Stress In The Neck And Shoulders

The average weight of the human head is 4.5-5kg/10-11lb. It contains the brain which weighs about 3 pounds. Then there is the skull, eyes, teeth, facial muscles and skin. When experiencing stress, you are more likely to increase tension in the neck, shoulders, and jaw, which can cause many symptoms, including headaches. How to combat it though?

There are 3 main points:

1) Posture

2) Abdominal Breathing

3) Biomechanics

Questions I ask clients to think about:

How long do you sit at a desk and/or drive per week?

How much do you use your last 3 fingers (middle to little finger), especially when gripping?

Do you look down a lot, such as texting or reading?

Do you prefer to slouch/lean/rotate despite knowing it is bad for your posture? And if so, do you take the time to correct your posture again, such as stretching the chest and shoulders?

When you breathe in and out, does your upper chest and collar bones move more than your gut?

Do you clench and/or grind your teeth?

When standing with arms down and relaxed, does your palm face forward, your side, or back?

1) POSTURE

There are many spinal deviants such as kyphosis, lordosis, scoliosis, and torticollis. In some cases it can be congenital, meaning you were born with it. However, in many cases it is due to poor posture and biomechanics!

Considering the weight of the head, think of the increased pressure on the front of the neck, shoulders and chest in order to maintain support, whilst the back is strained.

A correct posture should have a straight line through the ear, shoulder, hip and ankle as displayed in the picture above. One way to help correct this is simply doing "double chin exercises" and trying to maintain a posture with your head retracted. Julian Baker spoke about the SCM muscles (muscles going from the skull to the collar bone by the sternum) being a hip flexor at the British Fascia Symposium 2016, of which kyphosis overloads this muscle in posture, chest breathing and hip flexion!!!! Releasing the SCM can relieve many symptoms from headaches to neck and shoulder pain, including the fascial release it gives reaching the scalenes, occiputs, TMJ, pectoralis major and minor, sternum, and scapula.

TOP TIP: By simply keeping your head retracted with shoulders back and down, ensuring there is a straight line from ear to shoulder (taking into account the line then goes through the hip and ankle), it will help alleviate symptoms of stress. An important note is to be aware of grinding and/or clenching of the teeth by trying to maintain a relaxed jaw.

2) ABDOMINAL BREATHING

We have 12 pairs of ribs, with the lower 5 ribs being "false" and "floating" ribs giving them a greater capacity potential, compared to the 7 pairs of ribs attached to both the spine and sternum. Furthermore, our lungs are smaller at the top, and larger at the bottom with increased circulation supply to the lower parts, and our primary breathing muscle is the diaphragm. A functional respiratory diaphragm should move down on the inward breathe which pushes the gut outwards, and back up on the outward breathe, pulling the gut back in! During such inhalation and exhalation, it also mobilises the heart through attachments to the pericardial bag, the kidneys move up and down the central tendon, the stomach and pancreas down and left, the liver down and right, and the intestines move completely! Thus allowing for increased mobility of the gut, and thus, a more functional gut with the healthy elasticity and tensegrity relationships!

Only on exertion should we use the accessory breathing muscles, which recruits more chest breathing. Such accessory muscles include the scalenes, pectoralis minor, serratus anterior and both pairs of serratus posterior muscles.

Considering all of that, can you now understand how bad posture and bad breathing patterns influence each other? Such as stress headaches being due to both the strain on the neck and shoulder muscles, with reduced oxygen capacity due to restricted breathing patterns!

Dysfunctional breathing patterns:

1. Hyperventilatory: Rapid-breath pattern (averaging 20 breaths/minute) uses accessory muscles and restricts diaphragmatic movement being predominantly (thoracic patterns) in nature. Sometimes produced from poorly managed anxiety, this pattern manifests as very shallow, very rapid, and compounded by sputtered sighs (periodic patterns) and gasps (clavicular patterns). Panic, anxiety, and shock habituate this common phenomenon. People exhibiting this pattern immediately imperil their health.

2. Thoracic: These “chest-breathers” lack significant abdominal movement, with shallow and costal breaths. Enlarging thoracic cavity creates a partial vacuum by lifting the rib cage up and out through external intercostals muscles. Although the lungs do manage to be expanded by negative pressure, it is not enough to ventilate the lower lobes. This reduces pulmonary ventilation, since the lower lobes receive the greatest blood volume due to gravity.

3. Periodic: This pattern demonstrates rapid-shallow breathing, followed by a holding of breath, followed by a heavy sigh due to excessive CO2 concentrations in the bloodstream. This pattern flushes the CO from the bloodstream, which causes the brain’s autonomic system to shutdown respiration until the CO2 level raises to appropriate gas mixture. In the Periodic pattern, this cycle perpetuates. This is not to be confused with true Apnea, and can be diagnosed by witnessing that the pattern does not cause a change in color, such as no blueness of the lips, and the individual resumes shallow, rapid breathing without intervention, following the sigh. This pattern can be created through sustained anxiety, or by post-traumatic stress syndrome.

4. Clavicular: This pattern exhibits chest-raising that elevates the collarbones while drawing in the abdomen and raising up the diaphragm. People who are “open-mouth breathers” attempt to increase intake through oral inhalation, but this provides minimal pulmonary ventilation. Worse still, the accessory muscles used in this pattern consume more oxygen than it provides. In exercise, these individuals fatigue quickly.

5. Paradoxical: Often called “reverse” breathing, this abdominal pattern contracts during inhalation and expands on exhalation (using the muscles for the opposite purpose for which they were intended, thus, paradoxical/reverse.) Paradoxical breathing associates with the expectation of exertion, sustained effort, resistance to flow, and stress. Through stress, shock and fear, people can condition themselves to inhale (often married to clavicular and thoracic patterns), followed by hypoxic breath-retention and periodic sighs. As a result, this pattern causes very rapid fatigue.

6. Hypoxic: In preparation of perceived exertion, this pattern comprises an inhalation, withholding of exhalation (breath retention) until the perceived exertion concludes. Holding the breath dramatically increases intra-thoracic pressure, causing health risks such as, fainting associated with vagal nerve stimulation, increase in blood pressure, and hypoxia (reduced oxygen levels). Chronic baseline hypoxic breathing is very common, especially in "athletes”, due to conditioned exertion. Hypoxic patterning connects with the "flight-fright-freeze" response, predominantly more "freeze", the defense mechanism of “bracing” caused by anxiety.

TOP TIP: If you find it difficult to activate the respiratory diaphragm in abdominal breathing, try lying down as reducing the pressures of gravity in this way can help it's mobility. Also, speak to a Physical Therapist, ensuring they are aware of dysfunctional breathing patterns and how to correct them. Techniques that can be help include the Douglas Heels Technique, Muscle Energy Techniques to increase recoil, Soft Tissue work including Myofascial Release, Frequency Specific Micro-Currents (FSMC), and Feldenkrais.

3) BIOMECHANICS

In this context, a combination of both posture and breathing patterns, as biomechanics is based upon movement of the body, such as how well something is performed. The better the biomechanics, the more efficient and healthier the movement is.

This will be discussed in greater detail in future blogs, but for now, by improving posture and the respiratory diaphragm function, the shoulders and scapula's are better placed giving functional rotator cuffs, reduced pressure on the back of the neck due to reduced tension in the levator scapula's, and reduced tension in the jaw which decreases the likelihood of grinding and clenching of the teeth.

TOP TIP: Abdominal breathing, shoulders back and down, and head retracted. "Wall Angels" are a good exercise as it aids spinal alignment, and improved posture, noting practicing abdominal breathing during this exercise can advance it further. Also, focus training on the posterior deltoids, "lats" (latissumus dorsi), and triceps, of which neutral and supinated grips are better for improving the shoulder posture. Furthermore, ensure you are using ALL fingers in grip, rather than the thumb and index finger mainly and rather using more of the last 3 fingers, this helps create balance between the brachial plexus and suprascapular nerve chains.