Understanding Shoulder Pain: How Poor Posture and Spinal Alignment Can Lead to Injury

Dr. Benjamin Karpus
Jul 22, 2017
2 min read

Updated: Nov 6

Physical therapist performing shoulder treatment at Empower Rehab & Wellness in Buckhead to restore mobility and relieve pain.

Injuries in the body typically fall into two main categories. The first type is acute injuries, which occur suddenly—such as from a fall, car accident, or sports mishap. These are often difficult to prevent because they happen unexpectedly and are influenced by factors outside your control.

The second type, known as microtrauma, develops gradually over time. These injuries result from repetitive stress or faulty movement patterns. Common examples include rotator cuff tendonitis and shoulder impingement syndrome. Unlike acute injuries, microtraumas are often preventable through proper posture, balanced muscle mechanics, and corrective exercise.

How Poor Shoulder Mechanics Lead to Pain

Most shoulder tendonitis affects the supraspinatus and biceps tendons, especially when the scapula (shoulder blade) tips forward. This position causes the acromion—a hook-shaped bone on top of the scapula—to rub against the tendons with each overhead movement. Over time, this constant friction can cause irritation, inflammation, and even small tears.

Physical therapy for shoulder pain typically focuses on:

Avoiding repetitive overhead movements that aggravate symptoms
Stretching tight internal rotators such as the subscapularis, latissimus dorsi, and pectoralis muscles
Strengthening and retraining the scapular stabilizers to restore balanced movement

However, there’s another critical piece that’s often overlooked: the mobility of the thoracic (upper back) and cervical (neck) spine.

The Spine–Shoulder Connection

If the thoracic spine cannot properly extend, the ribs cannot glide forward, and the scapula cannot tilt back into its ideal position. When a person is simply told to “pull their shoulders back” without addressing this restriction, it often leads to overuse of the rhomboids and trapezius, resulting in even more tightness and discomfort.

Additionally, misalignments in the cervical spine can affect the brachial plexus, the nerve network that supplies the shoulder and arm. This nerve irritation can disrupt the normal rhythm between the neck, shoulder blade, and arm—sometimes causing a winging scapula or shoulder instability. When the scapula isn’t functioning properly, the shoulder joint loses its stable foundation, increasing the risk of impingement, tendonitis, or even full-thickness tears if left untreated.

Why Early Evaluation Matters

If you’re beginning to notice shoulder discomfort, tightness, or pain during overhead movements, don’t wait for it to worsen. Having your cervical and thoracic spine evaluated for restrictions or misalignments can prevent long-term damage.

At Empower Rehab & Wellness, our expert clinicians specialize in: