The Ribcage, Breathing and Chronic Neck Pain: Clinical Observations from 25 Years of Soft Tissue Practice in Bath, UK

Neck pain affected an estimated 203 million people worldwide in 2020, with higher prevalence in women and a peak between the ages of 45 and 74. Imaging of the cervical spine frequently shows age typical disc changes in people without symptoms, so scan findings often leave long term neck pain without a clear account of what is maintaining it.This practitioner report describes how one soft tissue therapist, practising since 2001 and including five years with the first team medical staff of a Premier League football club, assesses chronic neck pain from below: through the ribcage, the Diaphragm, the upper back and the sides of the trunk, before the neck itself. Recurring findings include upper chest breathing with little lower rib movement, dense tissue across the upper back and between the shoulder blades, tight tissue at the front of the chest and side of the neck, and one sided shortening along the Lateral Line. These observations are set alongside published work on respiratory muscle weakness in chronic neck pain, the postural role of the Diaphragm, ultrasound findings in the fascia of the neck, hyaluronan within Fascia and myofascial continuity.The report is observational and hypothesis generating. No standardised outcome measures were collected. It closes with four testable questions for future study.