Asthma-Related Musculoskeletal Tension: Causes, Symptoms, and How We Can Help

All information in this blog is supported by NICE guidance and peer-reviewed research. Reference numbers appear throughout, with the full list at the bottom of the page. This blog focuses specifically on the musculoskeletal aspects of living with asthma, not the medical management of asthma itself, which should always be guided by your GP or respiratory team in line with current NICE guidance.

The Connection Between Asthma and Musculoskeletal Tension

Asthma is fundamentally a respiratory condition, and its diagnosis and medical management is set out in NICE Guideline NG245, the joint British Thoracic Society, NICE, and Scottish Intercollegiate Guidelines Network collaborative guideline, published in November 2024. ¹ ² This represents a major, recent update to how asthma is diagnosed and managed across the UK. ¹

What's less widely understood, but genuinely relevant to the work we do, is that living with asthma can have a real, measurable impact on the musculoskeletal system, the joints, muscles, and structures of the chest wall and surrounding spine. This is exactly where manual therapy can offer genuine, evidence-supported support, working alongside, never instead of, your prescribed asthma management.

Why Does Asthma Affect the Musculoskeletal System?

This is a genuinely well-explained mechanism. The mechanical alterations related to the overload of respiratory muscles observed in people with persistent asthma can lead to the development of musculoskeletal dysfunctions. ³ During asthma flare-ups, lung hyperinflation and elevated lung volumes place the diaphragm, the primary breathing muscle, at a genuine mechanical disadvantage, reducing its normal movement (excursion) and its capacity to generate force effectively. ³

The diaphragm normally produces a smooth, downward and upward movement of its dome with each breath, contributing 60 to 80% of the air movement involved in normal breathing, making it genuinely the most crucial breathing muscle in the body. ³ When asthma repeatedly places this muscle under mechanical strain, diaphragmatic dysfunction can develop, related to the mechanical linkage between its different parts, placing it at a further disadvantage. ³ This particularly affects the diaphragm's ability to elevate and extend the lower rib cage at a specific area called the zone of apposition, increasing the overall work of breathing. ³

Closely related respiratory conditions provide further useful evidence of this same underlying pattern. In COPD, a respiratory condition sharing some mechanical similarities with asthma, osteoarthritic changes have genuinely been documented in the joints connecting the ribs to the breastbone and spine, the manubriosternal, costovertebral, and costotransverse joints, contributing to reduced thoracic movement and joint stiffness. ⁴ Changes in chest wall mechanics like these have been directly linked to breathlessness that limits exercise capacity, alongside peripheral muscle dysfunction and reduced overall strength and mobility. ⁴ Genuinely striking research has found that reduced thoracic spine mobility is itself linked to lower lung function measurements, reduced lung volume capacity. ⁴

Common Signs and Symptoms

• Tightness and tension through the chest wall, ribs, and upper back

• Restricted thoracic (mid-back) and rib cage mobility

• Compensatory neck and shoulder tension, often from prolonged reliance on accessory breathing muscles during periods of breathlessness

• Postural changes, sometimes including a more rounded upper back, connected to the breathing pattern changes associated with asthma

• Fatigue and reduced physical capacity, related to the increased work of breathing

When Should You Be Concerned? Red Flags to Watch For

Asthma itself can be a serious, potentially life-threatening condition, and it's essential to be clear about this. Please seek emergency medical attention if you or someone you're with experiences:

• Severe breathlessness, unable to complete full sentences

• Blue tinge to the lips or face

• A reliever inhaler providing no relief, or needing to be used repeatedly within a short period

• Exhaustion, confusion, or distress alongside breathing difficulty

• Chest tightness or pain that feels different or more severe than usual asthma symptoms

We will never attempt to treat an acute asthma flare-up, and will always direct you to emergency medical care if anything in your history or presentation raises concern. Our role is genuinely focused on the musculoskeletal consequences of living with well-managed, ongoing asthma, working alongside your respiratory care, not replacing it.

How We Can Help

This is an area of genuine, growing research interest. A preliminary study has found that manual therapy techniques can be used as adjunctive (supportive, alongside other care) therapy in asthma treatment. ³ A registered randomised controlled clinical trial is currently investigating manual therapy's efficacy specifically on diaphragm mobility in people with well-controlled mild, moderate, and severe asthma, alongside breathing retraining exercises, reflecting the seriousness with which this connection is now being studied. ³

Osteopathic manual techniques and manual therapy: manual therapy directed at the thoracic spine can increase mobility of the spine and chest wall, which may have a genuinely positive impact on lung function. ⁵ A variety of manual therapy techniques have been studied for respiratory conditions, including soft tissue therapy, spinal and joint manipulation and mobilisation, and specific diaphragmatic release techniques. ⁴ Whilst much of the strongest evidence currently comes from COPD research, the underlying chest wall and thoracic mechanisms are genuinely comparable, and ongoing research is now investigating these same effects specifically in asthma. ³ ⁴

Deep tissue and sports massage: targeted soft tissue work for the chest wall, upper back, and neck muscles, addressing the compensatory tension that builds up from prolonged or laboured breathing patterns.

Diaphragmatic release techniques: a specific manual therapy approach aimed at improving diaphragm mobility and function, the focus of current dedicated asthma research. ³

Thoracic mobility work: addressing the rib joints and thoracic spine specifically, given the demonstrated link between thoracic mobility and lung function. ⁴

Medical acupuncture and cupping: used as part of a broader treatment plan to support the chest wall and surrounding muscle tension associated with asthma.

It's genuinely worth being honest here too. Current research on manual therapy combined with exercise for respiratory conditions has shown mixed results, and benefits may depend on the specific technique applied. ⁴ This is exactly why we focus on a thorough, individualised assessment rather than a one-size-fits-all approach, and why we always work in close coordination with your respiratory care team.

Exercise and Self-Management

• Breathing retraining exercises (BRE): used alongside manual therapy in current research specifically investigating diaphragm function in asthma, reflecting their genuine, complementary role. ³

• Thoracic mobility exercises: gentle rotation and extension work for the mid-back, supporting the rib cage mobility that's been linked to better lung function. ⁴

• Postural exercises: addressing the compensatory upper back and shoulder positioning that can develop with prolonged breathing difficulty.

• Graded, appropriate physical activity: supported by NICE guidance, which itself recommends breathing exercises as part of broader asthma management strategies. ⁶

Any exercise programme will always be built around your current asthma control and in line with guidance from your GP or respiratory team.

What to Expect at Your First Appointment

We will take a thorough history, including your asthma control, current medication, and any recent flare-ups, and will always confirm that your asthma is currently well-controlled before beginning any treatment. We will carry out a hands-on assessment of your chest wall, thoracic spine, and rib mobility, alongside relevant neck and shoulder tension. We will explain clearly what we find and build a supportive, evidence-informed treatment plan that works alongside, never instead of, your prescribed asthma management.

Frequently Asked Questions

Can manual therapy treat my asthma? No, and we want to be genuinely clear about this. Manual therapy does not treat asthma itself, which requires appropriate medical management in line with NICE guidance. What we can support is the musculoskeletal tension and reduced chest wall mobility that can develop alongside living with asthma.

Is it safe to have manual therapy if I have asthma? Generally yes, provided your asthma is well-controlled, and we will always check this with you at your appointment. We will never proceed if you're experiencing an acute flare-up or your asthma feels unstable.

Will this help my breathing? Research is genuinely ongoing, including dedicated trials currently investigating diaphragm mobility specifically in asthma. Related research in similar respiratory conditions has found a link between thoracic mobility and lung function, supporting a sensible, evidence-informed rationale for this work, though we'll always be honest that this remains an evolving area of research.

Should I stop my asthma treatment and rely on manual therapy instead? No, absolutely not. Manual therapy is a supportive, complementary approach, never a replacement for your prescribed asthma medication and ongoing medical care.

Living with asthma and noticing tension through your chest, back, or shoulders? Get in touch using the contact form and we will assess and build a supportive treatment plan that works alongside your asthma care.

BOOK YOUR APPOINTMENT HERE

References

1. Asthma (Chronic), Diagnosis and Monitoring: BTS/NICE/SIGN 2024 Guideline Expert Insight. Medscape. Available at: https://reference.medscape.com/cc1/p10/what-does-new-bts-nice-sign-asthma-guideline-mean-primary-2025a10000uc

2. BTS/NICE/SIGN joint guideline on asthma: diagnosis, monitoring and chronic asthma management (November 2024), summary of recommendations. PMC. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12322379/

3. The Effect of Manual Therapy Techniques on the Mobility of the Diaphragm in People With Asthma. ClinicalTrials.gov. Available at: https://clinicaltrials.gov/study/NCT05709054

4. The Role of Manual Therapy in Patients with COPD. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473650/

5. The Immediate Effect of Manual Therapy Application on Respiratory Functions in Healthy Young Individuals. ClinicalTrials.gov. Available at: https://clinicaltrials.gov/study/NCT05934240

6. National Institute for Health and Care Excellence (NICE), British Thoracic Society, Scottish Intercollegiate Guidelines Network. Asthma: diagnosis, monitoring and chronic asthma management. NICE Guideline [NG245]. 2024. Available at: https://www.nice.org.uk/guidance/ng245