What if the chronic pain or tension you're feeling in your neck and shoulders isn't actually just a neck and shoulder problem?
This is something that often surprises my clients, and honestly, I LOVE seeing that lightbulb moment when they begin to understand the why behind what they're experiencing and, more importantly, how we can start addressing it.
If you regularly experience neck tightness, shoulder tension, headaches or that familiar feeling of carrying the weight of the world across your upper back, you've probably tried stretching, massage, strengthening exercises or adjusting your posture in hopes of finding relief.
And while these approaches can certainly help, there's another piece of the puzzle that often gets overlooked: your breathing.
It might seem strange to connect something as seemingly unrelated as breathing to neck pain, but the two are much more closely connected than most people realize. In fact, several of the muscles that help you breathe are located in and around your neck.
This means that the way you breathe, how your ribcage moves and which muscles your body relies on to move air in and out can influence the workload placed on your neck and shoulders.
At ETHOS Collective Physiotherapy, we believe this is an important reminder that the body doesn't operate in isolated parts. Understanding how different systems influence one another can sometimes reveal contributing factors that would otherwise be missed.
Let's take a closer look.
Your neck muscles aren't just there to move your head
When you think about the muscles in your neck, you probably think about their role in turning your head, looking up and down, or supporting your posture.
But some of these muscles have another important job: helping you breathe.
While the diaphragm is the primary muscle of inspiration (breathing in), it doesn't work alone. Your body also has accessory respiratory muscles that assist with breathing, particularly when respiratory demand increases.
Two important examples are the scalenes and sternocleidomastoid (SCM).
The scalenes attach from the cervical vertebrae to the first and second ribs. When they contract, they can help elevate the upper ribs during inspiration.
The sternocleidomastoid attaches from the sternum and clavicle to the mastoid process behind your ear. When your head and neck are stabilized, it can assist with elevating the sternum during inspiration.
These muscles are designed to contribute to breathing when needed. This is completely normal.
However, when someone relies heavily on accessory respiratory muscles during everyday breathing, these muscles may experience additional demands throughout the day.
Think about it: you take about 20 000 breaths every day. If your neck muscles are consistently working harder than necessary to assist with breathing, that's a considerable amount of repetitive muscular activity.
For someone already experiencing neck tension, this is an area worth exploring.
What does your ribcage have to do with neck tension?
Quite a lot, actually.
Your ribcage isn't a rigid structure. It's designed to expand and recoil with every breath, allowing the lungs to change volume.
During inhalation, the diaphragm contracts and moves downward, while the ribcage expands in multiple directions. During exhalation, the diaphragm relaxes and moves upward as the lungs and surrounding structures recoil.
This coordinated movement relies on the diaphragm, ribcage, thoracic spine and surrounding muscles and fascia working together.
But what happens when this movement is altered?
For example, someone who demonstrates limited ribcage expansion (due to poor posture or an old injury), reduced thoracic mobility or a breathing pattern dominated by upper chest movement may develop a different pattern of respiratory muscle recruitment.
This doesn't automatically mean they will experience neck pain, but it can change the demands placed on the muscles involved in breathing.
It's also worth considering that the relationship works both ways. Neck pain, guarding and restricted movement can influence how someone breathes, just as breathing patterns may influence muscular demands around the neck.
This is why looking at only one area can sometimes leave important pieces of the puzzle unexplored.
Are you an upper chest breather?
One thing I often encourage people to become more aware of is how their ribcage moves when they breathe.
Take a moment and observe your breathing without trying to change it.
Place one hand over your upper chest and the other around your lower ribcage.
As you breathe in, notice:
Does your upper chest rise noticeably?
Do your lower ribs expand outward and around your body?
Can you feel movement through your side and back ribs?
Does your neck feel like it's actively working with each breath?
Does your breathing feel relatively effortless, or do you feel like you have to work to get air in?
There isn't one perfect breathing pattern that everyone should demonstrate, and some upper chest movement is completely normal.
However, if your breathing consistently feels effortful, your neck muscles are visibly working with each breath, or your ribcage seems to have very little movement, it may be worth having your breathing mechanics assessed.
The goal isn't to force yourself to breathe into your belly or eliminate all upper chest movement. It's to develop efficient, coordinated breathing that suits your body's needs.
Why simply stretching your neck might not be enough
This is where I think we need to change the way we approach recurring neck tension.
If your neck muscles are experiencing additional demands because of how you're breathing, repeatedly stretching those muscles may not address the factors contributing to that workload. This doesn't mean local neck treatment is unnecessary. In fact, addressing cervical mobility, strength and muscular function can be an important part of rehabilitation.
But it raises a better question:
Are we treating the area that's uncomfortable, or are we understanding everything that may be contributing to WHY it's uncomfortable in the first place?
A more comprehensive approach may include looking at:
Cervical mobility: How freely does your neck move, and are there areas of restriction or guarding?
Thoracic mobility: Does your upper back move well, allowing the ribcage to expand and recoil?
Ribcage mechanics: Can your ribs move in response to breathing, or is movement limited in certain areas?
Diaphragm function: How effectively is your diaphragm contributing to inspiration?
Breathing coordination: Which muscles are contributing to breathing, and how efficiently are they working together?
Movement and posture: How does your body organize itself during everyday activities and exercise?
These areas don't necessarily need to be addressed in isolation. They are interconnected, and understanding how they relate to one another helps guide more individualized treatment.
3 ways to start bringing more awareness to your breathing
You don't need to immediately start doing complicated breathing exercises. Sometimes the best place to begin is by becoming more aware of how your body moves.
1. Explore 360-degree ribcage expansion
Sit comfortably or lie on your back. Place your hands around the lower portion of your ribcage, with your fingers wrapping toward the front and your thumbs reaching toward your back.
Take a gentle breath in through your nose and notice whether you can feel your ribs expanding outward, including into your sides and back.
Exhale comfortably without forcing the air out.
Repeat for a few breaths, focusing on ease rather than taking the biggest breath possible.
2. Introduce gentle thoracic mobility
Your thoracic spine and ribcage work together during breathing, so maintaining movement through this region is important.
Try a gentle thoracic rotation in sitting. Keep your pelvis relatively still and slowly rotate your upper body to one side, then the other.
Move within a comfortable range, allowing your breathing to remain relaxed.
3. Notice unnecessary neck tension
Throughout the day, take a moment to observe whether your jaw, neck and shoulders are unnecessarily gripping.
Allow your jaw to relax, soften your shoulders and let your breathing happen without deliberately forcing it.
The goal isn't to hold your shoulders down or consciously control every breath. It's simply to recognize when you're adding unnecessary muscular effort.
If breathing feels uncomfortable, causes dizziness or creates unusual symptoms, stop and seek appropriate clinical guidance.
The bigger picture: Your body works as a system
One of the biggest mistakes we can make when addressing persistent pain is assuming that the location of the discomfort tells us everything we need to know about its cause.
Your neck doesn't function independently of your ribcage. Your ribcage doesn't function independently of your diaphragm. And your breathing doesn't happen independently of the rest of your body.
This is why a whole-body approach to physiotherapy can be so valuable.
When someone comes to ETHOS Collective Physiotherapy with recurring neck tension or pain, we don't want to automatically assume that the neck is the only area that needs attention.
We want to understand how the person moves, breathes and functions as a whole, identify relevant contributing factors and develop an individualized approach to treatment. Sometimes the answer really is local. Other times, there's more to explore. And that's why looking beyond the obvious can make such a difference.
If you're experiencing recurring neck tension or pain and haven't been able to find lasting answers, it may be time to look at the bigger picture.
At ETHOS Collective Physiotherapy, located in Britannia Beach and serving the Squamish and Sea to Sky communities, we take a comprehensive approach to understanding how your body moves and functions.
Because when it comes to your health, it's worth understanding the system, not just the symptoms.
Ready to take a different approach? Get in touch with ETHOS Collective Physiotherapy to learn more or book an assessment.