Posterior Shoulder Pain? The Hidden Cause May Be Your Neck
Key insights: 60-second read
- Posterior shoulder pain can actually be a referred symptom from the neck - Pain at the back of the shoulder may actually be coming from hidden dysfunction in your neck and upper back.
- Test-retest is essential - Before and after each exercise, test a movement that alerts you to your shoulder pain to see if anything has genuinely changed.
- A simple ball technique can reveal the root cause - Using a lacrosse ball to find stiff, restricted spots in the neck and upper back can instantly improve posterior shoulder symptoms.
- Posture is the missing piece - The positions you put your body into the most throughout the day are often a root cause for dysfunction.
If you have pain at the back of your shoulder, you've probably tried stretching it. Maybe you've used a massage ball or had it massaged. Perhaps you've even worked through some of the standard rotator cuff exercises. And maybe it helped for a while but it ultimately hung around despite your best efforts.
If this is you, this could be because the pain at the back of your shoulder may not be coming from your shoulder at all. In many cases, it can actually be a referred symptom from the neck and upper back.
In this article, I will show you a simple technique to figure out where the root cause of that dysfunction might be - and treat it at the same time. Whether you are dealing with nagging posterior shoulder pain or just want to prevent it, this approach could change how you think about your shoulder pain and function.
"Pain at the back of the shoulder is a classic example of something that can certainly be coming from the where it hurts, but it can also be an expression of something related to your neck and upper back." - Grant Frost
On this page
The Test-Retest Protocol
Before you do any exercise, you need to establish a baseline. This is the most important step in figuring out whether what you are doing is actually working, or whether you're wasting your time.
Step 1: Test
Do a movement or activity that alerts you to how your shoulder pain feels. This could be:
- Taking your arm behind your back
- Lifting your arm above your head
- Reaching across your body
- Any specific movement that reproduces your pain
Pay attention to how it feels. Where is the pain? How intense is it? How far can you move before it hurts?
Step 2: Treat
Perform the ball mobility exercise described below. Work through any stiff, restricted spots in your neck and upper back.
Step 3: Retest
Immediately repeat the same movement or activity you did at the start. Has anything changed? If the pain is reduced, or you can move further, you may have found a connection - your shoulder pain is likely coming from your neck.
The Key Principle
"If you have tried a whole bunch of different stretches and exercises and you just can't seem to get that pain at the back of your shoulder to feel better, then there is a very good chance it could be coming from somewhere else entirely."
Ball Mobility Technique
Once you have established your baseline, it is time to go hunting for hidden dysfunction in your neck and upper back.
What You Need
- A lacrosse ball, tennis ball, or similar firm ball
- A floor, wall, or chair to lean against
How to Do It
1. Find the Right Spot
Start halfway down your neck, just off to the side where you have your shoulder symptoms. You are looking for spots that feel stiff, tight, and restricted - especially when compared to the same spot on the other side.
2. Apply Pressure
Lie down on the ball (or lean against it against a wall). Let the ball sink into the tissue. The joints of your neck are like piano keys - we need to push down through them. Give the ball a chance to sink into the tissue and get those stiff, restricted joints to give a little bit.
3. Move and Explore
Spend 1-2 minutes letting the ball press in. Then move it up or down, systematically working your way through the neck and upper back. If you feel a spot that is restricted, you can gently move your arm to help shear the tissue free.
4. Retest
Once you have finished working your way through the area, immediately retest the movement you did at the start. If your shoulder pain has improved, you may have found the hidden cause.
What to Look For
- Stiffness and restriction - not just tenderness. You are looking for spots that feel harder and more restricted compared to the other side.
- Systematic exploration - work your way from the neck down to the upper back and rib cage. Nothing should feel restricted in an ideal world, but there's a good chance a lot will.
- Arm movement - once you find a spot, you can gently move your arm to help the tissue release.
Why This Works
The nerves and joints of your neck can refer pain to the back of your shoulder. When the neck becomes stiff, tight, and restricted - often from prolonged poor postures and shapes - it can gradually overload the these and eventually create pain that feels like it is coming from the shoulder.
This is called referred pain. The pain is real, but the source is not where it hurts. By addressing the dysfunction in the neck and upper back, you can potentially relieve pain at the back of the shoulder.
If you found relief from this technique, then you may have identified the hidden root cause of your shoulder pain. But the next step is just as important: understanding why your neck became dysfunctional in the first place.
"If we're not trying to improve how the whole system functions, we're missing the bigger picture."
The Role of Posture
If you found relief from this technique, then you have found the hidden cause. But why did your neck become dysfunctional in the first place?
For most people, the answer comes back to the positions they put their body into most throughout the day. The active things - lifting, moving, exercising - tend not to be the most likely causes because you are moving through different shapes. The real culprits are the more sustained, stationary shapes and postures.
Common Postural Culprits
- Looking down at your phone - creates a hinge point through the lower neck
- Arts and crafts, painting, puzzles - sustained forward head posture
- Reading in bed - often in a compromised neck position
- Reclining while watching TV - for every degree you lean back, your neck has to bend forward to compensate
- Standing and looking down - at workbenches, kitchen counters, or workstations
What to Change
- Sit taller - bring your shoulders back and your head into a neutral position
- Remove the hinge - avoid prolonged forward head postures
- Arrange your environment - bring things into your immediate space rather than reaching or looking down
- Take regular breaks - change position every 20-30 minutes
The positions, shapes, and postures you put your spine into most throughout the day accumulate over time. You may never get to a point where you feel sore, but if you become sore, hindsight is perfectly clear. If you are taking the time to resolve this posterior shoulder pain, but you are not taking the time to improve the positions you are in, it may be genuinely hard to rid yourself of this dysfunction forever.
The Bottom Line
Posterior shoulder pain can genuinely be a symptom of hidden dysfunction in the neck and upper back - not just the shoulder itself. By using a simple test-retest protocol and ball mobility technique, you can identify whether your pain is coming from your neck.
But identifying the source is only half the battle. To permanently resolve the issue, you need to address the postural habits that created the dysfunction in the first place. The positions you put your body in most throughout the day matter. By improving your posture and arranging your environment to support better shapes, you can prevent this pain from coming back.
I genuinely hope this article offers a fresh perspective - or at least one useful takeaway. If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you'd like me to cover next.
- Grant
Frequently Asked Questions
How do I know if my shoulder pain is coming from my neck?
Use the test-retest protocol. Do a movement that alerts you to your shoulder pain, then perform the ball mobility exercise on your neck and upper back. Retest the movement. If your pain has reduced or your range has improved, your pain is likely coming from your neck.
How often should I do the ball mobility exercise?
Aim to do it daily, especially if you are working on freeing up restrictions. Spend 1-2 minutes on each spot, working your way through the neck and upper back. You can do this standing against a wall or lying on the floor.
What if the ball exercise doesn't change my shoulder pain?
If you don't notice a change, your shoulder pain may be coming from somewhere else - perhaps the shoulder itself or another area. That doesn't mean the technique is useless, just that it wasn't the right tool for your specific issue. It's worth getting a professional assessment to identify the true cause.
What posture changes should I make to prevent this from coming back?
Aim to sit taller with your shoulders comfortably back. Avoid prolonged forward head postures - especially when using your phone, reading, or watching TV. Arrange your environment to support good posture: bring your keyboard closer, lift your screen, and take regular breaks to move and change position.
One key insight
"Pain at the back of the shoulder is often referred from the neck and upper back. Use a simple test-retest protocol with a ball mobility exercise to identify if your pain is coming from your neck - then address the postural habits that caused the dysfunction."
Living With Persistent Pain?
If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our shoulder pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you'd like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
