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Background & Purpose: Shoulder pain is the most common orthopedic issue affecting swimmers.19 Swimming requires adequate cervical motion in order to breathe and high muscular forces at extreme ranges of shoulder motion, as majority of propulsive forces come from the upper extremities. Differential diagnosis in swimmers can be difficult due to similar presentations and interconnecting diagnoses, but remains essential to provide effective, efficient care. Case Description: A 14 year old female competitive swimmer with chronic right shoulder pain of one year in duration was treated in physical therapy after undergoing two prior unsuccessful episodes of physical therapy and one bout of chiropractic care. Differential Diagnosis: The top three diagnoses were cervical spine weakness and hypermobility, subacromial impingement, and scapular dyskinesia, respectively. Discussion: Abundant research discussing differential diagnosis in swimmers with shoulder pain is available, yet majority do not mention the cervical spine as a potential pain generator. Our patient had complete resolution of her shoulder pain following eight visits that focused on cervical spine strengthening and endurance without any periscapular or rotator cuff exercises. Therefore, this case provides an example of cervical spine involvement in a patient with chronic shoulder pain and evidence for the importance of including cervical spine in the differential diagnosis of swimmers.