Neck pain is one of the most frequent disabling musculoskeletal complaints with a mean prevalence in the general population of approximately 23%.¹

Chronic neck pain is characterised by fluctuating periods of remission (temporary decrease of pain) and exacerbation (worsening of pain), with the majority of suffers not completely recovering.

“Neck pain can lead to adaptive musculoskeletal and motor control changes.” ² Such as an adaptive posture (e.g. forward head posture); the imbalanced muscles with segmental instability; potential to affect the rib cage mechanics, and thus affect the breathing force production ability.

Chronic neck pain is associated with:

• Decreased cervical muscle strength and endurance^3,4
• Reduced cervical mobility⁵
• Forward head posture⁶
• Altered cervical proprioception⁷
• Anxiety, Depression, Kinesiophobia (movement avoidance), or Catastrophizing^8,9
• Respiratory dysfunction²

Investigation

The sternocleidomastoid and scalene muscles are muscles of the anterior (front) of the neck, and the trapezius muscle is the posterior (back) muscle of the neck. These neck muscles are also accessory muscles of respiration, which assist in the elevation of the rib cage.¹⁰

A controlled cross-sectional study published in the Journal of Manual Therapy investigated if there is any respiratory difference between the sufferers of chronic neck pain and those without neck pain. ² The muscles of respiratory were assessed through maximal mouth pressures from a standing posture with a portable mouth pressure meter (microRPM, Micro Medical Limited, Rochester, Kent, England), which is a handheld instrument that measures inhalation and exhalation pressures. The participants hold onto the instrument, close their mouth firmly around the mouthpiece, and then perform maximal inspiratory and expiratory efforts. The nose is fitted with a nose clip in order to avoid air leak.

The study reported that chronic neck pain sufferers have reduced the strength of the respiratory muscles.

Patients with chronic neck pain had a significant 13.8% and 15.4% reduction in their ‘Maximal Inspiratory Pressure’ and ‘Maximal Expiratory Pressure’ respectively. ²

Therefore, neck muscle strength is a predictor for ‘Maximal Inspiratory and Expiratory Pressures’.²

“Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment.” ²

For optimal athletic performance, optimal chest expansion is essential for maximal inhalation of oxygen to the demanding skeletal muscles and exhalation of carbon dioxide from the lungs. Your neck may be affecting your breathing performance.

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2.Dimitriadis, Z, Kapreli, E, Strimpakos, N, Oldham, J. (2013). Respiratory weakness in patients with chronic neck pain. Manual Therapy 18 (2013) 248e253.
3.Chiu TT, Lo SL. Evaluation of cervical range of motion and isometric neck muscle strength: reliability and validity. Clinical Rehabilitation 2002;16(8):851e8.
4.Harris KD, Heer DM, Roy TC, Santos DM, Whitman JM, Wainner RS. Reliability of a measurement of neck flexor muscle endurance. Physical Therapy 2005;85(12):1349e55.
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8.Mantyselka P, Lupsakko T, Kautiainen H, Vanhala M. Neck-shoulder pain and depressive symptoms: a cohort study with a 7-year follow-up. European Journal of Pain 2010;14(2):189e93.
9.Hill JC, Lewis M, Sim J, Hay EM, Dziedzic K. Predictors of poor outcome in patients with neck pain treated by physical therapy. The Clinical Journal of Pain 2007; 23(8):683e90.
10.Palastanga N, Field D, Soames R. Anatomy and human movement. 4th ed. Malta: Butterworth Heinemann; 2002.