Links Between Pain & Stiffness in the Neck/Shoulder and Breathing Issues

Connecting the Dots via the Phrenic Nerve

Introduction

As far back as I can remember, I not only had zero control over my diaphragm muscle, but also had no sense of it whatsoever [indeed this may go right back to the start due to the trauma of being born premature and Cesarean]. In short, my diaphragm was ever a frozen mystery to me. It took getting a Parkinson’s diagnosis, and then hitting rock bottom six years later, taking the responsibility for my health into my own hands, and then four years ago discovering the Block Therapy method of self-care fascia release, to even begin to start to sense, and have some voluntary control over, my diaphragm.

What Fascia Decompression and "Block Therapy" Did For Me

In particular, it was doing the Block Therapy belly position daily, that finally let me get in touch, and start to move it [you can also do this with a rolled up towel instead of a block].

I have no doubt that re-connecting with my diaphragm has been a huge factor in my progressive symptom reduction. Indeed, the best science article I ever read on the topic ("Symptomatology Correlations Between the Diaphragm and Irritable Bowel Syndrome" by Bruno Bordoni, Bruno Morabit), outlines all the things which are downstream of a poorly functioning diaphragm. These includes IBS, chronic pain, gut issues, inflammation, depression and anxiety, all of which I have suffered from.

In particular, I believe restoring diaphragm function had a significant impact on reducing my chronic neck and shoulder pain and stiffness [cervical dystonia]. Indeed, it seems a frozen diaphragm and neck pain/stiffness issues are strongly connected, and that this is bi-directional. The direct connections are via the phrenic nerve.

The Phrenic Nerve

"The diaphragm muscle is innervated [flexed] by the phrenic nerve"

I was unfamiliar with the phrenic nerve, which is responsible for both moving and sensing the diaphragm muscle. Given our interest in getting the diaphragm moving again, and increasing its range of motion, in order to return to healthy breathing, it is worth knowing about this nerve. The below includes brief notes from "Anatomy, Thorax, Phrenic Nerves" by Kaitlin A. Oliver; John V. Ashurst.

"The phrenic nerve originates from the... C3 through C5 nerve roots [from the third to the fifth vertebra in the neck] and consists of motor, sensory, and sympathetic nerve fibers. It provides complete motor innervation to the diaphragm and sensation to the central tendon aspect of the diaphragm."

"The left phrenic nerve innervates the left diaphragmatic dome, and the right phrenic nerve innervates the right diaphragmatic dome. The motor innervation activation will cause the diaphragm to contract with inspiration, resulting in a flattened diaphragm. During exhalation, the diaphragm relaxes and returns to the dual dome shape."

Here is a useful animation of what a functioning diaphragm might look like internally:

Interestingly, like the vagus nerve, the left and right phrenic nerves have highly asymmetric paths through the body and functions.

The Divided Brain and The Asymmetric Body

“The phrenic nerve... traverses the neck, heart, and lungs to reach the diaphragm. From its origin, the phrenic nerve descends vertically... adjacent to the internal jugular vein. In the neck and upper thorax, the left phrenic nerve tracts proximal to the subclavian artery… The right phrenic nerve runs superficial to the anterior scalene muscle and the second part of the right subclavian artery. In the thorax, the right and left phrenic nerve will continue to descend ... to the root of the lung…”

The important point here is there is a lot of scope for phrenic nerve pinching or compression, due to neck and shoulder stiffness, or injuries and fascia issues there [such as thoracic outlet syndromes] as it runs down the sides of the neck and passes through the clavicle regions. This nerve compression could therefore impact diaphragm function.

Pain in the Neck

Here is a good anatomy lesson video, which also discusses how the phrenic nerve runs between layers of fascia around the heart, and also how a weak or paralysed diaphragm, e.g. due to phrenic nerve damage, can even move up instead of down when inhaling.

“The phrenic nerves provide motor innervation to the diaphragm and work in conjunction with secondary respiratory muscles (trapezius, pectoralis major, pectoral is minor, sternocleidomastoid, and intercostals) to allow respiration.”

This is a second link between diaphragm and neck issues. If our diaphragm gets frozen, then we start using the muscles of the neck for breathing. Unlike the diaphragm muscles, these muscles are not designed to be constantly flexing, and they get fatigued. This can result in permanent neck pain and stiffness issues.

“The phrenic nerve supplies sensory innervation to the diaphragm. Pain arising from the diaphragm is often referred to the tip of the shoulder, also known as the Kehr sign. For example, a patient with a subphrenic abscess or a ruptured spleen may complain of pain in the left shoulder. The hiccup reflex is due to irritation of the phrenic nerve.”

So there can also be direct links between diaphragm issues and neck and shoulder pain, via referred pain along the phrenic nerve, where the pain stimulus is originating in the diaphragm region, but is felt in the neck/shoulder.

Summary

A frozen diaphragm, and hence breathing issues, can be directly linked to neck and shoulder pain/stiffness. So restoring diaphragm function may help to alleviate chronic neck issues. Conversely, attending to neck and shoulder injuries and fascia health may help to restore diaphragm breathing.

If you have got this far, we may be interested in investigating further how breathing and/or neck issues may be impacting your health, and moreover gaining unique pragmatic and practical knowledge of how to address these. If so then our online course “Emotional Trauma, Fascia and Breathing” may be for you:

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