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Cervical Referred Pain

Have you ever heard your chiropractor or other healthcare provider tell you your shoulder pain is actually stemming from something in your neck? One of the reasons this might be the case is due to referred pain patterns of the cervical facet joints. Facet joints are the joints that are located on the back of the vertebral column (your spine). Each vertebra has two superior (upper) and two inferior (lower) facet joints located on opposite sides of the vertebrae (See Figure 1) .

As seen in Figure 2, each of the facet joints have at least one location where they have been shown to refer pain to (1). The lower cervical vertebrae in particular have patterns that are surrounding the shoulder complex. Dysfunction located as high as the fourth cervical vertebra can refer pain to the top of the shoulder and thus be mistaken for true shoulder discomfort. When a chiropractor delivers an adjustment to your spine, these facet joints are one of the primary joints they are targeting (2). A systematic review and meta-analysis of randomized control trials found that chiropractic adjustments are an effective treatment for acute neck pain (3). And if you incorporate another modality, in one particular study they used cold laser, the outcomes are even better in terms of either treatment option by itself (4).

Neck joints and their referred pain patterns in your neck, shoulders and back
Cervical Facet and their referred pain patterns


  1. Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, Naganuma Y, Yuda Y. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain. 1996 Nov;68(1):79-83. doi: 10.1016/S0304-3959(96)03173-9.

  2. Anderst WJ, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M. Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. The spine journal : official journal of the north american spine society. 2018;18(12):2333-2342. doi:10.1016/j.spinee.2018.07.026

  3. Chaibi A, Stavem K, Russell MB. Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Journal of Clinical Medicine. 2021; 10(21):5011.

  4. Saayman L, Hay C, Abrahamse H. Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study. J Manipulative Physiol Ther. 2011 Mar-Apr;34(3):153-63.

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