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Coat Hanger Neck Pain

Coat Hanger Neck Pain
February 27, 2018 Dr. Patrick Nemechek and Jean Nemechek

Coat Hanger Pain

Many individuals with chronic or intermittent neck tightness and pain are misdiagnosed.


They are told their vertebrae are out of alignment, have muscular injury from an accident, have a pinched nerve, “carry their stress there”, or have arthritic changes noted on an x-ray.

While certainly some individuals may have nerve compression from a serious degree of vertebral or disc issues, many others have been incorrectly diagnosed. They are actually suffering from a common cause of neck pain and tightness called coat hanger neck pain.

Coat hanger neck pain gets its name from the shape of the upper trapezius muscles that run on the upper back, from shoulder to shoulder and attaching to the rear of the skull. The coat hanger pain often affects both sides, but it is not unusual for it to be one-sided.

The pain and muscle tightness results from a lack of proper blood flow and oxygen delivery into the muscles of the shoulder and neck. Lack of oxygen into a muscle is very painful; just ask anyone suffering from a lack of oxygen into their heart muscle (angina) or their legs (claudication).


But unlike those examples, coat hanger neck pain is not from a narrowed blood vessel due to atherosclerosis, it is the result of residual brain injury to the Autonomic Nervous System.


The Autonomics can be injured by a physical blow to the head (concussions, sub-concussive events), intense emotional experiences (bankruptcy, betrayal, combat), or inflammatory traumas (vaccines, surgery, fractures, chemotherapy, radiation).

The body is designed to completely recover from these types of brain injuries within weeks to a few months but mounting evidence suggests that potentially 60-80% of the population can no longer completely repair their brain traumas due to a chronic inflammatory condition called inflammaging (See our recent post on Inflamm-Aging).


As a result of inflammaging, brain injuries are not completely repaired and result in residual brain injury through a process called cumulative brain injury.

As the damage from successive injuries accumulates, symptoms from dysfunction of the Autonomic Nervous System increase.

Autonomic injury makes it difficult to drive blood upwards into the head and neck leading to poor oxygen delivery and tight, painful neck muscles. Low blood pressure and oxygen delivery into the head and neck also results in muscle pain that causes migraine headaches, TMJ (temporomandibular joint) dysfunction, and pain.

The brain does not work well without enough blood pressure and oxygen and this is a common cause of chronic fatigue, lightheadedness or dizziness, poor concentration, ADD or ADHD, increased hunger especially for salt and sugar, and generalized anxiety.

Sitting or standing still tends to worsen the neck pain because autonomic damage commonly allows blood to pool abnormally into the leg muscles resulting in inadequate delivery of oxygen into the muscle.

The blood and oxygen delivery into the head and neck region are improved with the movement of the leg muscles, and this fact helps diagnose coat hanger pain.

If neck pain improves or is absent with physical activity, this is an indication that the patient has coat hanger pain from Autonomic injury. Physical activity improves blood and oxygen delivery into the neck muscles and alleviates symptoms.

Coat hanger pain is suspected when an individual can play tennis or work in the yard without noticing pain but they feel increased pain when sitting at their desk or in a car for extended periods of time.

Mechanical sources of pain such as herniated disc may also hurt when sitting still but commonly worsen with activity since movement of the body often moves the neck vertebrae which aggravates the mechanical defect (think about pinched nerve between a disc and bone) and that increases the pain.


Treatment of coat hanger pain requires reversal of underlying autonomic damage through the reduction of inflammation.

When autonomic dysfunction improves or recovers the brain is better able to control the body and once again receive the proper delivery of blood flow and oxygen into the trapezius muscles that run on the upper back, from shoulder to shoulder and attaching to the rear of the skull.

I have been testing and treating the Autonomic Nervous System for 12 years and I have developed a treatment program called “The Nemechek ProtocolTM for Autonomic Recovery” (Patent Pending) that is specifically designed to reduce multiple sources of inflammation and restore the body’s natural brain repair mechanism.

Within months of being on The Nemechek Protocol™, many of my patients experience significant improvement in their coat hanger pain as well as a wide array of other symptoms associated with autonomic damage such as headaches, heartburn, and GI distress.

Knowing these important facts about autonomic dysfunction, neck pain, and tightness may help you find the right treatment for your neck and shoulder pain and discomfort.

I believe that the key to restoring our natural inflammation control mechanisms is through a reduction of inflammation throughout the brain and body by using every scientific, nutritional, and bioelectric tool available.


I am an internal medicine physician (D.O.) from UCLA and my Internal Medicine and Autonomic practice is in the Phoenix, Arizona area. For additional information, call my office 623-208-4226 or go to

This post is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, and it does not create any patient-physician relationship.

© 2018. Nemechek Consultative Medicine. All Rights Reserved.


  1. Gayathri Parangipettai 3 months ago

    My kid is 4yr old(ASD) , how much inulin, fish oil and olive oil recommendations for ADHD kid , rite now we are in 1/4 inulin, 1.5 tsp fish oil and 4 tbsp oilve oil. Recently only(past 4 months) we are suspecting he may have ADHD too, checked with doctor too even she is suspecting ADHD and rite now he has only ASD diagonsis. He is been in protocol for 8months and for past few months , he is turning into a completely different kid lots of hyperactivity, completely zoned out, aggressive and lots of behavior issues which he never had any of this before . We are so lost and losing our hopes. Please we need ur help to find the right dosage for my kid. I feel like after increased his fish oil dosage and olive oil for past 3 months , this all happened. I am totally lost to find the right dosage. Dr.Nemechek please help us.

    • Patrick Nemechek, D.O. 3 months ago

      You are experiencing the awakening. I discuss how to manage this in our YouTube video called Anxiety and Aggression as well in the protocol which can be purchased at

    • Gayathri Parangipettai 3 months ago

      My kid already had awakening period , is another awakening possible? We are waiting for ur Skype app and we have ur book with us, but we are clue less about the dosage ,please help , rite now his dosage is 1/4 Inulin, 1.5tsp fish oils and 4 tbsp olive oil .

    • Patrick Nemechek, D.O. 3 months ago

      I’m sorry but due to the high volume of requests, I’m restricting my response to those involving a broader level of explanation and am refraining from providing individual dosage advice.

      I believe the answer to your questions can be found in our protocol. A copy can be purchased at

  2. Madhu 4 months ago

    Hi Dr.Nemecheck,
    I have 8-year-old ASD/ADHD son.
    He is verbal. He diagnosed his ASD when he was 3-year-old. we started providing him ABA therapy and exploring ways to reduce his autism symptoms.
    when he was 5-year-old he also diagnosed as ADHD he has lot of hyperactivity.
    we gave him medicine Quillivant XR, as a mom I did not want to give him medicine and heal him naturally through diet but we gave him because of his uncontrol hyperactivity
    after few months I stopped it because he was crying and sad not able to express.
    Then I started biomed and GFCFSF diet with lots of supplements saw little progress.

    Finally, I came to know the Namecheck protocol and got lot of hope for my son.
    I started protocol on May 2018, initially he showed lot of aggression, modified the protocol stopped inulin. slowly increasing the inulin.

    His current dosage is:

    Inulin – 1/2 tsp (morning 1/4 tsp, evening 1/4tsp)
    olive oil raw – (15ml morning,15ml evening also cooking food in olive oil)
    fish oil-7.5 ml

    when I increased inulin from 1/4 tsp to 1/2 tsp he started eloping from school heard lot of complaints, but I trusted the protocol, wanted to see his gains continued the dosage, after few weeks he was doing ok at school
    but his hyperactivity is not reducing and still trying to elope.
    Form his ABA therapy they do not want to handle my son because of his safety and recommending ADHD medicine.
    all these years I am fighting against his medicine trying to reduce his hyperactivity through supplements but when people are advising ADHD medicine it is hard to go back and put him on medicine.
    now, we need to take a decision to go for ADHD medicine along with the protocol. your appointment is still long waiting list. please advise me, do I have to change his dosage? Shall I give him ADHD medicine along with protocol?

    so far, the gains we saw:
    improved eye contact, talking 3-word sentences clearly (previously did not pronounce properly), listening simple instructions.

    • Patrick Nemechek, D.O. 4 months ago

      I’m sorry but due to the high volume of requests, I can no longer provide specific advise of individuals.

      My comments will be limited to explaining the broader concepts of The Nemechek Protocol.

  3. Thalia 4 months ago

    Hi Dr Nemechek,

    My 3.5 year old son has this pain everyday. Thank you, your book/blog has helped me figure this out! He was seen at a pediatric pain management clinic but the doctor doesn’t seem to know what I mean when i describe his pain. My son has complained of this chronic pain ever since he learned to say “hurts” before he turned 2. It’s so bad but only when he is sitting or standing, like when we read or when he plays sitting at a table, washing hands, or just sitting. He is constantly complains of neck and head pain asking me “what is hurting me?” He also mostly runs from room to room instead of walking and he lays on the floor for hours EVERYDAY. I think the doctors think he might be doing it for attention because I tell them that he can run around at the playground and do physical things with no problem. But I know it’s not for attention, I see he is constantly suffering, I see it in his eyes they turn red and watery from the pain even when he doesn’t tell me.

    We started your protocol for this and other symptoms.

    My 2 questions:
    What is the best way to help relive some of the pain? He already lays on the floor on his own.

    He also complains of burning hot pain in his back and points to the upper part of his back, could this be related?

    • Patrick Nemechek, D.O. 4 months ago

      His pain sounds like either headache pain or coat hanger pain of the neck due to the low blood pressure from autonomic dysfunction.

      His core problem is he can’t generate pressure upward against gravity because of the autonomic dysfunction – laying flat eliminates the gravitational issues and gives him some relief.

      The protocol will help him recover soon. Increasing his salt and fluid intake can help as can wearing support hose on his legs until he recovers.

  4. April T 6 months ago

    Hi Dr. Nemecheck my son is 8 and high functioning asd and adhd. We did biomeds for 1 year with great success but I wanted to try your protocol to get better social skills and he struggles in school. He had urine tests that showed no dopamine, epinephrine and serotonin in his urine so we supplemented with L-tyrosine and it helped with adhd symptoms and his levels improved on urine test. Can I keep him on L-tyrosine with your protocol? Week 3 and all the adhd symptoms are back and he barely responds to his name since stopping it. Thank you

    • Patrick Nemechek, D.O. 6 months ago

      Did the symptoms worsen when you started the inulin or stopped the tyrosine?

      That will tell you what to do.

  5. Jaymie 7 months ago

    Dear Dr Nemecheck,
    I’ m a 35 yr old female started the protocol for my self at the same time I started for my 9 yr old non verbal Autistic /adhd/GDD son. I had olive oil, inulin and fish oil for couple of days and my speech started getting jumbled up, ideas constantly flowing , unusual adhd kind of behaviour started to show up. I couldn’t function as a normal adult and my confidence was really low. I have been having low self confidence , a shoulder &back pain as exactly described in your article “coat hanger pain” and having longterm stress issues. I think I have a cumilative brain injury from childhood and ongoing trauma and ever since I have trouble speaking fluently. I feel my brain is lacking oxygen as most of the time so I go outside the office and try to breath which brings down my stress levels temporarily. I appreciate if you could advise me your opinion on this. Thank you very much.

    • Patrick Nemechek, D.O. 7 months ago

      For these and other reasons I always treat my adults with rifaximin instead of inulin.

  6. Wanda Rabb 10 months ago

    Dr. Nemechek: I was approved to make an appointment with you in January 2018 but had recently been diagnosed with an idiopathic form of membranous glomerulonephritis (stage 2-3). My nephrologist put me on Cyclosporine and Prednisone immediately due to the fact my protein output had increased dramatically in a short period of time. I canceled my appointment with you as I was concerned about whether the protocol would interfere with the immunosuppressant medications (or vice versa). I desperately need to be treated by you as I have been very sick for over 30 years with CFS, FM, POTS, etc. What are your thoughts about whether I could do the protocol at the same time I am taking these meds? Would there be any contraindications? Would the protocol potentially be helpful in helping me to go into remission with the MGN? Even though the biopsy report indicated idiopathic my nephrologist feels it is likely autoimmune. I look forward to your thoughts on this.

    • Patrick Nemechek, D.O. 10 months ago

      Generally, my protocol simply lowers abnormal inflammatory responses in the body.

      You can simply ask the nephrologist or your pharmacist if fish oil, olive oil and rifaximin would interfere with your medications.

  7. Stacy 11 months ago

    Dr. Nemechek – I recently purchased your book and we started the Nemecheck protocol. My son is 10 years old and has autism. I also started the Protocol. We have been on the protocol for a little more than a week. My son has higher functioning autism and he is 10, so I think it will take longer to see real results. It seems like he is a bit more aware, but time will tell.

    I have a concern about a side effect, that I am experiencing: After about 5 days, I became so sleepy. I could sleep all day and almost did for 3 days, so yesterday I skipped a day. Have you seen this side-effect? Are taking too much fish oil? Did I start too quickly with the full dose of fish oil? I am using the NOW fish oil 1000mg 2x a day. My son is taking the Nordic Naturals DHA extra 1 pill in the morning and 1 pill at night 1600mg total. My son was a really tired yesterday, but its difficult to say because it was also the first day back to school after spring break. What do you think?

    • Patrick Nemechek, D.O. 11 months ago

      Adults need rifaximin for a better recovery. Could be the overgrowth bacteria you still is interacting in a strange way with the oils to make you feel this way

  8. Casey 11 months ago

    Dr. N, my son is 14 years old and 178 lbs (gained while taking psych meds but are slowly titrating down). Started protocol on 2/8. Your protocol worked wonders immediately but I cannot get my son past 1/8 tsp inulin or he literally becomes quite agitated and moody, aggressive, angered quickly, and looks all day to find ways to get in trouble when I went to 1/4. Even at 1/8 he is acting quite terribly. Do you have a recommendation? He is taking your recommended brands and doses (2 NOW DHA capsules 2xs a day, California ranch olive oil 1-2 tbsp a day, and 1/8 tsp inulin 1x a day, he also has 1 tbsp soaked chia seeds daily). We have seen gains in handwriting and cognitive skills even his teachers are noticing changes (they are unaware he’s on Protocol). His behavior is quite u manageable while using the inulin. Should I drop to none for a while? His pediatrician didn’t agree to prescribe Rifaxamin but I have not filled it yet for fear it could be a disaster with his behavior. Can you recommend what I should do? Also, after being on Protocol for a while I do plan to visit you with him as I think he would possibly benefit from the VNS machine. Thank you for your time and sharing then protocol. I’ve been telling everyone!

    • Patrick Nemechek, D.O. 11 months ago

      Just be patient and go slow with the inulin.

      As long as he is improving in other aspects this too will eventually improve and allow you to increase the dose of inulin and improve the rate of recovery even faster..

  9. Jason 11 months ago

    Thank you so much for your answer! That is exactly the information / clarification that I needed. Cleared it up perfectly. Thank you again, Dr. Nemechek.
    New York, NY

  10. Jason 11 months ago

    Dear Dr. Nemechek:

    I hope you can answer a quick question about something that I read elsewhere on your website, which I have not found mentioned anywhere else, but speaks directly to a question that I have. Under the heading “Blood Pressure Problems,” you discuss “High blood pressure readings without independently confirmed hypertension”. What does this mean? How are you here defining “independently confirmed hypertension”? After all, isn’t hypertension diagnosed via high blood pressure readings? For efficiency’s sake I will skip the details (can explain further if need be but for now want to be efficient with your time), but suffice it to say that this line speaks directly to what I have been puzzling over and it is the only thing I have come across that seems to intersect with what I am trying to figure out.
    Thank you very much!
    New York, NY

    • Patrick Nemechek, D.O. 11 months ago

      the disorder hypertension is a consistent elevation of blood pressure 24 hours per day.

      Many doctors simply see one reading in a patient and prescribe a medication for hypertension. Many times this reading is randomly high for a variety of reasons (traffic, lack of sleep, work stress, or other illnesses such as a sinus infection).

      A series of BP readings taken in the AM is a better indicator of one’s true blood pressure baseline.

  11. jane kibisu [email protected] 11 months ago

    Dr.Nemechek, how can i help my son He is Autistic. what treatment would you recomend in addition to your protocol. he is 27years old. non verbal though echolic

    • Patrick Nemechek, D.O. 11 months ago

      In our book I list the adult dosing guideline for adult children with autism.

  12. Jenny Blanchette 11 months ago

    This is exciting news. I’ll be in touch!

  13. Jenny Blanchette 11 months ago

    Dr. N,

    I just watched your video on VNS. I have Cerebral Palsy. I’ve struggled with fatigue, brain fog, depression, anxiety and… you guessed it, coat hanger pain…for most of my life. I always thought it merely a side effect of using mobility aids and the extra energy I exert on a day to day basis. But, I’m now wondering if it is ANS dysfunction. I am starting the protocol, next week, but I wondered if you thought VNS might help in my case. If so, sign me up!

    • Patrick Nemechek, D.O. 11 months ago

      If you are an adult and especially with a history of cerebral palsy, I think the VNS is critical to achieving maximal improvement

  14. JAIN 12 months ago

    Thanks Dr.
    I am getting Nordic Naturals – Daily Omega Kids, Brain and Visual Function, 30 Soft Gels.
    On bottle it says , 1 soft gel contains 320 Mg Total Omega 3S (EPA=163 Mg and DHA=112 Mg and Other Omega 3s = 45 Mg).
    My child is 3.9 years old with Autism.
    Please advise how many soft gels should i give him per day ?


    • Patrick Nemechek, D.O. 12 months ago

      The dosages and brands of fish oil and olive oil I recommend for my patients are listed in the book.

      Reading the book will answer your questions and provide with so much more useful information you are going to need if you try my protocol.

  15. Anonymous 12 months ago

    Dr Nemechek, Can we use anything vegetarian instead of fish oil for high Omega dosage for toddler with autism ?

    Please suggest

    Thank for your time.

    • Patrick Nemechek, D.O. 12 months ago

      Nordic Naturals has some algae-derived DHA products that might be an alternative but I’ve never used them with my patients.

  16. Jain 12 months ago

    Thanks Dr Nemecheck.
    Could you please advise me brand name ?

    • Patrick Nemechek, D.O. 12 months ago

      I recommend using fish oil from Now Foods or Nordic Naturals.

      We have very few problems when using these brands with our patients.

  17. Anonymous 12 months ago

    Hello Dr Nemchek,
    I am planning to buy “Multivitamin Gummies with , Inulin Prebiotic Fiber & Omega 3 DHA/EPA Fish Oil, Folate (Methylfolate) ” for my 3.9 years old son, who is on Autism Spectrum. Please advise if i can give him the same ?

    Thanks in Advance

    • Patrick Nemechek, D.O. 12 months ago

      I recommend just using the brands I’ve found useful.

  18. Tammy 12 months ago

    Thank you for your reply.

  19. Tammy 12 months ago

    Dr. Nemechek, I have told a number of specialists about this type of coathanger pain, and I notice when my POTS is bad, when I go from lying/sitting to standing, I feel like the blood literally stops in my neck and causes pain, but no doctor had an explanation or thought it was worth investigating. I always thought some of it had a blood flow component just based on how it feels. Thank you for explaining this! It is so refreshing to finally have confirmation of what I’ve tried to find an answer for.

    I have some questions about the impact of viruses on autonomic function. In your Screencast “Use of Vagus Nerve Stimulation in Reversal of Brain Injury, you mention certain issues that can lead to metabolic information including tobacco, viruses, periodontal disease, etc. I’ve heard some patients with a history of cold sores have had remission with their POTS symptoms after taking an antiviral (however, I have also heard of relapses), and there is a hypothesis by Dr. VanElzekkar that vagus nerve infection with HHV-6, EBV or other viruses cause CFS (and POTS symptoms) is currently being investigated.

    With your protocol, how does evaluating for/treating viruses come into play and how/when are they addressed with respect to other parts of your protocol? Have you found any in your practice that tend to appear more commonly in patients?

    Thanks for any input you can provide.

    • Patrick Nemechek, D.O. 12 months ago

      The virus issue is based on their propensity to produce pro-inflammatory cytokines. Chronic active viral infections (HIV, Hepatitis B & C) as well as recurrent herpes simplex outbreaks can cause consider amounts of pro-inflammatory cytokines.

      I believe the production from these viral conditions can be enough to influence neurological functioning and find it plausible that individuals will many forms of autonomic dysfunction would improve with suppressive therapy for herpes simplex as well as these other conditions.

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