With POTS, ANS dysfunction affects blood vessel function. Normally, blood vessels narrow when you stand to prevent blood from pooling in the lower body. In people with POTS, the blood vessels do not narrow when you stand, leading to decreased blood flow to the upper body.
Reduced circulation means the neck, shoulders, and back muscles do not get enough oxygen-rich blood, leading to muscle aches and tension in the form of coat hanger pain.
POTS can cause other symptoms like:
- • Dizziness or lightheadedness
- • Headaches or migraines
- • Brain fog
- • Trouble finding words when speaking
- • Difficulty with depth perception
- • A pins-and-needles sensation
Ehlers-Danlos Syndrome
Ehlers-Danlos syndrome (EDS) is a group of 13 inherited disorders that affect the body's connective tissues, including the skin, joints, and blood vessel walls. Although each type of EDS causes different symptoms, people with EDS often experience symptoms like:
- • Joint hypermobility
- • Chronic pain
- • Stretchy skin
- • Fatigue
Hypermobility of the connective tissues and joints can cause cervical (neck) instability, straining the muscles in the neck and shoulders. This affects the function of the nerves and blood vessels in the upper body, leading to coat hanger pain.
Neurally Mediated Syncope (NMS)
Neurally mediated syncope (NMS) is a chronic condition in which the body experiences a sudden drop in blood pressure and a lowered heart rate (bradycardia) when standing, leading to lightheadedness or loss of consciousness (syncope).
With NMS, autonomic nervous system dysfunction affects how the brain sends signals to blood vessels or how the blood vessels respond to these signals, disrupting normal blood flow to the upper body. Insufficient blood flow can prevent the neck, shoulders, and upper back muscles from receiving oxygen and nutrient-rich blood, which can cause muscle tension and pain.
Emotional stress, dehydration, prolonged standing, hot temperatures, and crowded environments can trigger pain and other NMS symptoms, such as:
- • Dizziness or lightheadedness
- • Fatigue when standing
- • Difficulty walking
- • Blurry vision
- • Brain fog
- • Feeling faint
- • Difficulty breathing
Multiple System Atrophy (MSA)
Multiple system atrophy (MSA) is a rare progressive neurodegenerative disorder that affects both the autonomic nervous system (which controls involuntary body functions) and the central nervous system (which controls motor functions, like movement).
MSA causes the death and loss of function of nerve cells in the brain and spinal cord, leading to symptoms like stiffness, tremors, slow movements, and lack of coordination.
MSA causes ANS dysfunction, leading to a sudden drop in blood pressure when standing and contributing to coat hanger pain. It can also cause stiffness, rigidity, and tension in the neck and shoulder muscles.
Pure Autonomic Failure (PAF)
Pure autonomic failure (PAF) is a rare neurodegenerative condition that affects the autonomic nervous system. It causes chronic postural hypotension.
Unlike other neurodegenerative diseases, PAF doesn't typically affect movement, but it disrupts the body's ability to regulate blood pressure, resulting in symptoms like dizziness, lightheadedness, and coat hanger pain.
People with PAF may also experience other symptoms related to ANS dysfunction, including:
- • Dizziness and lightheadedness
- • Visual disturbances, such as tunnel vision
- • Difficulty breathing
- • Anhidrosis (lack of sweating)
- • Constipation
- • Painful urination
Parkinson's Disease
Parkinson's disease is a chronic, progressive neurodegenerative disorder that affects dopamine-producing neurons in the brain, leading to problems with movement, including tremors, muscle stiffness and rigidity, slow movements, and balance problems.
Several factors can contribute to coat hanger pain in people with Parkinson's disease. Rigidity and postural instability (gait and balance problems) can strain the neck and shoulder muscles, leading to muscle tension and pain.
Parkinson's disease and some Parkinson's disease treatments can cause sudden drops in blood pressure, also leading to coat hanger pain.
When To See a Healthcare Provider
Knowing whether you're experiencing coat hanger pain rather than muscle strain from overuse or injury can sometimes be challenging. A classic sign of coat hanger pain is that the pain improves when lying down, whereas muscle strain due to overuse or injury may continue to hurt even when resting.
Most causes of coat hanger pain are chronic conditions requiring a medical diagnosis and ongoing treatment, so it's important to see a healthcare provider if you experience recurrent, persistent, or severe coat hanger pain.
See a healthcare provider as soon as possible if you experience coat hanger pain with any of the following symptoms:
- • Dizziness, lightheadedness, or fainting when standing up from sitting or lying down
- • Vision changes
- • Changes in your mobility, such as difficulty staying balanced or walking
- • Tremors
- • Difficulty breathing
How Is Coat Hanger Pain Diagnosed?
To diagnose the cause of coat hanger pain, a healthcare provider will likely begin by reviewing your medical history and symptoms. Since coat hanger pain is often associated with autonomic dysfunction or blood pressure issues, you may be referred to a specialist, such as a neurologist or a cardiologist (doctors specialized in diagnosing and treating brain and nervous system disorders and heart and blood vessel conditions, respectively).
Your healthcare provider will want to know whether you experience other symptoms in addition to coat hanger pain, such as dizziness, headaches, or slowed heart rate. They may also ask if specific triggers, such as sitting up after lying down, hot baths, dehydration, or emotional stress, cause or worsen your pain.
During the physical examination, your healthcare provider may measure your blood pressure and heart rate when lying down and then again while you stand or sit for 1-3 minutes. They may also examine your neck, shoulders, and upper back for tenderness, swelling, or muscle weakness.
Diagnostic Tests
Diagnostic tests can help identify the underlying cause of coat hanger pain. These include:
- Blood tests: These can check for underlying metabolic or hormonal imbalances that can cause symptoms similar to those of conditions associated with coat hanger pain.
- Neurological examination: If your provider suspects your coat hanger pain may be due to a neurological or neurodegenerative condition, they may perform a neurological exam to assess your muscle strength, coordination, and reflexes.
- Autonomic function tests: Certain tests can assess how well your autonomic nervous system regulates blood pressure and heart rate. This includes the tilt test, where you lie on a table that is slowly adjusted upward. As your position changes, the provider can track how your heart rate and blood pressure respond.
- Imaging tests: Your provider may order ultrasounds or other imaging tests to view your spinal cord, brain, or internal orders to check for abnormalities.
How Is Coat Hanger Pain Treated?
Treatment for coat hanger pain depends on the underlying cause. It may include at-home treatments to relieve pain and discomfort and medications or therapies to address the root cause of your pain.
At-Home Treatments
There are several ways to relieve coat hanger pain from the comfort of your home, including:
- Position changes: Coat hanger pain often worsens when standing, especially for prolonged periods. Before the pain worsens, lie flat on your back to allow your muscles to relax and improve circulation.
- Stay hydrated: Drink fluids throughout the day, including water or electrolyte drinks, to prevent dehydration. Drinking a bottle of water a minute or two before you get out of bed may also help reduce symptoms.
- Flex leg muscles: Pumping your ankles or tightening your leg muscles about 10 times before standing can constrict the blood vessels and promote blood flow to the upper body when you stand.
- Heat therapy: Applying a heating pad or hot pack to your neck, shoulders, and upper back can promote blood flow to the area and relieve pain.
- Over-the-counter medications: Pain relievers like Tylenol (acetaminophen) and Advil (ibuprofen) can reduce mild to moderate muscle pain.
- Compression garments: Wearing compression stockings or abdominal compression garments can help improve blood flow and reduce orthostatic hypotension symptoms, reducing coat hanger pain.
Medical Treatments
Some causes of coat hanger pain require ongoing treatment with medication or therapies, which can help manage coat hanger pain. Your healthcare provider may recommend one or more of the following to address coat hanger pain:
- Prescription medications: Medicines like Florinef (fludrocortisone) can help the body regulate its balance of sodium and fluids to manage orthostatic hypotension. ProAmatine and Orvaten (midodrine) help tighten blood vessels to prevent low blood pressure and improve circulation. Elavil (amitriptyline) is an antidepressant that relieves tension headaches, migraine, and neuropathic (nerve-related) pain.
- Physical therapy: A physical therapist can develop a treatment plan to strengthen neck and shoulder muscles and improve posture to manage coat hanger pain.
- Transcutaneous nerve stimulation (TENS): TENS units use low-voltage electrical currents to stimulate the nerves and reduce pain signals. Placing the TENS electrodes on the neck, shoulders, or upper back for coat hanger pain may help relax tight muscles and relieve pain.
