Neck Pain That Gets Worse Throughout the Day: Why It Happens and How to Keep It From Ruining Your Evenings
You wake up feeling relatively fine.
But come lunch time your neck is really starting to bother you.
You’ve learned to pack as much into the first part of the day as you can, because once the afternoon hits you know it’s a downhill spiral.
Your neck continues to feel worse and worse. On particularly bad days the pain and tension radiates up into your head.
Come evening time, you feel pretty worthless. You can’t focus and snap at everyone who breathes your air. You don’t like showing up like this but can’t help it because you feel so incredibly bad.
This is a sucky place to be. We get it. We see this all the time in our clients and have even lived it ourselves.
Let me share the truth with you- you don’t have to live like this. There’s a reason you feel neck pain that gets worse throughout the day and there is also a solution.
Let’s get your life back. We will show you exactly how.
Here’s what we are going to talk about in this blog post:
What causes neck pain that gets worse throughout the day
Habits that contribute to neck pain that gets worse throughout the day
Why ignoring it perpetuates the problem
How to keep neck pain from ruining your evenings
When to see a physical therapist
What causes neck pain that gets worse throughout the day
In our clinical experience, neck pain that gets worse throughout the day is typically caused by tight, tense, and pissed off muscles. They get to chill out and rest overnight, which is why mornings are typically the best part of your day. But they get irritated as the day goes on, leaving your afternoons and evenings feeling pretty rough.
The good news is that muscles are quite easy to treat. This means you can notice some quick improvements once you start doing the right things to help yourself.
The bad news? Well there’s really no bad news. Bet you were expecting it though
Now, which muscles are pissed off and why?
The muscles at play are usually muscles of the head, neck, and shoulders. Common culprits are the upper trapezius, neck and upper back paraspinals, suboccipitals, levator scapulae, sternocleidomastoid (SCM for short), scalenes, and even the muscles of the jaw like the masseter and temporalis.
Here’s the thing…muscles don’t get irritated for no reason. It is almost always a symptom of something else.
There are many habits and underlying factors that drive muscle tension, manifesting as your neck tension that gets worse throughout the day. That’s what we’re diving into next.
Habits that contribute to neck pain that gets worse throughout the day
Here are some factors we see all the time that increases muscle tension:
Posture
Bet you’re not surprised to see posture on the list.
Think of posture as the position you spend the most time in throughout the day. We believe that there is no “perfect posture”, rather the best posture is one that is always changing.
Movement is medicine. Motion is lotion.
Forward head posture gets demonized as the culprit for a lot of upper body problems. While there isn’t anything inherently wrong with this one position, the problem lies in the fact that most people spend the vast majority of their time in a forward head posture. This is not ideal and does indeed contribute to muscle tension and other problems.
For every inch your head comes forward, your neck muscles have to work exponentially harder to hold your head up. This extra strain on the neck muscles really overworks them and makes them unhappy. Here are the numbers for my fellow nerds or anyone who needs a little drama to realize the magnitude of what’s happening here:
Head upright= 12 pounds of force needed by muscles to keep head upright
Head 2 inches forward = 32 pounds of force needed by muscles to keep head upright
Head 4 inches forward = 42 pounds of force needed by muscles to keep head upright
For more detail on this, check out our blog Posture, Neck Pain, and Headaches: How Physical Therapy Can Break the Cycle.
The key here is optimizing posture and frequently changing positions.
Mental and emotional stress
The head, neck, and jaw are very emotional parts of the body. This means that mental and emotional stress commonly gets held in these muscles. You also develop habits in response to stressors that perpetuate the muscle tension.
This process is usually sneaky.
It’s not like one stressful encounter happens and you all of a sudden feel horrible tension in your neck. This process slowly accumulates over years or decades of stress response habits. So if your neck is bothering you and you really don’t know why, unprocessed stress is likely an underlying reason.
Common stress response habits include
Hiking shoulders up towards the ears
Clenching the jaw
Rapid, shallow breathing or breath holding
Storing emotion in the body
Over time, these habits lead to a lot of muscle tension in the head, neck, and jaw. The stress response habits become subconscious, so you don’t necessarily notice you’re practicing these habits.
But here’s the catch 22. Your body recognizes this tense state as “normal” and it becomes your baseline. You build up tolerance to this stress and tension. So you don’t realize it’s happening.
You start feeling pain and tension “all of a sudden” because your body has been operating in this tense state for so long.
The key here is becoming aware of your stress response habits, giving your mind and body quiet moments of peace (this gives a contrast to your “normal” stressed state), and creating new stress response habits that serve you.
Mouth breathing
Mouth breathing during the day and night is a huge detriment to overall health and wellness. It reduces oxygen delivery to the body, increases blood pressure via vasoconstriction (aka narrowing of blood vessels), activates the sympathetic nervous system (aka the fight or flight response), and negatively impacts metabolic health.
How does it impact your neck pain that gets worse throughout the day?
Muscles need oxygen to work. If blood vessels are narrowed and there is a shortage of oxygen getting to the muscles, then the muscles are working in a suboptimal state.
This paired with the increased postural strain we already talked about results in pissed off muscles. They’re working too much with not enough resources.
Additionally, mouth breathing activates the sympathetic nervous system, which primes the body to fight or flee. In this state, the body is more concerned about survival than repairing itself. More muscular demand + less ability to recover = pain and tension.
The key here is to breathe through your nose, day and night.
Neck breathing
There are two primary mechanisms of breathing. The most important one is breathing with the diaphragm. The secondary mechanism is with the neck and shoulder muscles.
Breathing with the diaphragm is the most efficient way to breathe. The diaphragm is a large dome-shaped muscle that sits at the bottom of the rib cage. It is designed to make you breathe all day, every day.
Here is a great visual that shows the diaphragm in action.
The neck and shoulder muscles can also be used for breathing. However, this strategy is designed to help increase oxygen uptake when taking a deep breath or breathing heavily during increased exertion. Watch professional athletes or sprinters and you’ll see this mechanism in action. You’ll notice their ribcage and shoulders lifting up with each inhale after a burst of activity.
The problem occurs when the neck and shoulder muscles become too active in breathing.
This happens for several reasons:
Active stress response (remember what we talked about in the mental and emotional stress section)
Learned dysfunctional breathing habits over time, usually from chronic stress response
Poor posture, which doesn’t allow the diaphragm to work efficiently
Vanity, aka sucking in your stomach, which doesn’t allow the diaphragm to work efficiently
The key here is to harness the power of your diaphragm and get it working optimally for breathing. This way, the neck and shoulders don’t have to work so hard with the 20,000 breaths you take per day.
Core weakness
The core is the primary stabilizer for the body. Before literally any movement you make, your brain activates your core muscles to stabilize your body to accomplish that movement. This happens whether you're lifting your arm to wave hello or lifting a 150 pound barbell. The core is important for all movements, whether big or small.
When the core is weak or not activating well (this is commonly from poor posture, not breathing optimally, or generalized muscle weakness from being sedentary), the body finds another way to stabilize.
The next place your body turns to for stabilization is the neck.
You’ll notice this pattern of neck stabilization if your neck feels sore and tight when doing ab exercises or doing a lot of lifting. You may feel it in the moment, later that day, or even the next morning.
The key here is to activate and strengthen your core.
Repetitive overhead activity
This builds on what we just talked about with core stabilization.
Reaching overhead is a complex movement that requires stabilization of both the core and shoulder blades. Think of your shoulder blade as the “core” of the shoulder.
If your reaching mechanics are off, the body shrugs the shoulders upward to help you reach higher overhead. Do this repetitively, especially with weight, and now the upper trapezius muscles are way overworked.
Learn more about shoulder blade strength and mobility and how it impacts your neck in our blog post Why You Get a Tension Headache After Working Out and How to Prevent It.
The key here is getting good mobility and strength of the shoulder blade muscles so you can reach and lift overhead optimally and not compensate with the upper trapezius and levator scapulae muscles.
Dehydration and electrolyte imbalance
Lastly, hydration and electrolyte balance is very important for muscle health. Electrolytes are literally the molecules that make muscles contract.
If you’re dehydrated or lacking electrolytes, it manifests as muscle tension, cramping, and pain. Note that electrolyte imbalances (especially sodium) won’t show up on blood work unless you’re having a medical event like a seizure or passing out. You need to assess how you’re feeling.
For me personally, electrolyte imbalance manifests as food cravings (especially salty food), moodiness, muscle cramps, and difficulty with mental concentration.
The key here is drinking enough water and also supplementing with electrolytes and/or magnesium.
Why ignoring it perpetuates the problem
As you can see from everything we just discussed, many of these processes that contribute to neck pain and muscle tension can be subconscious and accumulate over time.
You may be ignoring the underlying factors contributing to your neck pain and muscle tension, or you also may not be aware of what you’re doing that is perpetuating the problem.
Either way, ignoring it or not doing anything to change these patterns will result in you continuing to feel neck pain. And it will likely continue to get worse.
By doing nothing different, you’ll reinforce all the habits and patterns that are driving the problem.
It’s time to become aware and build new habits that actually help you.
How to keep neck pain from ruining your evenings
Let’s address each of the underlying factors that contribute to your neck pain that gets worse throughout the day and how to optimize it.
Optimize posture and move frequently
For desk workers, you’ll want to optimize your desk setup.
The first step is having adequate low back support. This is because the position of the lower back drives the posture of the head, neck and shoulders. To see how this works, check out our blog Posture, Neck Pain, and Headaches: How Physical Therapy Can Break the Cycle.
Once you’re well supported in the lower back, make sure you have good foot support so your feet aren’t dangling. Lastly, bend your elbows right at your side. Wherever your hands land, this is where your keyboard needs to be.
Now that you’re set up in a solid, upright position, bring everything towards you. That way you're not leaning or reaching for the items you use most frequently.
Whether you’re a desk worker or not, it is very important to change positions frequently. We recommend setting a timer every 45-60 minutes to remind you to get up and move or change your position. It’s easy to get engrossed in what you’re doing and lose track of time. Before you know it, three hours have passed and you’re feeling stiff.
Remember, the best posture is one that is always changing.
Become aware of your stress response and rewrite the pattern
The first step here is becoming aware of your stress response habits. Chances are, you have no idea what your body is doing under stress.
Start by simply observing your patterns throughout the day. When you have a conversation with your boss or coworker you hate, when your kid has screamed “MOMMY!!!!” for the millionth time, when you’re stuck in traffic, when your schedule is overloaded for the day…what do you do?
Do you clench your jaw?
Do you tense up your shoulders?
Do you hold your breath?
The only way to write a new pattern is to first become aware of your current pattern.
The next step is to give your mind and body quiet moments of peace. This gives a contrast to your “normal” stressed state and will help you better recognize when you slip into your stress response throughout the day.
Don’t give the excuse of “I have no time to do this.” There is plenty of time during the day that you’re not using optimally. Stop the scroll, stop the mindless Netflix binging, and let your mind and body experience peace. Start with just 3-5 minutes per day of sitting in silence and breathing.
Once you’ve done this, you can start rewriting new stress response habits.
Instead of clenching your jaw, intentionally relax your face.
Instead of tensing your shoulders, wiggle them around then let them relax down.
Instead of holding your breath, take slow inhales and exhales through your nose to a count of five.
While this process sounds simple, it takes consistent implementation and self awareness to reap the benefits. So start small, show up consistently, and get back on the bandwagon if you fall off. You got this.
Breathe through your nose
Nasal breathing is one of the quickest and easiest ways to hack your nervous system and allow it to chill out.
Nasal breathing activates the parasympathetic nervous system (aka rest and digest mode), stimulates the vagus nerve, increases nitrous oxide production (this dilates blood vessels and lowers blood pressure), and counteracts the stress response.
To perform nasal breathing, seal your lips together, keep teeth slightly apart, and rest the tip of the tongue on the roof of your mouth just behind your front teeth.
If congestion or sinus pressure prevents you from easily breathing through your nose, check out our blog post on how to relieve sinus pressure with natural fixes.
You can also try daytime mouth taping. Take a small piece of kinesiotape or masking tape and place it over your lips. You can do this while you wash dishes, read, watch TV, go on a walk, or really any time you’re not frequently talking. This will help you gain awareness of whether you’re breathing through your nose or your mouth, as well as build the habit of nasal breathing.
Once you try daytime mouth taping and know you can successfully breathe through your nose, you can try nighttime mouth taping.
*Note- do NOT tape your mouth at night if you have known sleep apnea or other breathing disorders. Consult your physician, dentist, or physical therapist first for personalized recommendations to keep you safe.
Diaphragmatic breathing
You’ve got to get your diaphragm working well for breathing to effectively fix the neck breathing problem.
Start by laying down on your back with knees bent up. Place one hand on your chest and one hand on your belly, just over your belly button. As you breathe, you want to feel the hand on your belly rising first, then the hand on your chest.
From here, make your hands into a “C” shape and place them on either side of your belly right at the lower ribs. As you inhale, feel 360 expansion in the front, sides, and back of the abdomen and ribs.
Your shoulders and ribcage should NOT rise upwards as you do this. Rather, the ribs and abdomen should expand outwards as you inhale.
Once you can do this well laying down, practice it while sitting, standing, and doing any kind of activity.
Activate and strengthen your core.
The diaphragmatic breathing technique we just discussed is the first place to start in activating your core.
While the diaphragm’s #1 job is breathing, its #2 job is core stabilization. This means that you have to first breathe optimally before you can effectively strengthen your core.
If you regularly do barre, pilates, yoga, or lift weights, and feel like your core should be stronger than what it is, you’re likely not breathing or activating your core properly. You’re also probably struggling with a lot of neck tension which feels worse after your exercise class.
To solve this problem, we’re going to build on the 360 diaphragmatic breathing exercise you just learned and layer on core activation.
Once you have a solid 360 inhale, exhale slowly and completely as if you’re fogging a mirror. When you get the full exhale, you should feel your core muscles tighten up. Be sure to keep your hands on your sides so you can tell what’s going on in the core.
Keep some of that core activation as you continue to breathe. Be sure to allow your belly to expand on the inhale- don’t totally brace yourself and bear down.
You can check out this video that teaches the complete core breathing technique. This is one of the first things we teach all our clients!
Once you have solid core activation, do exercises that strengthen the core. We love bear planks, side planks, pallof presses, and dead bugs.
Retrain overhead reaching mechanics
This builds on what we just talked about with core activation and strength. Do that technique first before working on your overhead reaching. Remember, your core turns on first before you reach for something.
The next thing to work on is giving your shoulder the mobility to get overhead. If you don’t have the required mobility, you’re 100% going to compensate with your neck muscles when trying to reach or lift overhead. If there are overhead mobility limitations, you must address this first.
One of our favorite moves to improve overhead shoulder mobility is called inverted breathing. Watch this video on how to perform the inverted breathing drill.
Next, teach your shoulder blade how to move and stabilize while reaching overhead. Our favorite exercise to start this type of training is the child’s pose rockback. Watch this video on how to perform the child’s pose rockback drill.
If you want to learn more about shoulder blade strength and mobility and how it impacts your neck check out this blog post.
Hydrate your body well and maintain electrolyte balance
A lot of people don’t drink enough water. Kudos to you if you do. The next step would be keeping a healthy electrolyte balance.
A good target is to drink at least half your body weight in ounces of water per day. For example, someone who weighs 150 pounds should drink at least 75oz of water per day.
Once you are drinking enough water, adding electrolytes can be very beneficial. We love LMNT for a clean and robust electrolyte supplement. If you’d like to try it, we sell it in our office or you can buy it online with our link and get a free sample pack.
Another supplement to consider is magnesium. Magnesium is involved in nearly every body process, but a vast majority of the population is deficient. Supplementing with magnesium is a great way to improve not only muscle health, but overall physical and mental health.
Consult with your physician or trusted healthcare provider on adding a magnesium supplement to your routine, as well as which type of magnesium supplement and dose would be best for you.
When to see a physical therapist
It is time to see a physical therapist if:
Your neck pain starts hitting earlier and earlier in the day
You’re calling off work or declining activities with friends and family due to neck pain
You are getting headaches along with your neck pain
You have numbness or tingling in the neck, upper back, or arms
You’re sick and tired of feeling sick and tired
You can’t keep living like this and missing out on life
You know deep down that there is a better way to live
If your go-to strategy is to self-treat your problems, you have a ton of information in this blog post to start addressing your neck pain that gets worse throughout the day. Give these strategies a try. If it feels like too much to do at once, pick one strategy that is a low hanging fruit for you and start there. Once you’ve made that one strategy a habit, choose another strategy to focus on.
It is a great idea to see a physical therapist either right away or once you’ve implemented one or two of these strategies. Individualized care for you as a unique human with unique needs will expedite your healing and eliminate the frustration of not knowing what strategy will work best for you.
Time is precious. If you want to be efficient with your time and energy, working with a physical therapist will get you the quickest and most customized results.
Where to find physical therapy for neck pain that gets worse throughout the day
Have you tried these strategies and want more individualized support?
If you are located in or near Westerville, Ohio we can help you with physical therapy to improve your neck pain that gets worse throughout the day!
You can get started right away by learning more about our physical therapy services or getting in contact with us.
If you have additional questions, we would love to talk with you, hear your story, answer all your questions, and see how we could help.
You can call or text us at (614) 423-9731 or schedule a free discovery call. You can also learn more about Empower Physio and Wellness + our team or check out other services we offer.