How Core Performance Can Influence the Neck, Upper Back, and Shoulders
When someone comes to me with neck, upper-back, or shoulder pain, I do not assume that the entire problem begins where the discomfort is felt.
The body works as an interconnected system. The pelvis, hips, abdominal wall, pelvic floor, iliacus, psoas, quadratus lumborum, diaphragm, lower ribs, and thoracic spine can all influence how the upper body moves and manages tension.
That does not mean every shoulder problem originates in the pelvis or that every sore neck is caused by poor core function. Pain can have many causes, and I am not a doctor. As a licensed massage therapist, I do not diagnose medical conditions. My responsibility is to listen, observe, work respectfully within my professional license, and refer clients to the appropriate healthcare professional when necessary.
Pain Location Is Not Always the Whole Story
The painful area deserves attention, but it may be only one part of the pattern.
For example, a shoulder may be working harder because the thoracic spine is not moving comfortably. The neck may be assisting with breathing when the diaphragm is not functioning efficiently. The upper back may be compensating for changes in the pelvis, hips, or lower trunk.
Research supports looking beyond an isolated joint. Studies of the kinetic chain recognize that the trunk and lower body can contribute to shoulder function, although the strength of the evidence varies and these relationships are not identical for every person.
This is why I assess the person—not simply the painful body part.
The Pelvis Provides a Foundation
The pelvis connects the spine to the legs. Its position and movement can influence how force travels through the lower back, rib cage, upper back, and shoulders.
Daily habits may contribute to these patterns:
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Sitting for long periods
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Standing primarily on one leg
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Repeatedly crossing the same leg
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Sleeping in one preferred position
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Carrying a bag on the same shoulder
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Previous injuries or surgeries
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Athletic and occupational demands
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Pregnancy and childbirth
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Differences in hip mobility
The goal is not to force everyone into one “perfect” posture. Human bodies are meant to move and change positions. I am more interested in whether a person can move comfortably, breathe naturally, and distribute effort without one area continually doing too much work.
The Iliacus and Psoas
The iliacus and psoas are deep muscles associated with the hips, pelvis, and lumbar spine. Together, they assist with hip movement and participate in the relationship between the legs and trunk.
If a person has been guarding an injury, sitting for extended periods, or moving differently because of pain, these muscles may become part of a larger compensation pattern. That pattern can affect the position and movement of the pelvis and lower spine. In turn, the upper back and shoulders may have to adapt.
This does not prove that the iliacus or psoas is the source of someone’s neck or shoulder pain. It means these areas may be worth evaluating as part of a complete orthopedic massage session.
The Quadratus Lumborum and Lower Ribs
The quadratus lumborum, commonly called the QL, is located on each side of the lower back. It connects with the pelvis, lumbar spine, and lowest rib.
Because of these attachments, the QL can participate in side bending, pelvic control, spinal stability, and the movement of the lower rib cage. If one side is working differently from the other, a person may show changes in standing, walking, breathing, or trunk rotation.
Those changes may continue upward through the thoracic spine and shoulder girdle. That is why I may assess the lower ribs and QL even when the main complaint is higher in the body.
The Diaphragm Connects Breathing and Stability
The diaphragm is our primary breathing muscle, but breathing is not its only relevant role. It also works with the abdominal wall and pelvic floor to help manage pressure within the trunk.
When breathing becomes shallow or restricted, muscles around the neck and upper chest may provide more assistance. Over time, this can be associated with additional effort through the neck, clavicle, upper ribs, and shoulders.
Research has found that people with chronic neck pain may show reduced respiratory muscle strength and changes in pulmonary function compared with people without neck pain. This is an association, not proof that breathing dysfunction causes every case of neck pain.
A systematic review has also examined spinal, diaphragmatic, and breathing-related interventions for nonspecific chronic neck pain. Although this is an evolving area of research, it supports considering breathing mechanics as one part of a broader assessment.
During a session, I may observe whether the abdomen and lower ribs expand naturally or whether most of the breathing effort appears to occur through the upper chest and neck.
The Pelvic Floor Is Part of the Core
The pelvic floor is sometimes discussed as though it were separate from the rest of the body. Functionally, however, it works with the diaphragm, abdominal wall, and deeper spinal muscles as part of pressure management and trunk support.
This does not mean that an orthopedic massage therapist diagnoses or directly treats pelvic-floor disorders. Those concerns may require evaluation by a physician or a properly trained pelvic-health physical therapist.
Within my scope, I can consider how the surrounding hips, pelvis, abdomen, breathing system, and spine are working together. When appropriate, I encourage collaboration with other licensed professionals.
The Thoracic Spine and Shoulder Blades
The shoulder blades rest on the rib cage. Therefore, the position and movement of the thoracic spine can influence how the shoulder blades and arms move.
Research has shown that changing thoracic position can affect scapular movement and shoulder range of motion. A separate systematic review found that thoracic posture alone was not consistently associated with shoulder pain, reminding us not to blame pain on appearance or posture alone.
Both findings are important. Thoracic movement can matter, but no single posture automatically explains a person’s symptoms.
What an Orthopedic Massage Session May Include
Every session begins with listening. I want to know:
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Where do you feel discomfort?
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When did it begin?
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Which movements make it better or worse?
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How do you sit, stand, work, exercise, and sleep?
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Have you experienced previous injuries, surgeries, or major changes?
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What activities would you like to perform more comfortably?
I may then observe breathing, standing balance, hip movement, trunk rotation, thoracic mobility, and shoulder motion. Treatment may include the pelvis, hips, iliacus, psoas, QL, diaphragm region, lower ribs, thoracic spine, upper back, neck, or shoulders when appropriate and with the client’s informed permission.
I continually reassess movement and comfort. The purpose is not to chase every tight muscle. It is to identify which areas may be contributing to the pattern and determine whether gentle, pain-free treatment changes how the person feels or moves.
Comfortable Clothing and Supportive Positioning
Clients wear athletic shorts and a tank top so they can remain comfortable and covered as we move through different treatment positions.
Depending on the individual, treatment may be performed face up, face down, or side lying. I use a Stronglite Premier massage table and a body-support system to help reduce strain and make positioning more comfortable.
Treatment should not feel like something a client must endure. Pain-free work often makes it easier for the nervous system to settle and for the person to relax. Communication and consent remain important throughout the entire session.
Knowing When Massage Is Not the First Step
Massage therapy is not a substitute for appropriate medical care. A person should seek medical evaluation for symptoms such as:
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Chest pain or difficulty breathing
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Sudden or severe unexplained pain
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New weakness, numbness, or loss of coordination
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Pain following significant trauma
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Fever or signs of infection
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Loss of bladder or bowel control
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Unexplained swelling, discoloration, or warmth
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Symptoms that are worsening or otherwise concerning
When something falls outside my professional scope, I respect that boundary and recommend that the client speak with the appropriate healthcare provider.
A Whole-Body Approach in Grapevine, Texas
Neck, upper-back, and shoulder pain can be complex. Sometimes the most useful approach is to examine how the upper body relates to breathing, the thoracic spine, the core, the pelvis, and the hips.
My goal is to provide careful, respectful, pain-free orthopedic massage therapy based on the individual—not on a one-size-fits-all routine.
Orthopedic Massage Therapy
Steven Valenzuela, LMT
110 S Barton Street, Suite #6
Grapevine, Texas 76051
Text: 817-305-6548
Website: OmassageT.com
This article is for general educational purposes and is not medical advice. Massage therapy does not diagnose, treat, or cure medical conditions. Please consult an appropriate licensed healthcare professional regarding symptoms, diagnoses, or medical concerns.
