Atlas was burdened with carrying the weight of the world on his shoulders after leading the Titans into battle with the Olympians. The load you carry may be less in comparison, but it may weigh you down just the same and cause neck and shoulder pain.

There are about 240 different structures in your neck and shoulder that work in unison to provide full active and strong movement. An issue in the neck may predispose you to shoulder problems and vice versa. It becomes the same battle as the chicken and the egg, which came first? In all honesty, if you’ve had neck and shoulder pain for years it may not matter which came first. All that matters is that you address both areas in the treatment of your neck and shoulder pain, because they do everything together.

How are the neck and shoulder linked?

Your neck is the bridge between your head and your trunk. This sturdy moveable bridge houses different structures, some anchored to your shoulderblade. This link between your neck and shoulders means that issues in the tissues can lead to problems in the other area.

Our muscles are essentially pulley systems that allow movement. The levator scapulae, trapezius, and scalene muscles attach to both the shoulder and neck, via insertional sites on the collar bone, shoulder blade, vertebrae, or base of the skull.

If you suffer from neck pain that travels to your shoulder, with distinct “nervy” features, it may be caused by nerves. “Nervy” pain for lack of a better word, are all those weird and wonderful sensations that’s difficult to explain or make you feel nervous to describe it. Pins and needles, numbness, warm or cold sensations, ants crawling up and down your skin, increased pressure, as though you have a very tight shirt on. The brachial plexus is an interlinked network of nerves from the neck that merge and diverge to ultimately form the three main nerves of the arm, the radial, ulnar and median nerves.

Read these articles if you would like to know more about specific structures of the neck and shoulder.

Physiotherapists spend years studying how to examine to find the culprit causing a specific shoulder or neck pain, sometimes the original problem is clouded by numerous other things that went wrong and we are skilled to start unpacking the problems one by one.

What do these nerves and muscles do?

The brachial plexus and the nerves of the arm are your power supply and communicating network. These nerves enable you to plan, move and manipulate different objects, like throwing a ball or turning a key in a lock, or playing an instrument. The nerves also send messages back to the brain regarding temperature, possible danger (pain or nociception), pressure, and proprioception. This enables you to know and change certain behaviours, like pushing a key deeper into a lock and slacking off pressure when writing. If you have compression or irritation from a bulging cervical disc all of these functions may be compromised. Your handwriting may be affected, becoming more clumsy or even feel weakness and let things fall.

The levator scapula runs from the top of the shoulder blade and inserts on the sides of cervical vertebrae  C1 – C4. The upper fibers of the trapezius muscle runs from the base of the skull and inserts on the collarbone and shoulderblade. Contracting both muscles at the same time will give you a shoulder shrug, like saying “I don’t know” and also rotate your shoulderblade, priming the blade to lift the arm out sideways. Trigger points and weakness of these muscles may elevate your shoulders all the time. This places an excessive load on the cervical vertebrae and changes the angles from which the shoulder moves.

This is all to common in the lives we lead. How are you sitting reading this article? Hunched over your phone or leaning closer to your computer screen? Then you are creating the perfect circumstances for these problems to develop.

How does neck pain lead to shoulder pain?

The structures that form a bridge from your neck to your shoulder can spread your neck pain to your shoulder. The most common culprits are the muscles, the trapezius, and levator scapulae. Compensatory movement patterns are useful when you have just injured yourself. If you slept with your head at a funny angle your muscles will protect the area by increasing tone and decreasing length, thereby limiting your movement for the next few days. This is a great strategy, for a short period of time. If you continue to keep your shoulders lifted and use your whole body to turn, instead of moving your neck, it becomes a problem. This useful, protective compensation becomes useless and in the long run and potentially harmful.

When you keep your shoulders lifted to protect your neck it alters the angles of how you move your shoulder to lift up a weight, groceries or your child. Repetitive poor movement can then strain the structures in your shoulder, most commonly it leads to posterior rotator cuff weakness and bicep tendinitis. You may have long forgotten the awful night on the strange pillow, but the way you moved committed the memory to your shoulder.

Neck joints do degenerate over time or from direct injury, like whiplash. This normal process of degeneration can refer pain to in your shoulder. Cervical disc bulge, prolapse or herniation can cause direct pressure on the exiting nerve root and radiate pain to your shoulder. Your shoulder pain can be caused by your neck,  you do not necessarily have to have neck pain for this to be true.

How does shoulder pain lead to neck pain?

Have you ever caught yourself with your shoulders lifted towards your ears, like you are standing outside on a cold day and trying to keep the wind away from your neck? As a generation we have appalling posture, just look around in your office to see the evidence. We lead sedentary lives, do minimal heavy lifting or weight-bearing on our hands, and are haunched over devices at work and at home.

Shoulder muscle weakness and decreased shoulder range of movement from bad postural habits can lead to neck muscle weakness, early degeneration of joints and joint or disc pathology.

Causes of neck and shoulder pain

Strains of neck muscles can happen when taking up new exercises or using the wrong muscle groups when training. Abdominal crunches and sit ups, when innitiated from the neck, may cause muscle pain the next day.

Falling asleep on the couch or on a long haul flight keeps your head and neck in the same position for an extended period of time. If your neck is held at an angle it may strain the joint capsule and lead to one sided stiffness.

Stomach sleepers keep their heads turned to one side all night. Add a pillow to the equation and the neck is extended for most of the night too, not optimal.

Poor posture, head held infront of the shoulder, shoulder hanging forward, turned inwards leads to deconditioning of important postural muscles. Once sufficiently weak these muscles lose the ability to contract, let alone from the lengthened position they are in most of the day. As a strategy to decrease their labour over a long lever they form pesky triggerpoints of muscle spasm.

Rotator cuff injuries that are not looked after causes weak shoulder stability. Now the body recruits postural muscles to help when you do the odd shoulder exercise, washing windows, painting or hanging curtains. Poor shoulder biomechanics leads to supraspinatus tendinopathy and shoulder impingement. Now you will most probably go around with the shoulder lifted to protect it from further use and then strain the muscles that connect your shoulder to your neck.

Injury to your cervical discs may cause inflammation or herniation of the disc. This occupies space where the nerve root exits the spinal canal. Pressure or irritation of the nerves causes referral pain from the neck to the shoulder and even into the arm.

Symptoms of neck and shoulder pain

Self tests for neck and shoulder pain

  • Sit comfortably on a chair with your arms relaxed on your lap
  • Turn to look over your left shoulder as far as you can, then look up towards the ceiling
  • Pain on the left may indicate muscle origin, pain on the right may indicate joint origin.
  • Repeat on the other side
  • Interlace your fingers behind your head
  • Look down towards the floor and pull the arms down too
  • Pain radiating to your shoulder may indicate disc origin
  • Stand next to a wall, at a 90 degree angle.
  • Place your hand at shoulder height on the wall, palm flat, fingers aimed backwards.
  • Move your head away from the wall by aiming opposite ear to shoulder, your gaze stays forwarD.
  • Compare on the other side.
  • Deep pulling sensation on the forearm and wrist is normal, reproducing your symptoms or more intense sensation on the affected side may indicate neural involvement.
  • Sit comforatebly on a chair with a backrest.
  • Slide your arm behind you, up your back as though you are scrathing an itch between your shoulderblades.
  • Note how far you can reach.
  • Now bring your hand down so that your forearm is parallel to the floor.
  • See if you are able to press your arm into the backrest of the chair and actually lift your arm away from your back.
  • Compare on the other side, both how for you can reach and how hard you can push.

How bad is my neck and shoulder pain?

As a general rule any type of pain that prevents you getting a good night’s sleep or participating in your every day life should be checked out. if you get nervous or anxious when nearing the end of your painkillers, nobody listens when you complain about your problem anymore or you avoid certain exercises, gatherings or activities where you need to lift and carry objects, you have already left it too long.

You can trust us to get to the bottom of your neck and shoulder pain and treat it.

Diagnosis of your neck and shoulder pain

We are skilled to test muscles, ligaments, joints and nerve to identify all the contributing factors. After your physical evaluation we will be able to tell you who is the culprit and who is the victim of your neck and shoulder pain. Now we can establish your treatment goals and give you a general time frame for healing your neck and shoulder pain.

Why is my neck and shoulder pain not going away?

You may be only partially adressing the problem yourself, by only changing your position at work but still slump over your phone during the evenings, or taking painkillers and not treating the contributing structures, or going for a lovely massage but never strengthening those lazy muscles.

To solve the problem you need to know the cause of the problem. We can help you there! You can think of us as the CSI team, carefully going through the evidence to find the culprit.

What NOT to do

  • Continuous use of medication is not going to help you in the long run.

  • Exercise or push through the pain

  • Do not ignore neck and shoulder pain that gets worse

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you should do

  • Take active rest from aggravating activities

  • Make an appointment to confirm the diagnosis and determine the severity of your problem.

Making the injury worse

  • Working on your computer or paper project with bad posture for extended periods of time. Set an alarm and get moving every 45 minutes!

  • Sleeping on a worn out mattress or pillows.

  • Driving long distances, especially if you are a nervous driver (think sitting close to steering wheel with shoulder pulled up to your ears)

  • Pushups

  • Repetitive overhead movements, hanging laundry/curtains, painting, blowdrying your hair.

A big problem we see with neck and shoulder pain

Abandoning treatment – just when we’re starting to win. Most people feel so relieved once the symptoms are better that they stop their treatment. And unfortunately, surprise! in a few weeks the symptoms are back because you didn’t address the cause. For all practical reasons you put a bucket under the leaking pipe but you didn’t fix the pipe.

Neck braces or shoulder slings are not the answer, inactivity and rest have its place but should be “prescribed” responsibly.

Long term use of over the counter medication can cause a long list of side effects, mostly gastrointestinal related, like acid reflux, stomach ulcers, cramping, diarrhea or contsipation. Please use responsibly as indicated.

Expecting a quick fix to a complicated problem. Everything worth while takes time. If your one issue leads to problems in another area so many dysfunctional changes have happened in your movement that you will need to put in the time and effort to fix all the compensatory movement patterns.

Physiotherapy treatment for neck and shoulder pain

We are able to find the structure responsible for your neck and shoulder pain. Once we have identified the structure we can treat it back to health. We will be able to provide you with a time line for your treatment and recovery and get you moving again.

Healing time

Every condition has a unique time that it will require to heal. Even two individuals with the same pathology may heal at different rates because of different life circumstances. In general, any soft tissue structure takes six weeks to fully recover, that is not six weeks of pain and agony, that is 6 weeks of improvement on a weekly basis and gradual reintroduction of exercise. So sit tight, be patient and sort it out in one go.

Other medical treatment

Your GP may prescribe analgesics, anti-inflammatories or muscle relaxants. These oral medications are to control your symptoms, not to heal the structure. Please check possible side effects and use medication responsibly.

Chiropractic manipulation will increase range of motion and decrease pain. Please make sure you know the structure that is causing your pain, being out of alignment is not a diagnosis.

Biokinetic rehabilitation may be used during your rehab once you have established pain free movement. The stronger your muscles the less likely the problem will resurface in the future.