Coat Hanger Pain: Causes, Symptoms, and Effective Relief Strategies
Coat hanger pain is a distinctive pain pattern that affects the neck, shoulders, and upper back, creating a shape reminiscent of a coat hanger. While it may sound unusual, this type of discomfort is common in certain medical conditions—yet it remains under-recognized and often misattributed to general muscle tension or poor posture.
Understanding what coat hanger pain is, why it happens, and how to manage it can help reduce discomfort and improve quality of life.
What Does Coat Hanger Pain Feel Like?
Patients often describe coat hanger pain with the following characteristics:
A heavy weight on the shoulders
A tight band across the base of the skull and neck
Burning, pulling, squeezing, or stiffness that spreads upward from the shoulders to the head
Deep aching, throbbing, or pressure where the neck meets the upper back
Worsening symptoms the longer you are upright, when standing, walking, or even sitting
Improvement when lying flat, especially with legs elevated
While these sensations may mimic muscle strain or tension headaches, coat hanger pain often has underlying circulatory or neurological causes.
Who Is at Risk?
Coat hanger pain is particularly common in individuals with orthostatic intolerance, including:
Postural orthostatic tachycardia syndrome (POTS)
Other forms of dysautonomia
Hypermobile Ehlers-Danlos syndrome (hEDS) and other EDS types
Hypermobility spectrum disorder (HSD)
Craniocervical instability (CCI)
Mast cell activation syndrome (MCAS)
In these conditions, the pain can be a clue to broader systemic issues with blood flow regulation and autonomic nervous system function.
What Causes Coat Hanger Pain?
The leading theory is muscle ischemia—when the muscles in the neck and shoulders do not receive enough oxygen-rich blood during upright posture. This can occur if blood vessels fail to adjust properly when the body is vertical, leading to inadequate circulation in the muscles that support the head and neck.
Other possible contributing factors may include:
Overworked muscles due to postural strain
Trigger points—small, hypersensitive knots in the muscle tissue
Irritated or inflamed nerves in the cervical and upper thoracic spine
Poor fluid drainage in the neck and shoulders
How to Relieve Coat Hanger Pain
Treatment focuses on improving blood flow to the upper body and reducing muscle strain. Strategies may include:
Modifying upright activities: Avoiding prolonged standing, especially early in the day when symptoms can be more severe. Rising slowly from bed to allow your circulatory system to adjust.
Incorporating rest breaks: Lying flat or with legs elevated for short intervals throughout the day.
Gentle movement and strengthening: Engaging in slow, controlled neck and shoulder exercises. Avoiding overstretching, which can worsen muscle strain.
Working with a physical therapist (PT) or occupational therapist (OT): Can provide gentle massage or myofascial release, dry needling, targeted strength training, or mobility programs
When to Seek Medical Advice
If you experience coat hanger pain alongside symptoms like lightheadedness, dizziness, palpitations, or fainting, consider consulting a healthcare provider familiar with autonomic disorders. Early evaluation can help uncover underlying causes and guide more targeted treatment.
Coat hanger pain is more than just muscle tension—it may signal underlying circulatory or autonomic dysfunction. With the right approach, many people find significant relief.
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Disclaimer: This blog post is for informational purposes only and shall not be construed as behavioral health or medical advice. It is not intended or implied to supplement or replace treatment, advice, and/or diagnosis from your own qualified healthcare provider.