If you’re experiencing nagging pain near or under your shoulder blade—commonly called scapular pain—you might assume it’s a shoulder or muscle issue. But here’s the truth: where you feel pain is not always where the problem is.
In many cases, scapular pain is actually referred from the cervical spine, particularly the cervical facet joints. Understanding this referred pain pattern can be a game-changer for people who have tried stretches, massage, or shoulder rehab exercises with no real improvement.
Let’s break down why this happens and what you can do about it.
What Is Scapular Pain?
Scapular pain is discomfort felt in the upper back, often around the shoulder blade (scapula). Patients describe it as:
- A dull ache between the shoulder blade and spine
- Sharp pain when turning the head or neck
- A deep, burning sensation under the scapula
- Pain that radiates to the shoulder or down the arm
It’s easy to assume these symptoms are coming from muscular tension or rotator cuff issues—but that’s often not the full story.
The Cervical Spine Connection
The cervical spine, or neck region, is made up of seven vertebrae (C1–C7) and includes facet joints, small joints at each vertebral level that guide motion and bear weight. When these joints become irritated or dysfunctional—due to poor posture, trauma, or prolonged static positions—they can refer pain to other areas.
One of the most common referral patterns of the lower cervical spine (especially C5–C7) is pain to the medial scapular border.
This referred pain is not caused by local tissue damage near the scapula—it’s a result of shared nerve pathways. Think of it like a wire that’s frayed upstream but causes flickering at the lightbulb. Treating the bulb won’t fix the wire.
Common Causes of Cervical Facet-Related Scapular Pain
- Poor posture (forward head, rounded shoulders)
- Prolonged screen time or sitting with head down
- Repetitive neck motion or loading (e.g., weightlifting, manual labor)
- Whiplash injuries
- Disc derangements that alter joint mechanics
It’s common for people with scapular pain to be misdiagnosed with rhomboid strain, levator scapulae tension, or scapular dyskinesis when the real culprit is higher up.
Referred Pain Patterns: How They Work
Referred pain occurs when pain is felt in a location different from the actual source. In the case of cervical facet dysfunction, the irritated joint sends signals along nerves that also service other areas—like the shoulder blade.
Some common cervical to scapular referral patterns include:
- C5-C6 facets: Refers pain to the top or middle part of the scapula
- C6-C7 facets: Refers pain to the lower scapular border
- C4-C5 facets: Can refer to the trapezius and upper shoulder area
If you’ve had scapular pain that didn’t respond to soft tissue massage or local treatment, it’s worth investigating cervical facet dysfunction.
The McKenzie Method: Our Approach to Scapular Pain
At Central Ohio Spine and Joint, we use the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) to evaluate and manage cervical spine-related scapular pain.
The McKenzie Method helps us:
- Identify centralization of symptoms (moving pain away from the scapula and toward the spine)
- Guide patients through directional preference exercises
- Avoid unnecessary treatments to areas that aren’t the root cause
- Empower patients with self-treatment strategies
If your pain moves from the shoulder blade to the neck with repeated movement testing, that’s a key indicator that the cervical spine is the source.
Why Treating the Neck Works (Even if Your Scapula Hurts)
One of the most eye-opening experiences for patients is realizing their scapular pain gets better with neck movement.
We frequently see patients who:
- Have done months of shoulder rehab with little improvement
- Get temporary relief from massage or dry needling to the scapular area
- Feel worse with sitting, driving, or prolonged computer work
- Improve dramatically when treated with cervical-specific interventions
This is because the real issue is biomechanical stress in the cervical spine, not a local muscle strain near the scapula.
Effective Treatment Strategies for Cervical-Origin Scapular Pain
Here’s how we treat it:
✅ Mechanical Diagnosis and Therapy (McKenzie Method)
As mentioned above, MDT allows us to identify the root cause and guide you through neck-based movements to reduce or eliminate symptoms.
✅ Cervical Joint Mobilization and Manipulation
Skilled manual therapy to the cervical spine can restore joint motion and reduce local irritation.
✅ Postural Correction and Ergonomic Advice
We assess your daily activities and help you correct contributing habits—like slouched sitting or looking down at your phone.
✅ Targeted Exercise and Stability Work
We often integrate deep cervical flexor activation, scapular stabilization, and thoracic mobility drills.
✅ Education
Understanding your pain is key to managing it. We teach you what movements help and what to avoid.
When Should You See a Provider?
If you’ve had scapular pain that:
- Doesn’t improve with shoulder rehab
- Gets worse with sitting or turning your head
- Radiates to the neck or arm
- Improves with posture correction or neck movement
…you likely need a cervical spine evaluation, not more local scapular treatment.
Final Thoughts: Treat the Source, Not the Site
Scapular pain can be frustrating, especially when traditional treatments don’t work. But if you’ve been targeting the shoulder blade when the real problem is in the cervical spine, you’ll keep missing the mark.
Our approach at Central Ohio Spine and Joint helps patients uncover the true source of their pain, not just mask the symptoms. Using tools like the McKenzie Method, we help you fix the root cause and get lasting relief.
If you’re dealing with stubborn scapular pain and think it might be coming from your neck, let us help. At Central Ohio Spine and Joint, we specialize in identifying and treating referred pain patterns using evidence-based methods like the McKenzie Method. Click here to schedule your evaluation today.
To read more about referred pain patterns from the cervical spine, see this overview from the National Library of Medicine.
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