Published November 27th, 2019 by Craig Kaler

Many caregivers fail to address how the alignment of the spine (in particular your neck and head position) changes the mechanics of the shoulder and how it can severely increase the incidence of chronic shoulder pain and eventually shoulder dysfunction. 

There is considerable overlap between shoulder and neck pain referral patterns. Any injury to the nerve, disc, joints, or soft tissues from C3-7 can refer pain to the shoulder.  The Accessory Nerve from upper neck has SVE Special visceral efferent nerves- meaning these are messages that are coming out of your brain in response to a command by you or automatically by your nervous system.  This nerve mediates head and shoulder movement! It also innervates the laryngeal muscles which are responsible for the production of sound. 

 A history of injury and physical examination is what we use to differentiate if your pain is coming from your neck or if you have a shoulder problem. Rotator cuff pain tends to be more pronounced at night while radicular (radiating) cervical pain tends to radiate into the arm or hand. If you have a shoulder and neck problem at the same time, it creates a treatment dilemma.  Most people with shoulder pain eventually end up taking an anti-inflammatory. If it continues they end up going to an orthopedist and are given a prescription for something stronger. If that is not effective the next step is usually a cortisone injection and MRI. Only when the MRI has negative findings is the cervical spine looked at. This is a typical treatment protocol for one primary reason. We live in a “non-holistic” symptomatic based medical model. If my shoulder hurts, it must be my shoulder.  The neck and head position is routinely overlooked in the initial stages of shoulder pain. Over the past decade in particular we have seen a significant increase in the number of patients coming in with a chief complaint of shoulder pain. Although the onset of symptoms is related to something they did in the gym, throwing something, or bad sleeping position, there are many patients that indicate that there was no “incident” that caused any injury.

Physical and postural exams with the majority of patients find several common factors that are usually contributing to stress on the shoulder joint. Physical exams reveal a “locked” upper neck or what we call an upper-cervical subluxation. Your skull is literally locked onto the first bone in your neck. As a result, people have a hard time looking down and usually feel pain in their upper back when they do. Postural findings usually reveal forward head posture (FHP) and a rounding of the upper back or an increased thoracic kyphosis (hunched upper back). This causes the shoulder to rotate inward almost 100% of the time. You may find yourself slouching right now as you read this or notice your child doing the same. This position causes the head of the humerus (shoulder) to be cramped pushing it closer to your acromion process (which comes off your scapula or shoulder blade).  This puts pressure on all the tendons that make up your rotator cuff and all the other joint spaces that make up the shoulder joint. This is the recipe that increases the chances of having  shoulder injuries like labral tears, rotator cuff tears, frozen shoulder, and impingement syndrome.

Chronic FHP  (forward head posture) can aggravate these structures on a daily basis causing pain, inflammation, and severely limit optimal shoulder mobility. The primary fix - or to prevent the issue entirely - is to use proper positioning at your computer and while using your other devices. However, if it’s been there long enough it’s a good bet you’re going to need some help to correct this. 

 Some Simple tips to help

1) Consider getting a chiropractic adjustment! There is considerable overlap between shoulder and neck pain referral patterns. Any injury to the nerve, disc, joints, or soft tissues from C3-7 can refer pain to the shoulder.  Over the past 18 years we have helped so many people with chronic shoulder pain without even touching their shoulder. Prior to coming into the office many of them have had multiple cortisone injections and many have cancelled surgery including a prominent cardiologist in our community.

2) Make sure your computer or workstation is ergonomically sound. Simply search proper computer ergonomics in Google images. What you’ll find is that all major joints are at 90°.

3) Sit and stand with a “chest out” butt out” posture. Upright position includes keeping your head and neck upright, shoulders positioned beneath ears, shoulder blades back and down. 

4) While texting maintain this upright position and hold your phone in front of you at eye level rather than below your chest. Starting to hold your phone vertical is a good start. Teach your kids this!


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