By Jennifer M. Nelson, PT, DPT, DScPT

Breathing is an automatic function that people often overlook and underestimate the influence it has on our lives. However, breathing plays a vital role in not only bringing oxygen to our bodies, but regulating our nervous system, general posture and mobility.

The diaphragm is a dome-shaped muscles that separates the chest and abdominal cavities. When we breath in, the diaphragm contracts, and the center of the dome is pulled down, making the chest cavity larger and pulling air into the lungs. When we take large breaths in our chest, shoulder and neck muscles will also contract to help increase space for our lungs and air. As we breath out, the diaphragm relaxes and recoils back into the dome, pushing out of the lungs. Breathing out is usually passive unless we need to force air out for activities such as exercises or speaking. When the air needs to be forced out with more pressure, we use our abdominal muscles to compress the abdominal cavity and pull the ribs inwards to help push the air outwards.

We are cued to breath by our bodies need for oxygen (O2) and the build up of carbon dioxide (CO2), which is one of the waste products our body produces. The oxygen is delivered to the body via red blood cells, but they will not release the oxygen if there is not enough CO2 in the blood. We take in O2 when we breath in and blow out CO2 when we breath out.

Breathing is the primary function of the diaphragm, as it is needed for survival, but the diaphragm is also a postural support muscles since it can help regulate interabdominal pressure. If you think of the abdomen as a soda can, the diaphragm is the top. Working together with the abdominal muscles and pelvic floor muscles, the sides and bottom of the can, the diaphragm can control how “stiff” the can is. Just as when you open a soda can, squeezing the can will push the contents of the can out the top and you no longer have a strong can.

There are a variety of reasons breathing can become less efficient and effective, including poor posture, stress, smoking, constricted airways such as asthma and breathing through your mouth, as well as many others. There is no single “right way” to breathe, and we need to be able to use the different breathing patterns depending on what we are doing, but we often get stuck utlizing just one of the breathing patterns, which becomes problematic. People who breath with their mouths open blow off more CO2, which will lower the CO2 levels in the blood and the red blood cells will not release the O2. The body will then tell the brain it needs O2, so you will start to breath in more air. This will lead to hyperinflated lungs and cause you to overuse the accessory breathing muscles in your neck, shoulder and chest. It also flattens your diaphragm, making it harder to push the air out, and you may start to overuse your abdominal muscles to push the air out.

Another common pattern is impaired diaphragm use caused by sitting in a hunched forward posture.  When you cannot use your diaphragm muscles to help you take a larger breath, you will start to use your neck muscles more. Stress breathing is another common pattern seen. When we are stressed, we take shallow breaths with our mouth open and use our accessory muscles to breath. When we breathe in short, shallow breaths, it also stimulates the sympathetic nervous system, the “fight/flight/freeze system” of our body, and increases our stress and promotes guarding patterns in our body and movements. Breathing out long and slow activates the parasympathetic system or the “rest and digest system”, which is why people are told to take a deep breaths when the are stressed or angry.

These are just a few of the ways that we can make breathing more difficult promote the development of inefficient and painful patterns.  Each change in breathing pattern can cause changes in our blood chemistry, making it more acidic, which promotes increasing the sensitivity of our bodies to changes and has been associated with persistent pain conditions, such as fibromyalgia and chronic fatigue. These breathing changes also promote stiffness in the ribcage, which alters how you activate your shoulder and core muscles.

A physical therapist can help with many of these conditions and patterns by evaluating your breathing patterns, helping you become more efficient at breathing, and encouraging your body to change to optimal patterns, improving your ability to function every day.  A commonly recommmended breathing exercise is abdominal breathing, which is best performed lying on your back with your knees bent, but can also be performed almost anywhere and in any position once it is eaiser.

Abdominal Breathing:

• Close your lips and keep them closed through the whole exercise
• Put 1 hand on your belly and the other on your chest
• Keep the belly relaxed as you breathe in, trying to fill your belly with air and keep your chest still
• Breathe out and gently pull your belly in towards your spine
• Try to breath in for 2 seconds and out for 4 seconds without pausing at any point
• Try this for 5-10 min a day and slowly increase the time as it gets easier

At PhysioPartners we take a comprehensive approach to your treatment and will screen your breathing pattern to see if it is a contributing factor or barrier to your function and limiting your ability to reaching your goals. Schedule a complimentary phone or telehalth consultation today to see if we can help you.