Cloward's Sign: Is Your Neck the Hidden Cause of Your Shoulder and Back Pain?

At The Impact Initiative Physical Therapy and Performance, we see many patients come in complaining of upper back and shoulder pain, only to discover that the true cause may not be where they think it is. In fact, some of these discomforts might actually be referred pain from the neck! It’s easy to assume that shoulder or upper back pain comes from overuse, poor posture, or muscle strain in those specific areas—but sometimes, the source lies higher up, in your cervical spine (neck). This is why a thorough assessment of your neck is critical when evaluating shoulder and upper back pain.

One key concept that can help us uncover this hidden connection is Cloward’s Sign. Let’s dive into what it is, and why it’s essential for your physical therapist to screen your neck as part of a comprehensive evaluation for any shoulder or upper back pain.

The Hidden Connection Between Your Neck and Upper Back/Shoulder Pain

The neck and upper back are closely linked in terms of both function and nerve pathways. The nerves that control muscles in your shoulders, upper back, and arms come directly from the cervical spine (your neck). So, if there’s irritation or compression in your neck, it can cause pain that radiates down into your shoulders and upper back. The problem is, it might feel like the pain is originating in those areas, leading to a misdiagnosis and treatment approach that misses the mark.

That’s where understanding Cloward’s Sign becomes crucial. This sign points to how nerve compression in the neck can refer pain to specific areas in the upper back and shoulder region, mimicking a shoulder or upper back injury. So, your shoulder pain might actually be coming from a cervical spine issue that’s not immediately obvious.

What is Cloward’s Sign?

Cloward’s Sign is a clinical test used by physical therapists to determine if your neck is the source of pain in the upper back or shoulder. This sign indicates that certain cervical spine issues can cause pain to be "referred" to areas like the shoulder blade or upper back, even though the actual problem is in the neck.

When nerve roots in the cervical spine are irritated or compressed, the resulting pain can travel along nerve pathways, creating discomfort in the shoulder or upper back. This referred pain can often feel very similar to conditions like rotator cuff injuries, shoulder impingement, or even upper back muscle strains—leading to misdiagnoses if the neck isn’t considered in the evaluation.

Why Screening Your Neck is So Important

When you come in with shoulder or upper back pain, it’s vital for your physical therapist to screen your neck. Without this, you could be treating symptoms rather than the root cause of your pain, which may result in ineffective treatment and prolonged discomfort.

The truth is, treating the shoulder or upper back without considering the neck may not give you lasting relief if the real issue lies in the cervical spine. For example, a person might receive treatment for shoulder impingement or muscle tightness in the upper back, but if nerve compression in the neck is the underlying cause, the pain will likely return until the neck issue is addressed.

By screening your neck, we can rule out —or confirm—whether the neck is contributing to your upper back or shoulder pain. This is crucial because it allows us to develop a more targeted treatment plan that addresses the true source of the pain.

Conclusion

If you’re dealing with upper back or shoulder pain, it’s crucial to understand that the problem may not lie in the area where you feel the discomfort. Nerve compression or irritation in the neck can often refer pain to the shoulder or upper back, mimicking common injuries. This is why a thorough neck screening, including checking for Cloward’s Sign, is an essential part of any evaluation for shoulder or upper back pain.

At The Impact Initiative Physical Therapy and Performance, we take a holistic approach to treatment by thoroughly screening both your neck and shoulder. If you’re struggling with unexplained upper back or shoulder pain, we encourage you to schedule an evaluation with one of our expert physical therapists. We’ll help you get to the root of your pain and develop a treatment plan that works.

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Performance Physical Therapy

Woodstock, GA