What Causes Chronic Neck Pain and Headaches (And Why They’re Often Linked)
Chronic neck pain and tension headaches affect millions of people—but many treatments still view them in isolation. Most focus narrowly on the neck or treat headaches as stress-based, ignoring a critical structural connection: your shoulder blades.
In fact, research shows up to 90% of people with headaches also report neck pain, suggesting these two conditions often stem from a shared origin. Yet most treatment plans fail to explore how misalignments in the shoulder girdle impact neck function.
“In my clinical experience, the root cause of chronic neck pain and headaches is often scapular depression,” says Rick Olderman, MSPT, a physical therapist specializing in musculoskeletal dysfunction. It’s a structural issue, not just a stress response.”
Understanding how the shoulder blades interact with the spine and skull is key to treating both neck pain and chronic headaches at their root.
Quick Insights: What You Need to Know
- The position of your shoulder blades can directly affect your neck and head
- A condition called scapular depression causes neck-supporting muscles to overwork
- This strain can lead to chronic tension, headaches, and reduced neck mobility
- A simple movement screen—The Armpit Test—can reveal the pattern
- Stretching, posture shifts, and ergonomic support can make a lasting difference
Why It Matters for People with Chronic Neck Pain & Headaches
Many people with neck pain or migraines turn to massage, pain meds, or posture fixes—only to see results fade. Without addressing shoulder blade alignment, even the best efforts may fail to stick.
“Treating symptoms without correcting structure is like replacing tires without realigning your car,” says Olderman. You’ll be back in the shop again soon.”
Neglecting this systems-level connection can lead to years of treatment fatigue, unnecessary imaging, or overuse of pain relievers.
COMPONENT THINKING VS. SYSTEMS THINKING
Most doctors and therapists still use “component thinking” when diagnosing pain—isolating the neck, spine, or joints as separate parts.
“But pain rarely starts in one place,” explains Olderman. It starts when the whole system gets out of sync.”
Systems thinking looks at how posture, movement habits, and muscle groups interact. It recognizes that a low, unstable shoulder blade can force the neck into unhealthy tension—especially during work, sleep, or stress.
WHY THE SHOULDER BLADES MATTER
The scapulae (shoulder blades) are to the upper body what the pelvis is to the lower body: a hub of motion, muscle control, and spinal stability.
Caption: Both the scapula and pelvis are broad, flat bones designed to anchor key
muscle groups.
Two key muscles link the shoulder blades to the spine and skull:
- Levator scapula, which pulls the shoulder blade upward and also connects to the upper neck
- Upper trapezius, which stabilizes the shoulder girdle and supports head posture
When the scapula sits too low—a pattern known as scapular depression—these muscles are forced to overwork, triggering stiffness, pain, and even nerve-related symptoms.
THE ARMPIT TEST: A SIMPLE SCREEN TO REVEAL THE PAIN PATTERN
The Armpit Test is an easy, hands-on way to assess whether scapular depression may be contributing to your pain.
How to Do It:
- Sit or stand upright and slowly turn your head side-to-side. Note any stiffness.
- Have a friend or therapist place their hands in your armpits from behind and gently lift your shoulders about an inch.
- While staying relaxed, repeat the head rotation.
- Lower your shoulders and compare the before/after difference.
Caption: When scapulae are passively elevated, neck mobility often improves immediately.
If your pain decreases or range of motion improves during the test, scapular depression may be a contributing factor.
“This test gives patients a feel for what normal, supported movement should feel like,” says Olderman. It’s usually a breakthrough moment.”
Note: Mild tingling in the arms is normal—focus on changes in neck comfort and motion.
THE IMBALANCE OF MUSCLE FORCES
Scapular depression isn’t just caused by slouching or poor posture—it’s a mechanical imbalance rooted in muscle strength and bodyweight distribution.
The large, powerful muscles responsible for pulling the shoulder blades downward—such as the latissimus dorsi and pectoralis major—far outweigh the strength of the smaller levator scapula and upper trapezius, which are tasked with lifting and stabilizing the scapula.
“Each side of your upper body can weigh 10 to 30 pounds,” explains Olderman. If the support muscles aren’t strong enough, the shoulder blade sinks under the load.”
Caption: Larger downward-pulling muscles overpower smaller scapular elevators—leading to depression and overuse strain.
This imbalance is what makes scapular depression so common—and why targeted interventions are needed to correct it. Stretching alone won’t be enough if the upper body isn’t properly supported.
HOW TO FIX NECK PAIN CAUSED BY SCAPULAR DEPRESSION
The All 4’s Rocking Stretch
This modified version of child’s pose helps decompress the spine and gently activates muscles that elevate the scapula.
Instructions:
- Start on hands and knees
- Slowly rock your hips back toward your heels
- Slide your arms forward until your head rests on a pillow or mat
- Gently shift side to side
- Hold for 30–60 seconds, repeat 2–3x per day
Caption: This stretch targets overworked scapular depressors and releases cervical tension.
This stretch loosens the latissimus dorsi and pectoralis major—strong muscles that pull the shoulder blades downward when tight.
POSTURE & ERGONOMICS: SMALL FIXES, BIG DIFFERENCE
Scapular depression is often reinforced by workstation habits, slouched posture, and poor seating.
Ergonomic Tips from Rick:
- Use armrests or cushions to elevate your forearms while seated
- Raise your screen height to prevent downward gaze
- Avoid carrying shoulder bags that pull one side of your scapula down
- Build in micro-breaks to reset posture throughout the day
“Posture isn’t just about sitting tall,” says Olderman. It’s about taking pressure off the system—so it doesn’t have to fight gravity all day.”
FURTHER READING: PAIN PATTERNS
Neck and shoulder pain are rarely isolated. They’re often symptoms of larger postural patterns affecting the spine, pelvis, and even the feet.
Rick Olderman’s book, Pain Patterns: Why You Are in Pain and How to Stop It, offers a clear, non-clinical look at the real causes of chronic pain—and how to fix them.
Visit rickolderman.com to explore free videos, a full masterclass, and downloadable home programs.
EXPERT BIO
Rick Olderman, MSPT, is an orthopedic physical therapist and author with over 20 years of clinical experience helping people resolve chronic musculoskeletal pain. He specializes in systems-based movement rehab.
DISCLAIMER
This article is for educational purposes only and does not replace medical advice. Always consult a licensed provider before beginning any new treatment.
New Insights on Chronic Neck Pain and Headaches — Your Shoulder Blade Could Be to Blame
What Causes Chronic Neck Pain and Headaches (And Why They’re Often Linked)
Chronic neck pain and tension headaches affect millions of people globally, yet they are often treated as separate conditions. This fragmented approach overlooks one essential truth: the muscles, joints, and alignment of the neck, shoulders, and head function as a connected system.
In fact, research shows that up to 90% of people with recurring headaches also report neck pain—indicating a shared underlying cause. Despite this, most treatments focus narrowly on isolated neck structures or symptom management, rarely addressing the broader mechanical imbalances driving pain.
“In my clinical experience, the root cause of chronic neck pain and headaches is often scapular depression,” explains Rick Olderman, MSPT, a physical therapist with more than two decades of expertise treating musculoskeletal dysfunction. In short, the problem is a structural issue, not just a stress issue.”
Understanding how the shoulder blades affect cervical alignment is key to relieving long-standing discomfort and preventing future flare-ups.
Quick Insights: What You Need to Know About Neck Pain and Headaches
- Shoulder blade position directly influences neck tension, alignment, and range of motion
- When the scapulae sit too low (scapular depression), neck muscles overwork to compensate
- This overuse can trigger tension headaches, radiating arm symptoms, and reduced mobility
- A simple movement screen—called The Armpit Test—can reveal this hidden pattern
- Targeted stretching and ergonomic strategies can reduce pain and support long-term relief
Why It Matters for People with Chronic Neck Pain and Headaches
Many patients with chronic neck pain or headaches try massage, posture correction, and pain relievers—but still struggle. Without addressing the postural mechanics of the shoulder blades, these efforts often fall short.
Scapular depression strains key muscles that support the cervical spine. Over time, this creates a domino effect of stiffness, alignment issues, and radiating symptoms.
“Treating symptoms without correcting the structure is like replacing tires without fixing the alignment,” says Olderman. Relief only lasts until the system breaks down again.”
Ignoring this systems-based pattern increases the risk of chronic dysfunction, overuse of medications, and escalating pain.
Understanding the Neck, Shoulder, and Head System
The scapulae (shoulder blades) are the foundation of upper body movement. Much like the pelvis anchors the spine, the scapulae stabilize the muscles that support the neck and skull.
Two key muscles directly affected by scapular position include:
- Levator scapula: Connects the shoulder blade to the cervical spine
- Upper trapezius: Supports shoulder elevation and the base of the skull
When the shoulder blades sit too low, these muscles are placed under constant tension.
This leads to:
- Reduced cervical range of motion
- Muscle fatigue and stiffness
- Radiating pain into the head, neck, and arms
- Chronic tension headaches and migraines
- In some cases, nerve-related symptoms in the hands
“I often call scapular depression the ‘invisible injury’,” says Olderman. It hides in plain sight—but fixing it can change everything.”
The Armpit Test That Reveals Source of Neck Pain.
If you’re wondering whether your shoulder blades may be contributing to your neck pain, try The Armpit Test — a quick, non-invasive screen Rick Olderman uses in clinical practice.
How to Perform It:
- Sit or stand upright.
- Slowly rotate your head left and right. Notice any stiffness or discomfort.
- Have a partner gently lift your shoulders from behind by placing their hands in your armpits.
- Relax fully while they lift your scapulae about one inch.
- Repeat the head rotations while your shoulders are elevated.
Interpreting Results:
- If your pain decreases or mobility improves during the lift, scapular depression may be contributing to your symptoms.
“This simple test shows what your body feels like with proper scapular support,” explains Olderman.
“It’s often a lightbulb moment for patients.”
Note: Mild arm tingling is normal due to temporary nerve compression. Focus on changes in neck motion and comfort.
How to Relieve Neck Pain Caused by Scapular Depression
Stretching Strategy: The All 4’s Rocking Stretch
To reduce tension in overworked muscles and restore balance, Olderman recommends a modified version of child’s pose known as the All 4’s Rocking Stretch.
Instructions:
- Begin on hands and knees
- Rock your hips back toward your heels
- Slide your arms forward, resting your head on a pillow
- Shift side to side gently to release different fibers
- Hold for 30–60 seconds, 2–3 times per day
This stretch decompresses the cervical spine and targets tight scapular depressors like the latissimus dorsi and pectoralis major—muscles that contribute to scapular depression when chronically tight.
The Role of Ergonomics in Fixing Neck Pain
Stretching is only part of the solution. Long hours of poor workstation posture can reinforce scapular depression and cervical strain.
Daily Ergonomic Adjustments:
- Use passive support like armrests or pillows to elevate the shoulders without muscle tension
- Adjust monitor height to prevent neck flexion or downward gaze
- Avoid carrying shoulder bags that pull the scapulae down
- Support the elbows and forearms to reduce gravitational load
“Ergonomics isn’t about sitting up straighter,” says Olderman. It’s about creating passive support so your muscles can rest and heal.”
Olderman uses a unique taping technique to retrain scapular elevation and reduce strain throughout the day. He includes this his digital programs for neck pain.
Further Reading: Understanding Pain Patterns
Neck pain and headaches rarely occur in isolation. They are often part of a broader dysfunction involving the spine, shoulder girdle, and even the lower body.
For a deeper exploration of how these pain patterns develop — and how to correct them — readers can refer to Rick Olderman’s book, Pain Patterns: Why You Are in Pain and How to Stop It.
The book outlines movement-based approaches to treating chronic pain at its source, connecting common symptoms to hidden postural habits that traditional evaluations may overlook. A second volume dedicated to neck pain and headaches is also available.
Visit rickolderman.com to explore free resources, exercises, and home programs.
Author Note
Rick Olderman, MSPT, is an orthopedic physical therapist, author, and educator who specializes in movement-based treatment for chronic musculoskeletal pain. His clinical approach blends biomechanical analysis with practical interventions to address the root causes of dysfunction, not just the symptoms.
Disclaimer
This article is for educational purposes only and is not a substitute for professional medical advice. Please consult a licensed healthcare provider for diagnosis and treatment of chronic pain conditions.