When Breathing Becomes a Pain in the Neck

by Isabelle Barter

Suffering from a chronically tight feeling neck, sore and painful shoulders, or experiencing strange tingling in your arm or hand? You may have blamed poor posture, poor alignment while reaching overhead, or stress as the culprit, but perhaps your breathing habits are playing a significant role in your upper body stiffness, decreased range of motion, and pain.

During quiet breathing, or “normal” breathing, there are actually very few muscles involved. Breathing while at rest is automatic, seemingly effortless, and only involves the contraction of the respiratory diaphragm and intercostal muscles to inspire, or breathe in. The diaphragm contracts and moves down, creating a slight puffing out of the abdomen, and the intercostals contract to expand the rib cage. Exhalation while resting is usually passive and does not require muscle action. The muscles referred to as accessory breathing muscles, like the sternocleidomastoid, scalenes, and abdominal muscles, are typically not used. However, for many of us out there, this “normal” breathing is anything but normal!

If you’re like me, your sternocleidomastoid (SCM) and scalenes just can’t seem to stay on the breathing sidelines and are ever so eager to jump into the game! The SCM is located on the anterior (front) and lateral (side) aspects of the neck. If you turn your head to look over your shoulder, you might be able to see how it forms a diagonal line from behind the ear to the space between the collar bones. You have one on each side of the neck, and they help you to tilt your head from side to side, rotate the head and neck, and flex the neck (like touching your chin to chest). They can assist in breathing by elevating the ribcage during inhalation (think drawing the top of the ribcage and sternum closer to your neck and jaw line).

Anatomography / CC BY-SA 2.1 JP (https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en)

The scalenes are also in your neck, originating along the cervical vertebrae and attaching to the first and second ribs. Like the SCM, they help you to tilt, rotate, and flex your head and neck. They also assist in breathing by elevating the ribs during inhalation. Part of the brachial plexus, an important network of nerves that innervates the upper arm, passes through a small gap between two of the scalenes. Compression or impingement of the brachial plexus can send a sharp, shooting, sensation or numbness down the arm.

The SCM and Scalenes are typically called upon by the nervous system to elevate the ribs in order to get more oxygen into the lungs whenever breathing becomes more difficult or when metabolic demands increase. They are quite useful to help rebalance your blood chemistry (O2, CO2, and pH levels) after your run up a flight of stairs or finish dancing the Foxtrot. You also appreciate their efficacy when you inhale a cloud of smoke, suddenly feel starved for oxygen, and need to breathe now!

Our shoulder and neck problems can develop or intensify when these useful breathing assistants get over-utilized and relied upon for routine breathing. This could happen for a variety of reasons – perhaps the diaphragm doesn’t move well or isn’t accustomed to working under strenuous situations or for prolonged periods of time. You might be an expert at diaphragmatic or “belly breathing” lying down, but never practice seated or standing and are therefore unaccustomed to varied positions. Perhaps certain sections of the intercostals aren’t used as much as other sections – you might favor one side of the ribcage or prefer breathing front to back vs. expanding the ribs side to side. Maybe you had a surgery that left scar tissue and poor sensation surrounding the area making movement there difficult. Your breathing habits could even be a collection of habits from a lifetime of watching other stressed out people breathe. And, of course there’s the learned behavior of sucking in the gut to appear thinner. An unfortunate long-term side effect of gut-sucking or wearing compressive body shapers or shapewear is that the abdominal contents cannot move as the diaphragm descends on inhalation. If the belly can’t move, the diaphragm can’t move, and over time we develop the habit of getting extra air through the upper chest and ribs.

So what can you do if your emergency breathing system is stuck “on”? The first task is to just observe and notice your habits in action. Sit against a wall or lie down on the floor, take your hands to different sections of your ribs and belly and feel where your body moves or doesn’t move when you breathe. Then try this little drill from Dr. Cobb.

Lastly, join me on Saturday, December 10th from 4:00-5:30pm for a Better Breathing Community Workshop to learn strategies, exercise, and tools to improve your breathing habits.