Neck pain is a common complaint in our office. Often times presenting not only as pain but also limited range of motion, headaches, and face and jaw pain. Neck pain can be caused by many different factors. There are the obvious causes like sleeping on the wrong pillow or in an unnatural position, poor computer posture, trauma, whiplash, etc. One common, but uncommonly thought of reason for neck pain, however, can be your shoulder.
This can be better explained by examining how the shoulder is put together. Your shoulder anchors itself to your rib cage and neck via muscles, tendons and fascia. When your shoulder is working properly, it recruits from these anchors in a very balanced manner. When your shoulder is injured or imbalanced, however, the shoulder starts recruiting from the the neck and the rib cage in an unbalanced way.
The shoulder is a joint complex made up of 4 joints:
1. The Glenohumeral (GH) joint: a ball and socket joint made by the head of the humerus and the glenoid cavity of the shoulder blade. This joint allows for a wide range of motion in many different planes and works just the way it sounds — like a ball in a socket.
2. The Acromioclavicular (AC) joint: at the top of the shoulder is the junction between the acromion process of the shoulder blade and the collarbone. This joint allows the shoulder to achieve slightly more rotation beyond what the GH joint allows by helping the shoulder blade slide further along the ribcage.
3. The Sternoclavicular (SC) joint: this is the joint where your collar bone meets your sternum. This joint provides a pivot point for the collarbone allowing you to elevate and depress your shoulder, in addition to rolling forward and backward.
4. Lastly, the Scapulothoracic joint (arguably a joint): this is the joint in which the shoulder blade articulates or slides along the musculature of the wall of the ribcage. Keep in mind that the shoulder blade holds the socket for the GH joint; therefore, the Scapulothoracic joint can either limit or allow for a larger range of motion, depending on its mobility.
What many people don’t realize, however, is the only place the shoulder is directly connected to the skeleton is at the SC joint (i.e. where your collarbone meets your sternum). What this means is that your shoulder is almost entirely held in place by cartilage, ligaments, fascia and muscles, which allows for incredible range of motion but, without proper strength and stability, also makes this joint particularly vulnerable to injury.
Some symptoms of shoulder imbalance include:
- Chronic upper trapezius/top of the shoulder tightness;
- Discomfort to mild pain down the shoulder blade or along the spine; can be made worse with neck extension;
- Pain in the back of the neck when lowering a barbell from an overhead position;
- Pain in the back of the neck when performing overhead presses;
- Neck pain when bicycling;
- Neck pain with pull ups and/or
- Neck stiffness and decreased range of motion
When you have an acute shoulder injury , the shoulder’s interaction with your neck is rather obvious and intuitive as the pain gradually radiates from your shoulder to your neck. The neck-shoulder connection can be less obvious when you have some sort of low-grade repetitive injury or instability in your shoulder. For example, neck pain after cycling for long periods of time can actually be instability of your scapulothoracic joint. Similarly, old rotator cuff tears or scar tissue can cause weakness and decreased range of motion in your shoulder. Without proper treatment, your shoulder will eventually start to recruit strength and mobility from your neck. This will then lead to increased pain and stiffness in your neck over time.
Shoulder instability can also be a patterning issue that was developed from a much younger age. Consistent with most anatomical development, shoulder stability is developed in infancy. It’s no coincidence that you had to learn to lift your head, roll, and crawl before you could walk — after all, these actions develop neurological patterning and control of your limbs and core. Scapular, or shoulder blade stability, is one of those critical patterns you develop, and if this pattern does not develop properly in early stages, it can lead to issues like scapular winging, making you more prone to weakness and injury.
In our office we take a multifaceted approach to all injuries by examining the body as a whole to discover the true source of your injury. Some of the treatments we provide for this issue are Chiropractic manipulations, dry needling, cupping, corrective exercises, and Graston or gua sha. If you think you have this issue, make sure to find a practitioner that tailors their treatment to your individual needs!