by Adrian Masoni, PT, DPT

Many factors may contribute to neck pain in our daily lives. Sustained, poor posture adds excessive force to the muscles, joints, discs, and other soft tissues of the neck. This postural dysfunction may be sitting at a desk, driving, or even reading the morning paper. Stress of our day further increases muscle tension and pain. Even while we are sleeping, the position and pillow you choose could be adding to your discomfort. While individually and in short duration, these loads may not affect our daily lives, over time the cumulative stress to the soft tissues of our neck may lead to significant damage and long-term health issues.

What about the way we breathe? How does our breathing pattern influence the health of our neck? It is an area that may not be as well-known as the factors listed above, but one that may significantly affect the occurrence of neck pain.

Diaphragmatic Breathing

With a normal breath at rest, we use a muscle called the diaphragm for inspiration. The diaphragm is a broad, flat muscle that separates our thorax (the area where our lungs reside within the rib cage) and our abdominal cavity. When we engage the diaphragm, it moves downward into the abdominal cavity, increasing the space in the thorax, and creating negative pressure in the lungs which draws in air.1

Additional assistance is provided by the external intercostal muscles which lift the rib cage and create increased space in the thorax- thus allowing more air to be drawn into the lungs.

During heavy breathing, such as with exercise, where the body requires increased amounts of air into the lungs and with greater force, accessory breathing muscles are required. For the purpose of this article, those muscles will only be discussed in regards to their misuse during resting, or quiet, breathing.2

During expiration at rest, no muscle use is needed. The diaphragm simply relaxes and recoils back to its original position and air is pushed out of the lungs.

Improper Breathing Patterns

For a number of reasons, one can move away from a normal, efficient resting breathing pattern. In these abnormal patterns, accessory breathing muscles are recruited and utilized even at rest. Two such muscles are the Scalene group and the Sternocleidomastoid. These muscles help elevate the ribs and the sternum to increase the space in the rib cage and thus draw in more air.2 When these muscles are used excessively, like any other muscle or tissue, they may reach a breaking point where damage will occur- similar to straining a muscle or tendon in the extremities with overuse.3,4

Additionally, these accessory breathing muscles originate on the spine (Scalene muscles) or the base of the head (Sternocleidomastoid muscle) and insert on the ribs or chest wall so when they contract during use they increase the compressive forces placed on the vertebra, intervertebral discs, and nerves.4

Pain may be a direct result of this excessive force over prolonged periods or pain may have been due to another event (car accident, fall, etc) but is further aggravated by overuse of these muscles.

When observing someone using this irregular breathing pattern (or observing yourself in a mirror), you will see an overall elevation of the rib cage and/or a shrugging of the shoulders due to the recruitment of the muscles of the neck. With a proper resting breathing pattern, the rib cage does not rise but instead the abdomen protrudes as the diaphragm fills that space.

Practice Makes Perfect

Improper breathing patterns are like bad habits. Breaking these bad habits takes time, self-awareness, and PRACTICE! New motor control and movement patterns must be established to allow for the return of proper mechanics and less strain on the neck. Like learning any new skill, the more practice you put in, the better results you will get out of it.

Physical therapy provides great insight into the identification of improper breathing patterns, instructions for retraining and proper patterns, and to identify potential contributors to improper patterns and other markers which may be adding stress to the neck – posture, decreased flexibility, ergonomics, etc. As is the case with all injuries small and large, early intervention is the key to speedy and complete recovery and physical therapists are experts in assessing and treating posture, body movements and mechanics.


  1. Moore, Keith (2014). Clinically Oriented Anatomy (7 ed.). Baltimore: Wolters Kluwer. p. 306.
  2. Raper, AJ, Thompson, WT, Shapiro, W, & Patterson, JL (1966). Scalene and sternomastoid muscle function. J Appl Physiology. 21, 497-502.
  3. Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Baltimore: Willam and Watkins; 1999.
  4. Jalil, NA, Awang, MS, & Omar, M. Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases. Malays J Med Sci. 2010 Jan-Mar; 17(1): 60-66.

Adrian Masoni PT, DPT has been a practicing physical therapist since 2008 and is currently the Director of Rehabilitation at BreakThrough Physical Therapy in Sunnyvale, California

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