Neck Pain and The Rib Cage

Take a Deep Breath

Does your neck hurt after sitting and staring at your computer? Try this test. Sit back, resting on your chair’s backrest and let your right forearm rest on your desk. Take your left hand and place it on your right shoulder, adjacent to your neck. Your left hand is resting on your trapezius, and with this posture the muscle is relatively relaxed. Now lift your right hand and forearm about an inch off your desk. While maintaining your arm at that height, slump forward while reaching your hand out. You should feel your trapezius contract and remain contracted. This is your neck pain. If you sit slouched forward all day long, your trapezius on both sides of your neck will remain chronically contracted. If you use a mouse, that side of your neck will most likely be more angry with you that the opposite side.

Why do our trapezius contract like this? When we slump, our shoulder are put in a position that mimics an elevation of your arm. When we reach up, our shoulder blades slide forward on our ribcage and they internally rotate while trapezius contract to lift our our humerus (upper arm) overhead. When we slouch, we move our ribs underneath our shoulder blades, thereby positioning our shoulder blades to move the upper arm overhead, causing your trapezius to contract. Is sitting up straight the answer? If you have been chronically slouching to the point of neck pain, sitting up is not the entire answer and could just move the pain down the spine to the mid or lower back. The fix is to expand your upper ribcage, thereby putting your shoulders in a better postural position.

Rib movement is often compared to that of a bucket handle, with the bucket being the spine and the handle being the ribs. When we inhale the ribs move up, anchored on each side of the spine. Likewise, when we exhale the ribs move down. Our inhalation compels the intercostal muscles (muscles between the ribs) to relax and stretch increasing the capacity of our thorax as the lungs fill with air. Our exhale compels the intercostal muscles to contract, compressing the thorax to empty the lungs. When slouched , your upper ribs are stuck in a chronically exhaled and internally rotated position. This exhaled, internally rotated position is what causes the shoulder blades to move forward on the ribs, causing the trapezius to contract. If you slouch all the time, the intercostal muscles shorten and begin to hold your upper ribs in a depressed/exhaled position. If your upper ribs are stuck in an exhaled position and you force yourself to sit up and pull your shoulder blades back, you are not moving those stiff ribs, you are extending and already extended mid-back. Moreover, your moving your shoulder blades into a position they don’t want to be in.

The solution to your neck pain is to mobilize the anterior chest wall and mid-back, and this is done with movement and breath work. The success of the following exercises depend on two things. One, pay close attention to the positions these exercises require of you. Two, slow down enough to feel specific mobilizations of your ribs as they expand and contract. You can’t power through repetitions of these exercises and affect change in your posture.

Seated Knee Hug

The first exercises to start with is called the short seated knee hug. This exercise will expand and mobilize the mid-spine and ribs. Take a seat on the bottom step of a staircase or another object of equal height. Place your feet as close to the base of the stair as is comfortable. Reach around your knees as if giving them a hug.

Take a big inhale through your nose while hugging your knees and compressing your lower ribs into the top of your thighs. By compressing the lower ribs we will force air into the back of your thorax, flexing your mid-thoracic spine and expanding your posterior upper ribs. By reaching forward and hugging your knees your chest wall musculature pulls the ribs forward and up, allowing air to flow into the anterior chest wall. In other words, we are moving your upper ribs into an inhaled position, out of their chronically exhaled position. Now exhale, using your abdominals to pull those lower ribs down and increasing your hug around your knees. With this exhale, there is now even less room for the next inhale to inflate your lower, anterior thorax which will allow for an even greater expansion of the ribs at the mid-back and anterior chest wall. Do this for 3 sets of 5 repetitions of deep and prolonged inhales and exhales. Try this 2-3 times per day.

Supine Hooklying Shoulder Flexion

For the next exercise, lay on your back, knees bent and arms raised straight out in front of you. If you have a light barbell to hold for this exercise, even better. Inhale gently through your nose, now exhale through your nose while you gently dig your heels in, pressing your low back into the floor. This removes the extension in your low back allowing your to better position your lower ribs. Upon exhaling, hold your lower ribs down with your abdominals. On the next inhale, fill your chest with air while allowing your arms to passively move towards your head. On the next exhale let your lower ribs sink further down while keeping your arms and hips stationary. Repeat this sequence 4 more times, inhaling into your chest with the arms moving passively towards your head and exhaling, letting your ribs sink lower. As your arms move further overhead, your upper back extends while the mid-back flexes and expands. At the same time your chest muscles pull the anterior chest wall up and out moving the ribs into our desired inhaled position. Do this for 3 sets of 5 repetitions of deep and prolonged inhales and exhales. Try this 2-3 times per day.

Overall the point of these two exercises is to regain mobility in the upper ribcage as your ribs should be able to move throughout a full inhaled and exhaled posture. As you regain a full range of motion in your upper ribcage, your shoulder blades will move into a better position allowing your neck and shoulder muscles to relax.