Shoulder pain is a common issue that many people experience, whether it's from an injury, poor posture, or overuse. However, one thing that might surprise you is that your shoulder pain could actually be originating from your neck! Yes, referred pain is a phenomenon where pain is felt in one area of the body, but its true source is elsewhere. In this blog post, we’ll explore why shoulder pain may sometimes be linked to the neck and how you can address it.
What is Referred Pain?
Referred pain occurs when pain is felt in a different location than where the actual problem is. This can happen because the nerves that transmit pain signals from various areas of the body are connected to the same nerve pathways in the spinal cord. So, when there’s an issue in one area, like the neck, the brain might misinterpret the pain signals and perceive it as coming from another area, like the shoulder.
How Does the Neck Affect the Shoulder?
The neck and shoulder are closely connected through muscles, nerves, and joints. The nerves that supply sensation and movement to the shoulder originate from the cervical spine (the neck). When the neck experiences dysfunction—such as a herniated disc, muscle tension, or nerve irritation—it can cause pain or discomfort that radiates down into the shoulder area.
Here are some common ways that neck issues can lead to shoulder pain:
Cervical Radiculopathy: This occurs when a nerve in the neck becomes compressed or irritated, often due to a herniated disc or spinal stenosis. The nerve irritation can radiate pain down the arm and into the shoulder, causing symptoms like sharp pain, numbness, or tingling.
Muscle Tension: The muscles of the neck, especially the upper trapezius, can become tight and overworked due to poor posture, stress, or repetitive movements. This tension can lead to discomfort that extends into the shoulder.
Sustained positions: Our body loves to move, and staying in one position all day no matter what is, or how "correct" or "incorrect" can make us grumpy. Aim for movement variability, get up and move throughout the day.
How to Tell If Your Shoulder Pain is Related to Your Neck
It can be tricky to determine whether your shoulder pain is truly coming from the neck or if it’s a direct shoulder issue. Here are a few signs that your shoulder pain might be referred from the neck:
Pain or tingling radiates down the arm: If the pain travels down your arm or feels like it’s coming from deep within the shoulder joint, it could be a sign that the problem is originating from your neck.
Worsening pain with certain neck movements: If turning your head, looking up, or tilting your head increases the shoulder pain, it might be related to neck dysfunction.
Pain pattern: Shoulder pain from neck issues often has a more diffuse, widespread feel. If you notice pain that’s not isolated to just the shoulder joint but also in the upper back or along the spine, this is a key indicator that the neck may be the culprit.
Shoulder Pain Referred from the Neck – Other Things to Think About
Are You Waking Up with Pain?
Waking up with shoulder pain can sometimes indicate a neck issue. When we sleep, our posture and pillow support are crucial in maintaining the alignment of the neck and spine. If your pillow doesn’t provide the right level of support, it can cause your neck muscles to tense up overnight, leading to referred pain in the shoulder area.
Does Your Pain Move?
Another key thing to consider is whether your shoulder pain moves or radiates down your arm. If you notice pain or tingling extending from your shoulder down into your arm or hand, this could indicate that the source of the pain is coming from the neck. Nerve irritation or compression in the cervical spine (neck) can cause referred pain that radiates to the shoulder, arm, and even the hand.
How to Address Referred Shoulder Pain
If you suspect that your shoulder pain is coming from your neck, here are some strategies to help you find relief:
See a Physiotherapist: Hello ! We know some good ones! At Move - Physio in Geelong - we can can assess your neck and shoulder for signs of referred pain. They may use manual therapy techniques, posture correction exercises, and stretching routines to help address the underlying cause of your pain.
Neck and Shoulder Exercises: Gentle neck stretches, mobility exercises, and strengthening routines for both the neck and shoulders can help reduce tension and improve posture. Strengthening the muscles of the upper back and neck can also provide long-term relief by reducing strain on the shoulder.
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OK So what EXACTLY Is going on? Somatic and Cervicogenic Convergence: How Neck Pain Can Impact the Shoulder
When it comes to pain that radiates from the neck into the shoulder, it’s important to explore two concepts that can explain how these areas of the body are so intricately connected: somatic convergence and cervicogenic pain. Both of these phenomena help to explain how an issue in the neck can manifest as shoulder pain, and understanding them can lead to better diagnosis and treatment.
What is Somatic Convergence?
Somatic convergence refers to the way pain signals from different areas of the body are processed together in the spinal cord and brain. The body’s nervous system is like a complex network of roads, where signals from various regions of the body travel to the brain via the spinal cord. Sometimes, these signals overlap or converge, meaning that the brain can’t distinguish exactly where the pain is coming from.
For example, the nerves that supply both the neck and the shoulder originate from the cervical spine (the neck region of the spine). These nerves send pain signals to the brain, but because they share the same neural pathways, the brain might interpret the pain as coming from the shoulder when the true origin is the neck. This is called somatic convergence, and it’s a key reason why neck problems can sometimes cause shoulder pain.
Cervicogenic Pain: When the Neck is the Source
Cervicogenic pain refers to pain that originates in the neck but is felt in other parts of the body, such as the shoulder, arm, or even the head. This type of pain is specifically caused by issues in the cervical spine, such as:
Cervical disc herniation: A herniated disc in the neck can compress the nerves that branch out into the shoulder, causing pain that radiates down the arm or into the shoulder joint.
Cervical spondylosis: Age-related wear and tear of the cervical spine can lead to degeneration of the discs and joints, leading to nerve irritation and referred pain to the shoulder.
Facet joint dysfunction: The small joints in the neck (facet joints) can become stiff or inflamed, affecting the movement of the neck and causing pain that may refer to the shoulder.
How Somatic Convergence and Cervicogenic Pain Work Together
The interaction between somatic convergence and cervicogenic pain can sometimes create a confusing picture for both patients and clinicians. Here’s how these two processes come together:
Shared Nerve Pathways: The nerves that supply sensation and motor function to both the neck and the shoulder are closely linked in the spinal cord. When a problem occurs in the cervical spine, such as nerve compression or muscle tension, pain signals travel along these pathways, and the brain might misinterpret the source of the pain. This is where somatic convergence plays a role in confusing the brain about whether the pain is coming from the neck or the shoulder.
Referred Pain Pattern: When a cervical issue causes pain in the neck, the pain might not always be felt at the source (in the neck itself). Due to the convergence of signals in the nervous system, the pain can be referred to the shoulder or even down the arm. This referred pain pattern is common with cervicogenic pain.
Compounding Symptoms: In some cases, people with cervicogenic pain may also develop muscle tension or postural changes in the shoulder, further contributing to discomfort. These additional factors can create a feedback loop, where the shoulder pain worsens, even though the root cause remains in the neck.
Treatment: Addressing Both Somatic and Cervicogenic Factors
What Can You Do About It?
If you suspect that your shoulder pain is referred from your neck, there are a few strategies you can try to manage the discomfort and improve your movement. Here are some simple exercises and approaches that may help:
Chin Tucks: One of the most effective ways to alleviate neck-related shoulder pain is through chin tucks. This exercise helps to strengthen the muscles that support the neck and improve posture, which can reduce tension in the neck and prevent the pain from radiating into the shoulder. To do a chin tuck:
Sit or stand tall with your shoulders relaxed.
Gently tuck your chin towards your chest (as if trying to make a double chin).
Hold for a few seconds, then release.
Repeat 10–15 times, several times a day.
Movement Variability: Our bodies are designed to move in many different ways. If you’re experiencing neck and shoulder pain, it's essential to incorporate movement variability into your daily routine. This could include turning your head in different directions, gently tilting your neck side to side, or even performing some gentle stretches. The more you vary your neck movements, the better you can improve mobility and reduce stiffness in both the neck and shoulder.
Turn or Dial Down the Threat: If your neck and shoulder pain is a result of tension or muscle strain, it’s important to dial down the threat to the nervous system. This can be done by practicing relaxation techniques such as deep breathing, mindfulness, or using heat or cold packs to soothe the muscles. Reducing overall stress and tension can have a significant impact on how your body perceives and manages pain.
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If you’re dealing with shoulder pain and suspect it’s coming from the neck, it’s important to take action early. Adjusting your pillow, incorporating neck exercises, and improving your movement habits can go a long way in relieving discomfort and preventing further issues. If your pain persists, consider seeking help from a physiotherapist, who can assess your posture and movement patterns to tailor a treatment plan specifically for you.
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