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Q&A, Coat Hanger Pain

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 Q&A Index

Aches and Pain, Stiffness and Soreness
in the shape of, place of a
Coat Hanger

Q. I get an ache across my neck and shoulders, and it gets worse the longer I am sitting trying to do something. Do others get this? Is there anything that helps?

A. Many people with Chronic Fatigue Syndrome, Fibromyalgia, and especially Orthostatic Intolerance have a tightness in their necks and across their shoulders that often progresses to an ache, then pain. It is in the shape of a coat hanger, where you might imagine a coat hanger would still be if your shirt was still on one. Professionals who work with patients with dysautonomia (problems with the autonomic nervous system including poor circulation) actually call it "Coat Hanger Pain."

Coat Hanger Pain is sometimes caused by whiplash, long periods of weightlessness  or being prone for a prolonged time who then try to function upright with gravity (astronauts or people emerging from a long bed stay), and other causes still unknown.

The sudden constricting of the muscles of the neck and shoulders and/or a lack of circulation through the area due to illness or muscle tension seem to fit many causes.

A sudden constriction could come from trauma of some kind including a fall or a car accident. If one is about to be hit, once often turns to let the back take the impact, protecting the front by tensing around it.

It could also come from a sudden overwhelming emotion such as fear, such as when hearing frightening news, or feeling "in trouble again," being yelled at.

If the tension in the area backs off some, but some remains, the constant presence of the tension could be a set-up for long term problems, and seemingly "sudden" flares later on.

If someone has orthostattic intolerance (OI) where being upright and still stresses circulation and brings on symptoms of irritability, feeling overheated, having to lock muscles and joints to overcome weakness, then a big provocation for more neck and shoulder tension is trying to remain upright and still with no head support, when too tired to do so, or when too stressed or already in too much other pain.

The coat hanger ache is often much diminished quickly (hours to days) by doing/pushing far, far less, and getting more flat: feet up, head down and supported.  A recliner of the appropriate size and design is a wonderful treatment for someone with coat hanger pain problems of the OI type. The mechanism of the recliner must be easy to use, even on "weak" days.

Supplements that help those with dysautonomia can also take the edge off the neck and shoulder pain. Electrolytes, especially chelated calcium and magnesium help the muscles relax more, and they also may aid sleep and alleviate some anxiety. Staying hydrated helps, too.

Support Hose can help improve circulation back to the upper body.

Moving around more than you usually do can help. Get up and walk a few steps every 10 minutes or as much as you can stand, wiggle, fidget. Do what you can to keep the blood moving.

A cold pack helps because cold constricts blood vessels and makes blood flow faster. Heat seams to help at first because by opening blood vessels, there is a feeling of the tension dissolving, a relaxation, BUT circulation is slowing. In the long run, if your body can not easily move the blood again due to whatever is going on with its poor circulation, the heat may have made things worse over time, especially in cognitive processing, and ability to read.

Consciously relaxing the area may help. Noticing and acknowledging the tension building or existing there can turn things around. A few times a day, try spending a few minutes concentrating on relaxing the neck, then the shoulders, everywhere. Take a deep breath into the area, but only one deep breath. Perhaps some visualization of a soothing massage or hot or cold packs being applied, whatever feels good to you, can bring some flow back to the area.

Be cautious not to use the benefit one finds from a supplement or other treatment as an excuse or opportunity to push yourself harder. There will be consequences. Consider re-investing gains into taking more care of yourself.

In the long term, coping with the stresses at hand and long term accumulated stresses we collect in our shoulders (feeling like burdens, what makes us feel like burdens to others) might relieve enough underlying tension for a fuller circulation through the area. 

Elly adds:

The "coat hanger" shaped pain that hooks in the neck and can then go in the shoulders and eventually down the back started for me when I was young, elementary school age. I didn't like people massaging my "tight" shoulders. I didn't think it too much of a problem, didn't tell people, but it became a problem later as it gradually worsened into an all the time thing.

Sitting on a regular feet-on-the-floor chair with no head support started to really bother me my last year at work. It had always bothered me taking long tests in school, the ones  where the teachers didn't want you to get up and move, use the bathroom.

In the working world where more and more sitting was required of me, the more I sat, the more tense and tender my shoulders got. The more I was cutting off my own circulation to my brain, just trying to sit and be productive.

The coat hanger pain became not so much front and center as back and center during times of the worst circulation, even before I was diagnosed with orthostatic intolerance, with CFS. If I pushed to do anything, to much sitting up to drive, too much standing to do dishes, the activity of going to too many doctor appointments, it got worse. And you know they don't have chairs there that support your head. You have to slouch, which makes them mad or something when all you are doing is trying to feel a bit better, survive for your appointment.

Reclining or lying flat again, resting helps me. With enough reclining, the nutrition and liquids that helps me, my ache goes almost completely away, but the tension still remains. I'm working on it, making progress with visualization, looking at my tensions and stresses there, acupuncture, and other things. It is so much improved from before though. I want people to know it can change, improve.

My ache can come back with just a few days of activity with no head support if I'm not doing well. If I keep pushing, or sometimes after a virus, in addition to the coat hanger pain, some of the rest of my dysautonomia symptoms worsen as well: stiffness, the awful sensation in the center of my head, not being able to hold up head, tensing up more and more and cutting off and already struggling circulation of blood, dropping things, bumping into walls, feeling too hot or too cold, becoming extra sensitive to noise and smells, the sore throat and losing voice, communication.

Toni adds:

Pain in neck, shoulders, back is called "Coat Hanger Pain" as related to Problems of the
Autonomic Nervous System (PANS) and its many types: postural tachycardia syndrome (POTS), neurally mediated hyptotension (NMH), mitral valve prolapse syndrome / dysautotomia (MVPS/D).

I find the longer I am upright and pushing, the farther down my back and legs this pain
travels. It is relieved upon lying down unless I have pushed so far for so long; then it will
take days for me to recover from horrible back, shoulder, neck, leg pain. Ice gel packs for 20 minutes at a time helps recovery time. I know, if you like the heat, it sounds
antithetical, but worth a try, maybe?

Pushing also causes a cascade of all the other symptoms above plus major cognitive
impairment which is only temporary. Putting my feet and semi or fully reclining brings
back cognitive functioning, what I couldn't remember 5 minutes ago, suddenly available to me once I lie back or down with feet up.

More Member Comments

The pain pelvic girdle and the shoulder girdle seem to be related. I have seen for myself and family members similarly affected with coat hanger pain, CFS, dysautonomia, that helping the pelvis, helps the coat hanger pain. We have also found help with found certain lymphatic therapy, sometimes TENS.
                -- Val Hodge Williams, former Physical Therapist.

Even as a teen, I heard repeatedly "Stand up straight. Put your shoulders back!" I'd think, "I am. They are, they already are." I was already hunched over, stressed, feeling like I had a hump on my back. Rounded shoulders. Poor posture. Yes, my breasts were heavy, but I was trying to stand up. Something was already worn out with my neck and shoulders. When it gets bad for me, when I have to keep going and I can't rest, for me it goes further, even higher, into TMJ, jaw pain, and it would even go into the muscles in the front on neck become so tight I have to keep swallowing. Feels like I'm being strangled. It affects the flow of oxygen. As that coat hanger pain gets worse, I feel it spread to my pelvic floor muscle, in spasms, pain, and dysfunction. When I used to go for pelvic floor muscle osteopathy, and it worked, it helped both the pelvic pain and the shoulders. When the neck and shoulders improved, the pelvis stayed better longer. The excellent cranial sacral bodywork I had really helped.
                -- Anonymous

I use a meditation wedge on my chair at work and find that it helps with the shoulder and back pain. Reading this [page], I can see that I had my problems long before they became they became overwhelming.  Thanks for the info.
                -- Pat M

What's on the Web about Coat Hanger Pain

Clinical Symptoms of Orthostatic Intolerance - Medscape

It has been suggested that the symptoms of dizziness, syncope, and visual disturbances are all related to cerebral hypoperfusion. The subocciptal / paracervical "coat hanger" pain, conversely, has been hypothesized to relate to hypoperfusion of the paracervical muscles. [2, 3] Severity of neck pain appears to correlate with the degree of orthostatic hypotension. [32] 

[DOC] Coat-Hanger pain - Bleasdale-Barr KM and Mathias CJ.
Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension. J R Soc Med. 1998;91:355-359.

Supplemental data E Appendix 1

‘Coat-Hanger’ pain

The term ‘coat-hanger pain’ describes the neck pain, specifically in suboccipital and paracervical regions, observed in patients with autonomic dysfunction. It is often ameliorated by lying down (or by other manoeuvres which increase blood pressure) and worsened in the head-up posture. It is noted in 93% of patients with pure autonomic failure and in 51% of patients with multiple system atrophy1. The aetiology is thought to be hypoperfusion in these bulky muscle groups. Consistent with this is the crampy and ischaemic nature of the described pain and its relationship to posture.


Whiplash Symptoms

The symptoms of whiplash include neck pain and stiffness, headaches, pain in the shoulder or between the shoulder blades (sometimes called "coat hanger pain"), low back pain, and
pain or numbness in the arms or extremities.  

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Updated April 13, 2021