Breathing Exercises

Breathing Exercises – Reduce Neck & Back Pain, Decrease Stress & Help Lower Blood Pressure

Breathing exercises involving deep breathing are easily performed while standing, sitting or lying flat on a comfortable surface. Lack of correct breathing mechanics can lead to neck pain by placing abnormal loading on front neck muscles. These muscles are the “Scalene” muscles and even though these muscles become problematic, the pain can radiate or travel into the shoulders, arms and, as illustrated below, into the hands into the hands.

As deeper muscles with direct cervical spine attachments, the scalene muscles are primary, however, the sternocleidomastoid and trapezius muscles are often involved as well, and these muscles are often involved with cervical muscular strain. So, if you breathe only with the upper body, your blood pressure may increase, leading to decreased amounts of air to fill the lungs. This upper body breathing (through the chest only) forces the scalene muscles in the neck to contract to assist in lifting the chest. The scalene muscles are not intended to perform this function and this overloading of the scalenes may lead to chronic neck pain as they become stiff and fatigued from overworking.

breathing exercises - scalenes scalene pain

As the exercises detail, proper breathing technique features an expansion of the stomach area, which can be seen as the stomach area rises. This is diaphragmatic breathing bringing air to the bottom portion of the chest which increases oxygenation, lowering blood pressure and relaxing muscles. Observing a newborn or small children, this is proper breathing. This type of breathing permits the highest volume of air intake, which can ultimately reduce stress and increase relaxation throughout the body.

Practicing over the years, these poor breathing techniques are seen frequently – in almost every patient! Not only from my experience in anatomy and physiology, but also from years of Martial Arts study, I made it essential to instruct these exercises which, in addition to reducing neck muscle strain, can increase oxygen throughout your body, reducing whole body stress. The results can be dramatic. This method of deep breathing was natural at first, but as we age and stress accumulates we abandon this correct form of breathing and practicing the breathing exercises is a great way to return to this beneficial method of increasing oxygen, energy and decreasing neck pain.

You may feel somewhat awkward to begin with as coordination must be re-established, using all the involved and correct muscles for breathing, however, practice will ingrain this into “muscle memory”, thus becoming second nature. The benefit will be apparent during periods of anxiety and stressful situation, when you feel your neck muscles tighten and heart rate increase. Begin to use the technique and you will notice a reduction of these mental and physical difficulties.

Breathing Exercises Detailed

Getting started: Lie down facing up making sure your neck is properly supported with a pillow or neck roll which places the neck in a posture that helps to open the airways.

The first illustration here indicates the incorrect method to notice. The middle shows proper exhalation, while and the right illustration indicated proper inhalation.

breathing exercise 1 breathing exercises 2 breathing exercise 3

Breathe through your mouth with one hand placed on the abdomen and the other on your chest and notice the movement. Typically when taking a deep breath, the improper method is observed where either the chest only is used or the abdomen pushes in while the chest pushes out.

To learn abdominal breathing, place the hands as described and exhale fully. Keep your chest in and relaxed. Start by contracting the abdominal muscles and the diaphragm. Then, without expanding the upper chest, inhale and allow your abdomen to expand out. Go for a smooth even rhythm. Once you are good at abdominal breathing you can begin to coordinate the movement of the abdomen with the chest.

A good method is to take air in for the count of 4, then pause for a count of 4, then exhale for a count of 4. Try to remain aware of your breathing throughout the day. Placing the tip of your tongue on the roof of your mouth right behind the front teeth and breathing around your tongue will aid in relaxation and moisten your mouth.

Another useful exercise is to imagine the air coming in going down in front to your abdomen then on exhale imagine the air going back and up the spine to the head and out. At the point when you pause or hold the breath, focus on the area your having trouble with such as the neck, shoulders, head etc…

breatheYou can provide needed relief for already overworked muscles in the neck by avoiding lifting unbalanced things requiring
using your arms to be held far away from your body, or having to exert sudden force. If you have to strain during everyday tasks, remember to think about the breathing exercises and reducing the tension of the neck muscles as you lift or shrug your shoulders and let the head be placed in a forward posture.

As you learn the new breathing exercises, you can also find use of a exerciser specifically designed for the neck to assist normalization and proper balance of the neck muscles. When straining during any activity try to keep breathing. When turning in bed roll the head instead of lifting it off the pillow. Always observe correct neck posture and use a good neck pillow to promote an open airway and correct alignment of neck curve.

Just as improper breathing techniques may cause neck problems, which the exercises help to correct, neck pain itself may cause breathing problems. In chronic neck pain, loss of contraction ability of the deeper neck muscles along with increased activity and overworking of the outer neck muscles, limited motion ranges and disturbance of control related to the nerves and muscles, including mental stress provides a link between neck pain and breathing problems.

Practice breathing exercises in this new and correct manner whenever possible. Try and make it “muscle memory”. The exercises can be a great tool in relaxation and coping with neck pain like managing chronic whiplash.

Breathing Exercises: Pain & Posture

Neck Pain

Due to related altered cervical spine biomechanics, changes in muscle function and reduced motion, the associated mechanical changes in respiratory muscles can reduce their ability to generate appropriate forces; which may lead to deterioration of pulmonary function and, over time, may cause permanent respiratory weakness or pathology. The evidence would suggest the breathing exercises are an interventional approach in those with chronic neck pain that may produce long term benefits.

  • In a 2009 edition of the Journal Cephalalgia, the authors did a pilot study on dysfunction of breathing in chronic neck pain patients. The results indicated that chronic neck patients have decreased breathing capacity as well as poor breathing muscle strength.

They also found a significant association between an forward head posture and low breathing muscle strength in neck pain patients. They consider the relationship between breathing and neck pain to be an important factor in the assessment of neck pain patients, as well as in rehabilitation and medication use.

  • In a 2013 edition of the Manual Therapy Journal, a study was performed to assess breathing weakness in association with chronic neck pain. The authors noted that individuals suffering chronic neck pain have weak respiratory muscles. They advise professionals treating chronic neck pain patients to consider breathing assessment and also treatment when necessary.
  • A 2014 study in Respiratory Care found a significant correlation between breathing function and chronic neck pain for intensity of pain, neck muscle strength and kinesiophobia (fear of motion). Therefore; respiratory dysfunction is associated with cervical spine muscle dysfunction, pain and reluctance to perform proper motion due to fear of increasing pain (movement avoidance).
  • A 2018 study in the Journal of Physical Therapy Science found that forward head posture increased the sternocleidomastoid and the scalene muscles activity, while decreasing forced vital capacity of the lungs. The authors of the study stressed the necessity to produce better therapeutic interventions for treating forward head posture based on pulmonary function and related synergist muscles.
  • A 2017 study in the Journal of Back and Musculoskeleletal Rehabilitation found a correlation between respiratory function, forward head posture, and accessory respiratory muscles. The authors noted significant correlations between altered posture and lower respiratory functions, indicating postural interventions to improve functional pulmonary reductions.

Back Pain

  • A 2009 study in the European Spine Journal noted altered breathing patterns in chronic back pain patients. The results of the study indicated over half of the chronic low back pain patients exhibited altered breathing patterns when required to do movements where trunk stability muscles are used. They suggested clinicians should evaluate breathing patterns in low back pain patients. The authors also suggest that breathing related disc pressure changes may have a function in proper disc nutrition.
  • A 2013 edition of the Journal of Physical Therapy Science, studied deep breathing training and found it had a positive effect on improving breathing as well as enhancing low back stabilization. They used a method of deep breathing exercises consisting of holding in the breath for 10 seconds at the end of inhaling. They did 5 sets of 10 repetitions of deep breathing using this technique to achieve the results.

They were given a one minute break after each set, and did the training one time per day, 3 times per week, for 4 weeks. The authors indicated the diaphragm is an important part of core stability during breathing in, reducing low back spinal stress through a combination of muscular actions, along with intra-abdominal pressure.

Low back instability is a cause of back pain. Stability of the back is important to prevent and treat low back injuries. This method of deep breathing may be used to reduce back pain and improve respiration as well as trunk stability when performing back stabilization exercises.

  • A 2017 review study in the Journal of Sports Rehabilitation indicates that alterations in core activation muscle patterns, lung function, breathing patterns, and diaphragm mechanics may occur in back pain. They postulated that breathing training may be effective in reducing pain, improving respiratory function, and quality of life.

They found these exercises were effective in improving lung function, reducing back pain, and improving quality of life. They recommend treatment for chronic, nonspecific low back pain should include breathing exercise when indicated.


  • A 2018 study in the journal Gait & Posture found a direct relationship between increased muscle tone due to stress and postural stability, noting that daily stress can lead to joint overload and increase the risk of falls.

The authors indicate that breathing can have a direct effect on pain and stress management and were troubled by the fact that most of the population may not be able to breathe properly.

Author Bio

Stephen Ornstein, D.C. has treated thousands of neck, shoulder and back conditions since graduating Sherman Chiropractic College in 1987 and during his involvement in Martial Arts. He holds certifications as a Peer Review Consultant from New York Chiropractic College, Physiological Therapeutics from National Chiropractic College, Modic Antibiotic Spinal Therapy from Dr. Hanne Albert, PT., MPH., Ph.D., Myofascial Release Techniques from Logan Chiropractic College, and learned Active Release Technique from the founder, P. Michael Leahy, DC, ART, CCSP.