How altered breathing patterns—diaphragm inhibition, accessory-muscle overuse and forward-head posture—can cause or worsen chronic neck tension (and what to do about it).

This week in clinic I kept noticing a theme: patients arriving with persistent neck tension that just wouldn’t shift, even after stretching, strengthening, or manual therapy. And I felt it in myself too.

Here’s what the research shows: a large proportion of people with chronic neck pain also have signs of a breathing pattern dysfunction. In other words, the way you breathe could be making your neck tighter, and your neck tightness could be making your breathing less efficient. It’s a two-way street.

What is a breathing pattern dysfunction?

It’s when the body adapts to an inefficient way of breathing: relying more on the upper chest and neck muscles, using less diaphragm, breathing at an irregular rate, or even chronically over-breathing. It’s not just “stress breathing” — it has real muscular and postural effects.

How breathing and neck pain feed each other:

• Accessory-muscle overuse: if the diaphragm isn’t doing its job properly, your sternocleidomastoids, scalenes, and upper traps pick up the slack. That creates constant tension.
• Posture changes: reduced diaphragm function is linked with forward-head posture, which places more strain on the neck.
• Shallow breathing: chronic neck pain patients often breathe more from the chest, with lower lung volumes. This keeps the neck muscles switched on.
• Nervous system effects: dysfunctional breathing can alter CO₂ levels, increasing muscle excitability and sensitivity — making you feel even tighter.

The good news?

When breathing retraining is added to usual neck-pain treatment, patients often see faster improvements in pain, posture, and lung function.

Practical tips you can start today:

1. Notice your breath. Is it more chest-based than belly-based? Do your neck muscles look busy even at rest?
2. Reset posture + breath together. Try sitting tall, soften your shoulders, and take a few slow nasal breaths down into your lower ribs.
3. Train, don’t just calm. It’s not about exaggerated “big belly breaths.” Aim for smooth, quiet, efficient breaths that use both the diaphragm and ribcage.

If your neck pain keeps coming back despite all the usual strategies, it might be time to look at your breathing. Next week I’ll share a simple 5-minute breathing screen you can use on yourself — plus two retraining drills you can do anywhere.

Bibliography

• Nair SP, Nair S, Karunakaran U. Chronic neck pain and respiratory dysfunction: a review paper. J Bodyw Mov Ther. 2022;29: 1–10.
• Stephen S, Radhakrishnan K, et al. Dysfunctional breathing and stress in chronic neck pain patients: a cross-sectional study. J Back Musculoskelet Rehabil. 2021;34(5): 789–797.
• Kapreli E, Vourazanis E, Strimpakos N. Respiratory dysfunction in chronic neck pain patients: a pilot study. Cephalalgia. 2009;29(7): 701–710.
• Cefalì A, Bizzarri F, et al. Effects of breathing exercises on neck pain management: a systematic review. Healthcare (Basel). 2025;13(2): 124.
• Dareh-deh HR, et al. Therapeutic routine with respiratory exercises improves neck pain, disability and breathing pattern. Sci Rep. 2022;12: 13456.
• Dimitriadis Z, Kapreli E, et al. Respiratory weakness in patients with chronic neck pain. Clin J Pain. 2013;29(9): 763–768.
• Han J, et al. Postural and breathing pattern changes in patients with chronic neck pain. Man Ther. 2016;21: 18–23.

By Niamh Knightly, our breathing Physio. To book a breathing assessment in with Niamh, please click on the link alternatively please book a complimentary call with her HERE.

Auckland Physiotherapy are experts in pain and injury management, highly recommended by 97% of over 500 clients surveyed. Housed in the beautiful Foundation Precinct, sandwiched in-between Newmarket, Parnell & Remuera.