start with around 20-30 seconds and build gradually if the shoulder responds well.
My advice: Frozen shoulder exercises should be guided by how the shoulder responds. The goal isn't to force through severe pain. Find a tolerable position, spend time there, and gradually work on improving the movement.
Again, retest your movement afterwards.
If the distraction version gives you a better response than the compression version, I would be more interested in progressing with that one. If the opposite happens, use that information to your advantage.
My Clinical Takeaway
This is what I find clinically
When I assess people with frozen shoulder, I very frequently find associated stiffness and restriction around the mid-to-lower neck.
Improving the function of the neck does seem to have a positive influnce over the function of the shoulder, and I do believe it's worth exploring to see if it is a potential root contributing factor to the development of adhesive capsulitis.
We need more research to establish exactly what this relationship means. But until then, my approach is to assess it, treat it when appropriate, and most importantly, test and retest to see whether it actually makes a difference for the individual.
Frequently Asked Questions
Can the neck be involved in frozen shoulder?
It can be relevant to an individual person's presentation, although neck dysfunction has not been established as the cause of frozen shoulder. Based on what I find clinically, stiffness and restriction around the mid-to-lower neck are common findings in people I assess with frozen shoulder, which is why I routinely assess the area.
How can I tell whether my neck is contributing to my frozen shoulder?
A useful clinical approach is to test and retest. Assess your shoulder movement, perform an appropriate neck mobility technique, and then repeat the same shoulder movement. If there is a meaningful immediate change, that suggests the neck may be relevant to your symptoms or movement.
Which is better for frozen shoulder: compression or distraction?
There isn't one version that is necessarily best for everyone. I would use the person's response to determine which movement is more useful. If one produces a better change in movement without aggravating symptoms, that gives you a reason to prioritise that approach.
Should frozen shoulder exercises be painful?
Some stretching discomfort can occur with a stiff shoulder, but I don't recommend forcing severe or alarming pain. Start within a tolerable range and gradually progress according to how the shoulder responds.
How often should I work on my frozen shoulder?
That depends on the stage and irritability of the condition. Gentle mobility work may be performed regularly when tolerated, but the appropriate frequency and intensity should be individualised rather than forcing the shoulder through a rigid program.
The key message from this video
Don't automatically assume that the shoulder is the only thing that matters. In my clinical experience, the neck is frequently involved in people with frozen shoulder. It could be the root cause, or it may not be, and this isn't currently established medical consensus, but it is something I believe is worth assessing, treating when appropriate, and then testing to see whether it actually changes the shoulder.
- Grant
Want personalised guidance?
If you'd like help with your shoulder or any other persistent musculoskeletal issue, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
Disclaimer: This article provides general educational information and is not a substitute for an individual assessment by a qualified health professional. Frozen shoulder can have different presentations, and exercises are not appropriate for everyone. Seek professional assessment if symptoms are severe, worsening, associated with significant trauma, or accompanied by unusual neurological symptoms.
