Breathing and Neck Pain:  Breaking Down the Breath

Our breath is vital to everything that we do. Yet, it’s something we rarely pay attention to unless we are short of breath or in a situation where our breath is labored due to sickness or exercise. However, the way you breathe can contribute to a variety of health issues, including neck pain.  

To understand how your breathing could be affecting your neck pain, let’s review a few things.  

How Well Are You Breathing?  

Try this test:

  • –Measure how many breaths you take during the course of one minute.  
  • –How many breaths did you take?  Record that number.  
  • –Now take one deep breath in.  
  • –Notice, where did you take that breath from?  
  • –Did you breathe from your chest or from your belly? 

How did you score?

  • If you are noticing that you had a high respiratory rate, that you were breathing through your mouth, or that you inhale and pull air into your chest, your breathing technique could be contributing to your neck pain.  
  • What’s great is with practice you can work to slow your resting respiratory rate, improve your technique and reduce your neck pain.  
  • Try the following exercise to improve your breathing technique to help with this.   

The Anatomy of Breathing

1. The number of breaths you take per minute matters

The guideline for resting respiratory rate in the US is 12-20 breaths a minute at rest.  Guidelines for mechanical ventilation (someone on a ventilator) are in the range of 8-12 breaths/minute. There is increasing literature supporting the benefit of a low respiratory rate in resting individuals.

In 2014, the NIH cited a study by Lin et al (Int J Psycholophysiol) looking at heart rate variability (HRV) and changes in HRV with a 5.5 breath/minute respiratory rate. Heart rate variability refers to the way your heart and heart rate respond to stimulus or how reactive your heart is to stimulus.

Think about this in practical terms.  It’s like waking up a hill. If you are in good shape, your heart rate will not increase as much as someone who is out of shape. So heart rate variability can be a good indicator of physical health and adaptability.

Slower breaths in the study were correlated to a less reactive heart rate response to stimulus. Participants who were able to slow their respiratory rate (RR) to 5.5. breaths/minute had greater HRV than other breathing patterns that were studied. 

Respiratory rate has not just been linked to HRV. There is now research to support that it can help to lower BP, decrease anxiety and influence many other systems of the body including resting muscle tension especially muscles in the neck. 

2. Where you breathe into matters.

If you took your deep breath from your chest or you moved the chest in when you took a deep breath in, you were breathing paradoxically

Paradoxical Breathing is a sign of respiratory distress associated with damage to the structures involved in breathing.  With paradoxical breathing, instead of moving the chest out when taking in a breath, the chest wall and abdominal wall moves in.  The physiology of how you take your breath actually makes a difference

Dysfunctional or paradoxical breathing often also causes people to breathe through their mouth rapidly, hold tension in their shoulders and breathe using the upper chest.  This can cause hyperventilation and increase neck strain. Working on breathing from the diaphragm into the belly on the inhale reduces paradoxical breathing patterns thus taking tension away from the neck.  

3. Where you take your breath from matters

The more efficient your respiratory diaphragm, the slower your breathing can become. This is because you don’t have to rely on as much work from the smaller respiratory muscles found in the neck to do the work. Bigger muscles are more efficient. Smaller muscles have to do more work to get the same work load done.

This is how neck pain can be exacerbated. Your neck muscles are postural. They help hold up the weight of your head and assist with core strength. The neck muscles might already be overworked from poor posture, so if you add extra work on these muscles to help you breathe, it can cause them to become strained.

By improving breathing efficiency by using your diaphragm instead of your neck muscles, you can reduce the strain on your neck significantly.  By using the diaphragm to breathe, this further facilitates improved core muscle support for posture as your diaphragm is the muscle that drives your core. 

Slow Down your Breath to Improve your Breathing Efficiency and Decrease Neck Pain


  1. 1. Lengthen your posture by gently elongating your neck through the crown of the head. As you do this, visualize the back of your neck motioning to the wall behind you. This is another way to lengthen the spine.

2. Gently maintain this elongation and take a breath into your belly. Keep the tension relaxed in the neck.  Allow the work to be done by expanding the lower ribs and belly when you take your breath in.  Inhale into the belly not the chest. You may even be able to think about expanding your back lower ribs wide as you inhale.  There are several ways to visualize this movement. Use the one that works best for you.  

  1. 3. Slow down your breathing. Work on doing a 3/3/3 breath. Perform a 3 sec breath out, then inhale for 3 sec, pause for 3 sec/ then another 3 sec breath out. 

As you become more proficient with this, you can start to lengthen your exhale up to 8 sec. Using a 3/3/3 breath will put you more in the range of 5.5 breaths/minute.  

By performing this breath while relaxing the neck muscles, you will not only reduce tension in your neck, but also impact the health of many of the other systems in your body including the cardiovascular system, the nervous system, and the digestive system just to name a few. 

So during the course of your day, evaluate your breathing a few times a day. Take a minute to take a breath. Consider the way that you are taking that breath. Do it once every hour or two. The frequency and the practice will be cumulative. Try it for a few weeks and see how your body responds.  You may be surprised how much better hour health and your neck will be better for it. 

Physical Therapy Can Help with Diaphragmatic Breathing

Want to learn more about diaphragmatic breathing? Physical therapy can help. Click here to schedule a complimentary phone consultation with one of our physical therapists.

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