Shoulder pain when breathing CAN be relieved. Sarah Key explains what may be causing it, and demonstrates how you can help yourself at home.
People often refer to a pain in the shoulder or shoulder blade, when what they really mean is a 'back shoulder pain'.
And while it is almost never possible to get true (as in tip of shoulder) shoulder pain when breathing, it is indeed very common to get a glancing upper back and shoulder pain - particularly on taking a deeper than normal breath.
Shoulder pain related to breathing and coughing can originate from the spinal and rib-cage joints in different parts of the neck and thorax. If the pain is in the high upper-back and back of shoulder it is more likely to be coming from a jammed and inflamed facet joint in the neck and the muscles protecting it. These problems tend to be more severe and harder to deal with.
The muscles of the neck can be used as emergency breathing muscles that raise the clavicle (collar bone) and the first rib
The C5 to C7 facet joints in the neck are situated deep under the the web of muscles in the corner angle of the neck and shoulder. When annoyed or strained, they tend to refer pain down over the back of shoulder and upper back. The lower cervical facet joints are more than usually susceptible to becoming locked and painful, particularly during times of emotional stress when tension in the jaw and shoulders causes them to stay raised for weeks, even months.
Using a computer particularly compresses the cervical joints in
the neck-shoulder corner
Long hours at a computer with the head poked forward can also strain these cervical facet joints. The weight of the head held in front of the rest of the body for long periods is a great strain. The muscles that span the cervico-thoracic junction must keep a static hold on the head to keep it in position (so that the eyes and fingers can co-operate). Low grade neck symptoms are commonplace in the computer age and it is for this reason that complaints such as upper back pain when breathing are increasingly prevalent. You can read more about this in detail in the pages on computer neck
How common a pain is this?
With the stresses and strains of life, the jaw and trapezius muscles (that run from the back of your skull down either side of your neck, fanning out to to each shoulder tip) develop a permanent state of low-grade contraction that bunches up the joints in the neck/shoulder angle. In a similar way, our emotional response under duress (and this includes tiredness) subtly causes our breathing mechanism to change, which hoists up the shoulders and clutters the joints trapped at the neck angle.
Raised shoulders may be imperceptible to you until you face yourself squarely in the mirror and deliberately let them go. You will be amazed by how far the shoulders drop down when you will them to relax. (The problem invariably is keeping them there!) Reading below, you will also see how breathing through the mouth and chronic stress states raise the shoulders through over-exertion of the neck muscles.
Often, from the combination of the sustained neck angle and the stresses involved,
breast-feeding can bring on severe shoulder pain
The lower cervical facet joints caught in the neck angle by tense muscles inevitably become inflamed. This becomes more serious when the joints swell, causing an escalating domino effect that makes the neck muscles to go into a more heightened state of protective alarm.
Then you can get a savage jab of pain whenever you turn your head suddenly, take a deep breath, cough or sneeze - or even when you accelerate suddenly in the car!
For some reason - no doubt related to high stress levels, lack of sleep and looking down steeply to the side during breast-feeding - young first time mothers are particularly susceptible to this condition.
People who breathe through their mouth - and this is increasingly common in modern life with the high levels of stress hormones (cortisol) - often chronically over-use their emergency muscles of respiration in their neck. They literally use their neck muscles to breathe as a chronic default setting, rather than using their lower, slower, more thorough and less hurried diaphragm muscle deep in the chest.
Because these 'accessory muscles of respiration' are not designed for permanent use, they quickly tire and develop hard cordy strands of fatigued muscle either side of the neck that readily refer pain down through the shoulder and upper back.
The same mouth-breathing habits and poor use of the diaphragm is thought to be at the root of the modern pandemic of panic attacks, sleep apnoea, asthma and the use of inhalers.
Chronic mouth breathing causes neck problems.
To breathe well - and to look after your neck - you must keep your mouth closed
In acute crisis with a painful neck, particularly one that is causing shoulder pain when breathing, the first principle of treatment is to get the muscles to relax.
There's no two ways about it, you may need medication to start with. You really should also consult your treating doctor to take you though this, explaining what the tablets you should take and how often to take them. Meanwhile there is some further information on medication for spinal problems that you should perhaps read.
For severe neck pain and shoulder pain when breathing there are two important exercises:
1. The sideways neck stretch
2. The teapot stretch
The sideways neck stretch releases the cervical joints in the neck/shoulder corner
1. Sideways neck stretch
This exercise must be taken slowly. It's purpose is to gently stretch out over-active neck muscles that are keeping the lower cervical facets joints in the side of the neck bunched together and inflamed. But if you pull the neck too hard and try to stretch out the muscles too savagely they will simply clench harder and everything will become more painful.
At the start, it's important while doing this exercise to sit your shoulders down as low as possible, trying to keep your neck long. This in itself is the beginnings of a stretch, although your neck will feel strangely jangly and twitchy letting go the protective hunch and trying to let the shoulder down.
To stretch the left side of your neck, take your right arm up over the side of your head, with your forearm resting on the side of your forehead and your fingers clasped under your ear and as low as you can under the jaw. Not allowing your right shoulder to hitch up, let the weight of your right arm rest heavily on the side of your head. This will slowly bend the head over to the right. Try to keep your breathing slow, low and controlled, feeling your belly swell as your diaphragm activates more effectively. Hold this for 15-30 seconds and repeat another two times to the more painful side, once to the freer side.
The teapot neck stretch takes then neck back on the thorax rather than simply the chin up, tipping the head back on neck
2. The teapot stretch
In some ways this stretch replicates the action of the upper BackBlock (see below) but it is gentler and more able to be modified and regulated by you. It can also be done on the run when you are working at your desk and you need relief there and then.
To do this exercise you must interlace your fingers of both hands down to the web and place them under your jaw, trying to get as much of the hands under your chin as you can. Now, with the fingers still interlaced and your elbows pinned together, lift your elbows as high as possible. Through this action, you will tilt your head and neck backwards on your thoracic spine. Note that this is not simply an action that tips you head back on the top of your neck. Rather, it should emphasise the movement coming from the base of the neck, where your neck dives into your upper thorax.
In the early acute stages, you will barely be able to lift your chin back at all, with over-pressure often reproducing your familiar pain into the shoulder. Go as far as you can to 'nudging gently into the pain' holding for 5 seconds. Then let the head come back. Repeat another 2 times, trying not to panic so that your shoulders hunch up and you gulp air. As your neck relaxes and the pain starts to subside over the next few days you can push your neck back further and for up to 15 seconds.
For chronic neck pain there two important exercises:
1. The Thoracic BackBlock
2. The Swastika
1. Thoracic BackBlock
The perfect treatment for a nagging pain into the shoulder is using the BackBlock under the upper back. When you advance to this you will still continue to do the earlier exercises.
The forced BackBlock posture here is important because it is the opposite or antidote posture to head-forward position that most of us are in for the greater part of the day. It mainly angles the cervical spine back on the thoracic spine. But beware! This exercise means business. You may have to use a book or something shallower than the BackBlock if you head is really stuck forward. For more reading on how to use the upper block, go to the page Upper Back Pain Treatment with the BackBlock
The BackBlock is the ultimate self-treatment tool for all spinal therapy. It both decompresses the spine and re-aligns a stooped forward skeleton. You can order one here.
2. The swastika
On face value, this seems an alarmingly confronting exercise for a neck that is having trouble turning freely and working normally in any way. However it's a spectacularly successful exercise that simply involves getting your body (and head and neck) into position and letting gravity do the rest.
It involves a passive, sustained rotation of your neck which reduces the swelling and restriction around all the cervical facet joints, like wringing out a dishcloth. It is particularly effective for all chronic neck problems, typically when you are having difficulty turning to reverse the car.
The exercise involves lying prone on the floor, with the left arm and leg bent to a right angle out to the side of the body; the left hand palm down on the floor. On the other side, the right arm is also bent to a right angle but hand down, palm facing the ceiling. It is important to have both arms bent to a right angle at the elbow, one arm up-palm down, the other arm down-palm up.
The piece-de-resistance is the to turn your head and rest it on the floor facing the right hand (the hand you cannot see). In this position, try to relax as much as possible (this isn't easy) letting the weight of the back of your head go back, and gently twisting your neck further into rotation. Remain in position for 15 seconds, periodically lifting your head and taking it imperceptibly further around into range. Repeat once to each side. Dont panic.
The swastika is one of those cruel-to-be-kind exercises that is spectacularly successful. It should only be used in cases of non-severe neck pain with minimal shoulder pain referral
It's always easier to watch and listen than read. The following videos are of Sarah talking and explaining how the first principles of spinal treatment are always spinal decompression - both to ease the spinal segments apart and to correct faulty postures. And with many computer users in poor postures for hours each day, the need is great.
You can see Sarah herself showing you how to use the BackBlock for the upper back on Video 4 of the Back Pain Exercises video package. It helps to see it done properly, and besides, knowing you are doing the exercises right makes them work better - and there's nothing like seeing the pro do it.
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