It has been another interesting week at the office. The ever evolving COVID situation has many folks wearing facial coverings including all of us at the Office. But for many folks getting used to wearing a mask has had some rough patches, especially if you have to be somewhat physically active or talk a lot. Breathing with a facial covering is different than breathing without, regardless of what you try to do intentionally. Our brain is hardwired with some very strong primitive reflexes to decrease the depth and vigor of your inhalation if there is a physical barrier to your airways, to conserve energy and oxygen use during decreased availability. Hence this sensation of being breathless even when the actual venting of your masks lets enough oxygen pass through.

The above fact is instinctively understood by most, but a patient posed me a great question that is understood by fewer: Is there a correlation between use of a facial covering and a sensation of unusual neck straining? The answer is yes, there definitely can be. Several of the anterior and lateral muscles of the cervical spine are “accessory muscles of inspiration”: they are recruited to enhance the efficiency of breathing in, normally born largely by the diaphragm muscle below the lungs. So wearing a mask for a long time, especially when you have to talk or get your heart rate up, will build up over recruitment of the accessory muscles. The sensation of straining will often be felt deep within the neck radiating to the collarbone and into the top of the shoulder blades, and can trigger headaches to the front of the head.

Masks are not going to go away soon or completely, so we better develop some coping strategies.

• Several times a day when NOT wearing a mask, practice some breathing exercises to fully empty out the lungs, such as puffed exhalations, slowly breathing out as far and as long as you can, or blowing up a balloon slowly as big as you can in one breath. This will stop the shallow breathing cycle and retrain your brain to take a full breath. I personally do that during my morning and evening commute to reset my normal breathing.

• Learn to stretch the accessory muscle: dangling one arm and letting your relax to the other side and slightly in extension, or lay on your back with your head hanging very slightly over the edge of the bed.