Case Study: Resolving Left Shoulder and Neck Soreness Through Fascial Counterstrain

Sometimes the source of shoulder pain isn’t in the shoulder at all.

(Fascial Counterstrain Treatment – 30-Minute Session)

Disclaimer: The following case study is based on a single 30-minute treatment session and is shared for educational purposes only. Individual results may vary.

Why Shoulder Pain Keeps Coming Back

Diagram showing the falx cerebri dividing the brain hemispheres — relevant to dural restriction and neck-shoulder tension.

Image created using Complete Anatomy © 3D4Medical. Used with permission for educational purposes.

Neck and shoulder pain are very common, particularly among people whose work involves repetitive or static movements.

At our clinic, we recently saw a patient who had been struggling with persistent soreness in their left shoulder for several months. The discomfort was centred around the upper trapezius and rhomboid muscles, creating a dull, aching tension that always seemed to return soon after every massage or stretching session.

They worked as a phlebotomist, performing repetitive arm movements throughout the day, which often aggravated the discomfort during busy shifts.

An X-ray ordered by their GP showed mild, age-related changes at the C3/4 level of the cervical spine (the middle of the neck) but no signs of injury. Their medical history was largely unremarkable, except for a minor motorbike accident many years ago.

Assessment Findings

During the assessment, their shoulder movement was only slightly limited, and tests for rotator cuff strength and shoulder impingement were both negative. These findings suggested that the pain was not due to a local shoulder problem.

When they bent forward, their spine moved freely — until neck flexion was added. With the neck flexed, their back flexibility decreased significantly. This pattern indicated a restriction in the mobility of the spinal cord and dural system, rather than a simple joint or muscle issue.

A Fascial Counterstrain Perspective

Using the Fascial Counterstrain diagnostic protocol, several key restrictions were identified:

- The Falx Cerebri, a connective tissue membrane within the skull that separates and supports the two brain hemispheres.

- Local fascial stiffness at the C3/4 level of the cervical spine.

Treatment began gently at the cranial level, where releasing the Falx Cerebri helped restore balance within the dural system. As their body responded, further tension patterns became apparent at C3/4, where the phrenic nerve was contributing to neck tightness.

By addressing this nerve and its surrounding fascial structures — including the venous system and periosteum (the outer layer of bone) — cervical restriction eased. The muscular tension across the upper trapezius and rhomboid regions softened naturally, and their forward-bending flexibility improved, showing better spinal cord mobility.

What Is the Phrenic Nerve?

The phrenic nerve arises from the cervical spine (C3–C5) and controls the diaphragm, allowing us to breathe.

There’s a simple mnemonic: “C3, 4, 5 keep you alive.”

If the phrenic nerve loses its signal, breathing can no longer be controlled voluntarily.

A well-known example is actor and director Christopher Reeve, famous for playing Superman. After a severe neck fracture, he relied on ventilator assistance because of damage at this level.

Illustration of cervical spine (C3–C5) and phrenic nerve. It goes down from the neck to the thorax, next to the heart

Image created using Complete Anatomy © 3D4Medical. Used with permission for educational purposes.

Understanding the Connection

Why did treatment focus on the neck and dura instead of the shoulder itself?

In this case, the shoulder joint, tendons, and muscles were not injured. They were reacting to tension within the neural and dural tissues higher up the chain. When the spinal cord or nearby nerves experience tension, the body often responds with a protective muscle-guarding reflex — a natural way to prevent further strain.

Nerves in our body form a continuous network rather than being separate segments. When one part of the nervous system becomes irritated or restricted, it can create corresponding tension or symptoms elsewhere — depending on the body’s history of injuries or sensitised areas. Because the nerves that supply the shoulder originate from the spinal cord, irritation of the dura (the protective covering of the spinal cord) can send abnormal signals along these pathways. This explains why someone may feel shoulder discomfort even though the true source lies within the dural system itself.

That’s why massage or stretching only brought temporary relief: the underlying neural restriction hadn’t been resolved.

In this situation, the tightness around the neck was also irritating the phrenic nerve on the same side, creating secondary restrictions in the rib cage, thoracic spine, and shoulder complex. These compensations can alter biomechanics and reduce shoulder mobility. Over time, they may contribute to excess mechanical stress and eventual degenerative changes if left unaddressed.

Illustration to demonstrate the continuum spinal cord to the left upper limb nerves.

Image created using Complete Anatomy © 3D4Medical. Used with permission for educational purposes.

What About Stretching?

Stretching can be very helpful when muscle tightness comes from a local soft-tissue imbalance, such as after a hamstring strain in sport.

However, if the restriction originates from nerve or dural tension, stretching may actually worsen symptoms, because nerves are not designed to be stretched like muscles.

For instance, in a person with sciatica, stretching the hamstring might irritate the sciatic nerve, increasing pain or numbness.

The same principle applies to the neck and shoulder — when nerves or the dura are involved, a gentle manual approach that targets these tissues is often more appropriate.

Outcome

After treatment, the patient reported a noticeable lightness through their neck and shoulder, and their forward-bending motion returned to normal.

These improvements suggested that restoring dural and neural mobility helped reduce the reflex muscular tension contributing to their discomfort.

Key Takeaway

Not all shoulder pain results from overuse or local strain.

Sometimes, the true restriction lies within the nervous system or dural membranes that connect the spine and brain.

By addressing these deeper structures through Fascial Counterstrain, it may be possible to gently restore mobility and ease tension throughout the body.

FAQ

Q: What is Fascial Counterstrain?

A: Fascial Counterstrain is a gentle, hands-on technique designed to identify and release strain patterns within the body’s connective-tissue system — including muscles, nerves, blood vessels, and fascia.

Q: Is Fascial Counterstrain safe for neck and shoulder pain?

A: Yes. The technique uses light touch and comfortable positioning. It does not involve forceful manipulation or stretching.

Q: How many sessions are usually needed?

A: Each individual is different. Some notice change after one session, while others may need several to address more complex or long-standing restrictions.

Q: Does this replace traditional physiotherapy?

A: Fascial Counterstrain complements traditional physiotherapy. It releases underlying restrictions so that movement retraining and postural correction can progress more effectively.

Kenneth Yuen

APA Titled Musculoskeletal Physiotherapist

Certified Fascial Counterstrain Practitioner (USA)

Fascial Release Clinic, located in Glenelg, Adelaide, provides advanced physiotherapy and Fascial Counterstrain treatment for pain and movement dysfunctions.