If you have ever gone to a physical therapist for shoulder pain and been told your hips need work, you may have walked out wondering if they had mixed up your chart. It seems implausible — what could your hip possibly have to do with your shoulder? As it turns out, nearly everything.

The body is not a machine made of independent components. It is a continuous web of fascia, muscle, bone, and nerve — all of it interconnected, all of it in constant communication. When one part of that web is restricted, shortened, weakened, or injured, the rest of the web reorganizes around it. This reorganization is called compensation, and it is one of the most important concepts in understanding chronic pain.

The Unfolding

The hip is one of the body’s most powerful joints. It is designed to carry load, generate movement, and provide a stable base for everything above it. When the hip is restricted — whether from injury, surgery, prolonged sitting, or muscle imbalance — it loses its ability to do its job fully. The body, being remarkably resourceful, does not simply stop functioning. It recruits help.

The lower back is usually the first to answer the call. It begins to absorb forces and ranges of motion the hip can no longer manage. Over time, this extra demand strains the lumbar muscles and compresses the lumbar spine. The lower back, now under stress, signals its own limitations. And so the chain continues upward.

The thoracic spine — the mid-back — begins to compensate for the lower back. Because the thoracic spine is closely connected to the rib cage and shoulder girdle, its movement patterns directly affect how the shoulder blade moves, how the rotator cuff functions, and how the arm tracks overhead. By the time you are reaching for something on a high shelf and feel that familiar ache in your shoulder, the story may have begun many months ago in a hip that was quietly struggling.

This is called the kinetic chain — the linked sequence of joints and muscles through which force travels during movement. Research published in the Journal of Shoulder and Elbow Surgery found that dysfunction in any segment of the kinetic chain results in altered performance or injury to segments further along the chain (Lluch-Girbés et al., 2023). A separate cross-sectional study confirmed that individuals with chronic shoulder pain consistently showed reduced range of motion and muscular endurance in the thoracolumbar spine and hips, as well as diminished neuromuscular control of the lower extremities — even when the pain was entirely localized to the shoulder (Fonseca et al., 2025).

Research has further identified that the myofascial system — the connective tissue web that links muscles throughout the body — plays a critical role in transmitting force between the hip and shoulder via the trunk. The latissimus dorsi and gluteus maximus, for example, are directly connected through this myofascial network, meaning that what happens in the glutes does not stay in the glutes (Krause et al., 2016).

This is why treating pain only at the site of pain so often provides incomplete relief. You may massage the shoulder, ice the shoulder, even rest the shoulder — and still find it returning, because the hip conversation was never addressed.

Grow in Understanding

First, develop curiosity about your body as a system. When something hurts, ask: what else might be contributing? What is upstream or downstream of this pain? Are there restrictions elsewhere that this area might be compensating for?

Second, invest in whole-body movement practices. Yoga, Pilates, and functional movement training are valuable not just because they build strength or flexibility in isolation, but because they teach the body to move as an integrated unit. They reveal where compensation patterns have taken hold and gently invite the body back toward balance.

Third, work with practitioners who think in systems. A skilled physical therapist, osteopath, or structural bodyworker will assess the whole chain — not just the loudest link.

Your shoulder is not betraying you. It is covering for someone else. And the kindest thing you can do for it is find out who.

This summer, Gardenia Group, will be offering wellness packages that includes the mind and body.  The idea of balance is not just for the strong and athletic.  Gentle yoga focused on mobility will be accessible for all ages. 

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🌸 References:

Lluch-Girbés, E., et al. (2023). Kinetic chain revisited: Consensus expert opinion on terminology, clinical reasoning, examination, and treatment in people with shoulder pain. Journal of Shoulder and Elbow Surgery, 32(8), e415–e428.

Fonseca, H.R.F., et al. (2025). Association between kinetic chain factors and the presence of shoulder pain in the non-athletic population. Journal of Shoulder and Elbow Surgery. doi:10.1177/17585732251328338

Krause, F., et al. (2016). Intermuscular force transmission along myofascial chains: A systematic review. Journal of Anatomy, 228, 910–918.

📚 Recommended Reading:

• The Body Keeps the Score by Bessel van der Kolk, M.D. — Essential reading on how the whole body holds and expresses its history.

• Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists by Thomas W. Myers — The definitive guide to understanding the fascial connections linking the body from foot to shoulder and beyond.

• Move Your DNA: Restore Your Health Through Natural Movement by Katy Bowman — A practical exploration of how habitual movement patterns shape the body’s structure and function over time.