Neck and back pain can be connected to rib cage stiffness
How to assess stiffness and what to do about it
In the clinic, my schedule is full of people suffering with neck and back pain. Practicing for many years, I have seen changes in the way physical therapists practice. When I was first out of school, we used a lot of modalities like moist heat, therapeutic ultrasound, electric stimulation, and cold packs. And, a lot of stretching of the upper traps for neck pain and hamstrings for lower back pain. Extension exercises for the lower back when pain referred down the leg, and posture correction to reduce forward head positioning. Many of the things I learned in school have been proven to be ineffective, like the passive modalities. I used to never look at the way people breathe and up until the past few years, I didn’t think I could help people heal by working on their breathing.
But, since 2020, I completed my 200-hour yoga teacher training and a level 1 meditation training. I have tried many online classes with teachers including Seane Corn and Tracee Stanley where the breath is used in synchrony with the body’s movements and used to move energy, create awareness within the body and to help with changing the body’s responses to stress and trauma. It’s been an interesting journey and one that is evolving the more I learn and practice. Currently, to continue my learning, I am taking an online certification with Sarah Duvall, DPT, that is a pregnancy and postpartum corrective exercise specialist program, and I am finding the information relevant to many, not just for people who are pregnant.
Some of the things I have learned recently are to look at how the rib cage moves when someone takes a deep breath. I’ll share some of it with you and then I’ll relate it to how it may contribute to neck and back pain. I invite you to take a video of yourself breathing and notice what you see. If you have neck and/or back pain, maybe you can use some of this information today to explore your own way of moving and breathing and to see if you can help your body feel better. Of course, as always, this is not medical advice and I invite you to get curious with what I share here, but don’t take it as personal medical intervention or treatment.
To start, lie down and bring your hips and knees to a 90/90 position, meaning the hips are bent at a right angle and the knees are bent at a right angle and feet on the wall or legs resting on a chair. A nice place is on the floor with your feet up on the wall if it’s accessible to you. But, really, any position is a good position to practice.
Some things to notice:
Do you inhale through your nose? Mouth breathing contributes to neck pain because we tend to move into a forward head position to open the throat to allow more air in. This can cause tension in the upper neck and muscle tightness along the sides of the neck
Do you use your neck muscles and upper chest to breathe? When you inhale, does the chest rise along with the shoulders? Does it look as if you shrug your shoulders when you breathe? If so, this can contribute to tightness and pain in the neck due to overuse of the neck, chest and shoulder muscles. If you are laying down, does it look like your body slides up as you inhale? If so, that can be an indication of using your neck and upper chest muscles to help you breathe.
What happens to your lower rib cage? Does it flare up and out when you inhale or does one or both stay flared all the time? Sometimes, the oblique muscles are not working effectively when the ribs flare. Sometimes, it’s the internal obliques and sometimes, it’s the external obliques. The oblique muscles help flex the lumbar spine, help with forced exhalation, and they also help with trunk rotation. Sometimes, the ribs flare because of lower back paraspinal muscle overuse. When you inhale, does your back arch? If so, you may be using your back muscles to help you breathe. The rib flaring can come from stiffness, so if the flaring does not change as you inhale and exhale, it may indicate stiffness either in the rib cage or with the diaphragm.
What happens when you inhale? Does your belly rise? Do the sides of your ribs expand? If you breathe up and out with the belly rising and little to no side rib expansion, you may have difficulty with managing the pressure in the abdomen. This can contribute to lower back pain because the abdominal muscles work ineffectively and the lower back muscles are working overtime. If the lateral and posterior rib cage does not expand well, then you may need to work on rib cage mobility and diaphragm mobility.
What happens when you slightly force your exhale? Does your belly bulge? Are your upper abdominals gripping and holding the rib cage down? If so, you may end up pushing or bearing down on your pelvic floor. This can contribute to lower back pain due to excessive pressure on the pelvic floor. If you seem to grip in your upper abdomen, skin rolling here and doing some soft tissue massage can help alleviate this.
Do you notice movement in your rib cage? Measure the circumference of the lower ribs. Take the biggest inhale you can and measure. Then, exhale as much as you can and measure. The difference can be 5-7 cm, so if yours does not move this much, you may need to do some stretches, work on mobilizing the rib cage, or practice breathing with focus on side and back rib expansion.
To assess the movement of your thoracic spine includes the movement of the ribs, so notice how your ribs move as you breathe. Is there pain with an inhale or an exhale? Sometimes, a rib can become elevated or depressed and cause pain on an inhale or exhale.
To check the movement of the spine, it’s good to video yourself again. Get on your hands and knees and try a cat/cow motion with arching the back up and down. Notice where you see the spine moving. Is there uneven movement in the upper back, the middle of the back or the lower back? There is no specific right or wrong movement here, but if you notice a lot of movement associated with pain or little movement associated with pain, then you may want to address those areas. Look at side to side movement. Does one side have greater ease with movement? And, lastly, look at rotation. Cross your arms across your chest and turn side to side. Notice ease of movement, amount of movement and any pain associated with movement. All of these can give you clues about how this area moves and feels. Take time to notice and acknowledge what is going on with your body.
I invite to explore this and let me know what you notice!
Take good care,
Sharon