Bra Strap Syndrome (Mid-Back Pain)

I have previously written about mid-back pain and upper crossed syndrome and this post follows on nicely from there. Whereas upper-crossed syndrome is caused by changes in posture, Bra strap syndrome is a selection of neck, shoulder and mid-back pain and arm symptoms (such as pain, numbness or tingling (pins and needles) caused by prolonged pressure by an ill-fitted bra.

Bra strap syndrome can directly affect the muscles underneath the bra causing pain and tightness, for example, the trapezius muscles, the scalenes, the pectorals, the spinal muscles at the mid-back region and the muscles that attach on to the scapula. It can also form part of a larger neurovascular condition called costoclavicular syndrome, which falls under the umbrella of Thoracic Outlet syndrome. In the image below, you can see how pressure from a bra strap (yellow) can compress on the scalenes, pectorals, narrow the costoclavicular space (between the clavicle and the ribcage underneath) and compress or irritate the brachial plexus (nerves), axillary artery & vein.

Bra strap (yellow) impacting structures that run underneath

Causes

• Bra-strap tension. Prolonged pressure from bra straps, dig into the upper trapezius muscles, scalenes and/or pectorals causing redness, soreness, tightness and pain. Tight, narrow or poorly positioned bra-straps can also aggravate the costoclavicular space where delicate nerves and blood vessels exit from the neck to provide nerve and blood supply to the shoulder, arm, hand and fingers.

• Inadequate support: Ill-fitting bras do not provide the required support, particularly of larger breasts, which increases strain on surrounding musculature causing them to become tight and sore. The breasts themselves are not supported directly by any muscles, only by their surrounding skin. Coopers ligaments, which form part of the support system for milk ducts, do not provide any or minimal structural support (I have a post on breast injury which dives into this under-researched topic) so the breasts are a relatively vulnerable area. Increased breast weight can cause postural changes such as upper crossed posture, the shoulders and mid-spine (thoracic spine) to round further (increased kyphosis), which leads to strain and pain in these overworked postural muscles.

Symptoms

• Pain, soreness and tightness in the muscles of the shoulders, neck, upper and mid-back and base of the skull

• Red sore grooves in the skin of the upper shoulders, around the chest, into the breast tissue, and or into the sternum (chest bone) caused by the pressure of the bra straps, the underband or underwires.

• Symptoms caused by any changes in posture as a result of poorly supported breasts

• Headaches triggered by muscle tension

• Sore areas of skin, or rashes such as sweat rash, where skin touches or rubs on skin.

Treatment

• Wearing a correctly fitted bra and type of bra for the activity you are wanting to do. A broad supportive and correctly sized underband provides the majority of breast support rather than the straps themselves, and the correct sized cup is important to avoid any material digging into delicate breast tissue. Depending on the activity, wearing a bra with broad straps and straps that are the correct length, can help reduce direct pressure on the upper shoulders and costoclavicular area. Some research has suggested that sports bras with a racer-back may have better outcomes for reducing mid back pain during exercise (McGhee et al., 2013 and Ocran et al., 2022). Remember, different brands and even different styles within the same brand, have varying sized bras, so don't rely on your size when buying off the shelf, try it on and see if it fits (see below).

If you need a larger underband size but your cup size is spot on, then you will need to go down a cup in your new bra. For example, a 34C becomes a 36B for the cup size to remain the same.

• Ensure your bra is in good condition so that the elasticity and support is still there.

• Improve posture by strengthening weak postural muscles and stretching tight muscles.

• Treat sore, tight muscles with massage, trigger point therapy, stretching (both passive and active), and Active Isolated Stretching.

Check your bra fits

The University of Portsmouth are one of the leading researchers in bra technology and breast biomechanics and they have a short video which outlines 5 steps to check a bra fits well.

1. Make sure the underband is a good fit and level all the way around your ribcage, it shouldn't ride up at the back or move about when you raise your arms and should have no more than a 5 cm gap when you stretch the material away from your body. Most of the support comes from the underband

2. The cups should cover your breasts with no spillages, no bulging or gaping and the tops or sides (near your armpit).

3. The underwire (if present) should follow the natural curve of your breast and torso and not dig in to any areas of breast tissue. Note that not all bra designs are suited to everybody and every activity, so if you find it difficult to find a design where the wire doesn't dig into your chest or under arm area, then there are other options out there.

4. The centre front of the bra should sit flat against your body, if it lifts away then a larger cup size may correct this.

5. The bra straps, surprisingly, are not the main support in the bra so they just need to be comfortable, not digging in or falling off the shoulder with movement. They are adjustable and should be checked every now and then as they can change after repeated wearings. You can also make them different lengths to account for one breast being larger than the other or one shoulder height being different.

If you feel you are suffering from an ill-fitted bra or conditions related to it, get in touch with Melyn Chiropractic for further information on our bra-fitting assessment and treatment of mid-back, neck and shoulder pain.

References

Lindsay, KW and Bone, I. (2004). Neurology and Neurosurgery Illustrated 4th Ed. pp 444-445, Churchhill Livingstone, Edinburgh.

McGhee, D.E and Steele, J.R. (2010). Optimising breast support in female patients through correct bra fit. A cross-sectional study. Journal of science and medicine in sport 13(6) 568-572. [Online] Available at: Optimising breast support in female patients through correct bra fit. A cross-sectional study - ScienceDirect (Accessed 29.06.2023).

McGhee, D.E., Steele, J.R., Zealey, WJ. and Tacaks, GJ. (2013). Applied Ergonomics 44(1) pp. 112-118 [Online] Available at: Bra–breast forces generated in women with large breasts while standing and during treadmill running: Implications for sports bra design - ScienceDirect (Accessed 06.07.2023).

Ocran, FM. and Ji, X., Zhai, L., (2022). A study to evaluate pressure distribution of different sports bras. Journal of Engineered Fibres and Fabrics 17 [Online] Available at: A study to evaluate pressure distribution of different sports bras - Francisca Margarita Ocran, Xiaofen Ji, Lina Zhai, 2022 (sagepub.com) (Accessed 06.07.2023).

Souza, T.A. (2005). Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms 3rd Ed. pp 70 - 71. Jones and Bartlett Publishers, Boston.