PT Insight: Why Shoulder Pain Starts in the Spine

Physical therapists see it every day:
Patients come in for shoulder pain — but the shoulder isn’t the problem.

The issue usually lives below the neck and above the low back.

🩻 The Spine–Shoulder Relationship

For a shoulder to move freely, three things must happen:
1️⃣ Thoracic spine must extend
2️⃣ Ribs must expand with breath
3️⃣ Scapula must glide on the rib cage

When the thoracic spine stiffens, the shoulder compensates — and pain follows.

🚫 Common Misdiagnosis

People are often told they have:

• Rotator cuff issues

• Shoulder impingement

• Weak delts

But strengthening a shoulder that can’t move creates more irritation.

🧠 What PTs Actually Look For

• Rib expansion during breathing

• Thoracic rotation symmetry

• Scapular movement timing

• Neck posture under load

Fix the spine → shoulder pain often disappears.

🏁 Final Thought

If shoulder pain comes and goes, changes with posture, or improves after breathing drills —
it’s not a shoulder issue.
It’s a spinal coordination issue.