The likely reason why your shoulder pain hasn’t improved

Published 1:30 am Friday, May 15, 2026

Shoulder pain is an extremely common ailment affecting a wide range of people. It is estimated that up to two-thirds of the population will experience shoulder pain at some point during their life, and up to one-fourth will have it at any given time. It is important to remember that shoulder pain is a symptom, not a diagnosis, so there are many reasons why people develop it.

When you see a medical professional for shoulder pain, whether it be an orthopedist, physical therapist, or chiropractor, they will likely conduct a series of tests. These generally include physical exam tests or imaging, and the provider will use this information to arrive at a diagnosis. While this seems like a straightforward process, these tests are often unreliable and may not reveal the true source of symptoms. That said, this course of action doesn’t always indicate the best way to treat the condition.

One reason for this confusion is that shoulder pain can be referred from the neck. Essentially, where symptoms are felt (the shoulder) is different from where they originate (the neck). Recent research has shown that nearly half of people with shoulder pain have a relevant connection to their neck, and therefore require that treatment be directed at their neck for their shoulder pain to improve.

Failure to recognize the neck as a source of symptoms is a common reason why people with shoulder pain don’t recover, despite numerous interventions directed at their shoulder. When this happens, patients continue to seek care from a variety of healthcare professionals and may even progress to one or more surgeries.

As hinted at earlier, traditional diagnostic testing is almost always unable to determine if the neck is the source of someone’s shoulder pain. The best way to determine if this relationship exists is a cause-and-effect mechanical assessment per the McKenzie Method. If shoulder pain, range of motion, and functional tests change in a meaningful, lasting, and reproducible manner in response to mechanical loading strategies (repeated movements or sustained positioning) of the neck, a connection is likely.

In addition to this form of mechanical testing, certain clues increase the likelihood that shoulder pain is driven by the spine. These include, but aren’t limited to, pain that is also felt in the shoulder blade, numbness or tingling in the hands and fingers (especially on the same side as the shoulder pain), pain that occurs when you aren’t moving your shoulder (e.g., sitting on the couch), and being able to comfortably lie on the side of the painful shoulder.

Determining the source of symptoms in those with musculoskeletal pain is extremely important, as it sets the foundation for effective management. You can’t treat what you don’t understand, therefore you cannot effectively treat shoulder pain when the intervention is directed at the wrong location. Most medical professionals either aren’t aware that the neck can cause shoulder pain or lack the skill set to determine whether a connection exists, making a well-done McKenzie Method assessment an invaluable part of the diagnostic process.

Dr. Jordan Duncan is from Kitsap County and writes a monthly health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.