Neck Pain And The Relationship to Breathing

The diaphragm is one of the most crucial muscles of our body. Primarily because it is the primary muscle that is used in breathing. Unfortunately, a lot of us rely on the accessory breathing muscles to breathe rather than the diaphragm, which can lead to a lot of dysfunction.

Before I get into the dysfunction bit, let me just give you a quick lesson on the anatomy of the diaphragm and the accessory breathing muscles. The diaphragm attaches to the lower ribs as well as to the last vertebrae in the thorax and the first couple vertebrae in the low back. When the diaphragm contracts, it moves downwards, towards the abdomen. Movement of the diaphragm depressing causes an increase of space within our rib cage causing air to rush into the lungs due to a negative pressure. Essentially this process is how we breathe when not under stress, or exercising.
 

​The accessory breathing muscles are all above the diaphragm. Two main muscles are included in the accessory muscle group. These muscles are the scalenes and the sternocleidomastoid (SCM). Both of these muscles attach in the neck and insert on the ribs.
 
Now let us move on to how these muscles relate to breathing pattern disorders and resulting pain. There are two types of breathing mechanics; diaphragmatic breathing and thoracic breathing. Diaphragmatic, also known as normal breathing is defined by using the diaphragm as the primary muscle to control breathing. Thoracic breathing is when the upper ribs are moved more in relationship to the lower ribs. To get further movement in the upper ribs the accessory breathing muscles such as the scalenes and SCM are used. Over time, since this is not their main function the muscles get overused and can be a potential source of pain. On top of having pain, there will also be a decrease in range of motion in the neck as well as a decreased ability to take in more air to the lungs.
 
So the next part of the puzzle is why did we start breathing more with the neck and chest muscles rather than our diaphragm? Unfortunately, there is no easy answer to this question as the reality is that everybody is different. Some people who sit a lot tend to have a more rounded out posture known as the upper cross syndrome. (If you need a refresher on this postural condition, see an earlier post). This posture can lead to a breathing pattern disorder as these muscles are not in their most functional position.

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Alternatively, people tend to “hold their stress” in their upper back and neck. Hopefully, I can break this down into a simple way to understand. Initially, it starts with a stressful situation, something happens at work, stress at home, traffic is backed up, and your late for an appointment and you start to develop a bit of anxiety. This event causes your sympathetic nervous system to kick in. The sympathetic nervous system is initiated for a fight or flight situation. You’ll start to breathe more quickly as the body believes you will need to start moving and get your butt in gear. To breathe faster, the accessory breathing muscles that we talked about earlier are recruited. Breathing this way is a natural response and quite necessary, the issue arises when we don’t rid ourselves of the stressful stimulus and don’t remember to focus on breathing with our diaphragm. Because these muscles are being used to help us breathe, they continue and are forced to carry out lengthy periods of breathing when they were never made to do this action for an extended time. This situation is how we start to develop pain in the neck, shoulders, and head.
 
So now what? You realize that you are doing something as simple as breathing incorrectly, how do you fix it?
 
It’s all about retraining yourself to do it properly again. Start by lying on your back and get comfortable. You can bend your knees a little bit if that helps. Next take each hand and place one on your stomach, and the other on the center of your chest. Now breathe. The hand on your belly should be the only one that moves. With only the bottom hand moving means you are using your diaphragm to breathe rather than the accessory muscles. Once you feel like you are more confident, try breathing while sitting or standing while using the diaphragm. An old professor of mine used to say “Practice doesn’t make perfect, perfect practice makes perfect.” So start slow, begin with the basics and then move on to harder stuff when the foundation is already set.
 
After all of this, I do not want you never to use your accessory breathing muscles. You are going to need them whenever you exercise intensely or need to go on a quick sprint to cross the street. You just don’t need to use them all the time! And these are not the only things that can cause neck pain; there is a multitude of structures in your neck that can be injured in different ways. Breathing incorrectly is just one of those ways.
 
If you are still a little bit confused or would like more guidance in this area, please do not hesitate to book an appointment with me to talk more about this.
 
References
 
1. Chaitow L. Breathing pattern disorders, motor control, and low back pain. Journal of Osteopathic Medicine. 2004;7(1):33-40.
 
2. Kapreli E, Vourazanis E, Billis E, Oldham J, Strimpakos N. Respiratory Dysfunction in Chronic Neck Pain Patients. A Pilot Study. Cephalalgia. 2009;29(7):701-710.
 
3. Chaitow L, Bradley D, Gilbert C. What are breathing pattern disorders?. In: Chaitow L, ed. by. Recognizing and treating breathing disorders. 1st ed. 2017. p. 1-10.
 
4. Bradley HEsformes J. BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT. The International Journal of Sports Physical Therapy. 2014;9(1):28-39.

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