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The Connection Between Neck Pain and Breathing

brething exercise dysfunctional breathing muscles of breathing neck pain neck pain with inhale pain with inhalation shoulder pain shoulder pain with inhale strength breathing muscles the pain free athlete Nov 18, 2020

 Although the diaphragm and intercostals are the primary muscles of inspiration, several neck muscles play an accessory role in bringing air into the body. Furthermore, when these primary muscles of inhalation are not working optimally, or you are breathing heavily while exercising at a high level, the accessory neck muscles can become more active during respiration leading to breathing-related neck pain.


 Neck pain is often a symptom of poor breathing patterns!


Breathing Fundamentals

“Breathing” just means a gas exchange between the body and the environment. When we breathe in, we take oxygen (O2) into our lungs. Then, when we breathe out, carbon dioxide (CO2) is released out into the atmosphere. Our biochemistry triggers our need to inhale. In other words, when receptors in our brain sense that CO2 concentrations have risen a certain amount, that triggers inhalation. So, we inhale to bring in more O2 to reduce the CO2 concentration. This, consequently, lowers the acidity of our blood.

The rib cage expands with breathing

Inhalation is an active process that requires expansion of the lungs and rib cage within the torso.

The diaphragm, a primary muscle of inspiration, divides the thoracic cavity, which contains the lungs, rib cage and heart, from the abdominopelvic cavity, which contains the pelvis and many of our internal organs. In a relaxed state, following exhalation, your respiratory diaphragm should be in a lifted, domed-up position. I say “should be” because this is not always the case. Issues with the diaphragm position and function can lead to chronic neck pain. (I will explain this more later.) 

Diaphragm movement with breathing

Here’s the process. When you inhale, the respiratory diaphragm moves downward into a stretched position, as shown in the image. The respiratory diaphragm descends into the abdominopelvic cavity. This reduces the pressure in the thoracic cavity and draws air into your lungs. 



Primary Muscles of Inhalation

In addition to reducing the pressure in the thoracic cavity upon inhalation, the diaphragm also increases the volume of the thoracic cavity. The diaphragm is one broad muscle sitting at the base of the rib cage. It extends laterally in all directions from your center—forward, backward, and to both sides. Therefore, when it descends and flattens, it moves the ribs wider apart from the bottom of the cage. This then creates space for the lungs to expand as they fill with air.

Primary muscles of breathing

Besides the respiratory diaphragm, the intercostal muscles are primary muscles of inhalation. These muscles are located between each of the ribs. Their function in breathing, like the diaphragm, is to create more space in the thoracic cavity for expansion of the lungs and rib cage. They do this by elevating the ribs and expanding the chest from the sides.


Accessory Neck Muscles of Inhalation

Similar to the primary muscles of inhalation, the accessory muscles also assist in spreading and lifting the rib cage and chest. If overused, breathing-related neck pain can result.

Take a look at the Neck-muscles image. As you can see, there are three main muscles, including one group of three muscles, to focus on in the image. The scalene muscles (anterior, middle and posterior) and the upper trapezius muscle are on the back of the neck. Additionally, the sternocleidomastoid (SCM) muscle is equally important. It transverses from the front of the body and links the clavicle (collar bone) and sternum on the front of the rib cage to the temporal bone on the side of the skull.

Accessory neck muscles of breathing


These accessory neck muscles perform the following functions during inhalation. First, the scalenes elevate the first and second ribs, creating more space at the top of the rib cage. Also, the upper trapezius lifts the rib cage to allow the upper chest to enlarge. Finally, the SCM aids in the front to back expansion of the chest by raising the sternum.



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