Is Breathing a Pain in the Neck?

If you are suffering from a pain in the upper trapezius (at the base of your neck), and that no one can seem to diagnose and that just won’t go away no matter how much it’s stretched and massaged, it could be due to incorrect breathing patterns.


Look in the mirror- take a deep breath- what do you see?

Do you see your shoulders rising up? Well they shouldn’t be!


Normal, efficient and effective breathing uses the diaphragm and lower rib cage. When you are breathing correctly your lower ribs should expand and on inhalation your tummy should move outwards, this is a sign that you are using your diaphragm.


What is the aim of breathing?

Is it not to breathe in oxygen which is then transported in our arteries throughout the body so that our bodies can work for us?

When you breathe by lifting the shoulders (apically), most of the air breathed in ends up in the upper lobes of the lungs. Most of the blood vessels into which the oxygen needs to perfuse for transportation around the body are in the lower parts of the lung underneath the lower parts of the rib cage. It therefore makes very little sense to breathe into this upper chest area if we want to get the maximum amount of oxygen in.

Breathing with the diaphragm has many other benefits such as relaxation; creating a pump effect on the abdominal cavity which improves blood flow, lymphatic drainage and function of the organs…..but that’s enough for another article.


Why do we end up breathing with the upper chest?

All of us have at one time or another experienced stressful situations which make us hold our breaths and pull our shoulders up. Unfortunately for some, when these circumstances have passed, our breathing is left in a ‘maladaptive pattern’. We then start using the upper trapezius, scalenes and lavatory scapulae muscles to breathe. These muscles are ordinarily known as ACCESSORY BREATHING MUSCLES, meaning that they can be used in addition to the normal muscles of breathing in stressful situations.


So we now have muscles which are not designed to be primary breathing muscles contracting 30 000 times a day! A job which they are not designed for. No wonder that spasm and trigger points develop in theses muscles!


The approach to treating this pain is thus twofold….

Treatment of the painful area and most importantly, correcting breathing techniques and teaching our patients to breathe with the lower rib cage and diaphragm.

Once the correct muscles are engaged in breathing it gives the others a chance to rest and recover thereby reducing pain.


A breathing technique to try at home:


Put a tape measure or piece of string around the chest about 5cm below the nipples. Breathe in through the nose, the tummy should rise up and the tape/string should expand. Now breathe out as if you are blowing through a straw. Breathing out like this creates an eccentric contraction of the diaphragm which help to strengthen this muscle.

Now breathing correctly takes time as does any good habit ……what I do with my patients is give them little stickers to stick on laptops, steering wheels, phones, next to their beds etc to serve as a reminder, you too can try this in an effort to become more aware.

not to breath



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Cheryl Stacey BSc (Physio) SPT

Cheryl qualified from Wits in 1993 and worked for a variety on practices locally and abroad to gain a vast scope of practice. She opened her own practice in 1999 seeing orthopaedic and sports patients as well as 6 years spent treating post- operative spinal patients.

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