Breathing
The nature of pain can make moving through life feel like you’re swimming in a raging river, sometimes you manage to catch a breath and move forward other times you get dragged right back to where you started. You’re tired and weary; you long to be free of this damn ache! You try to remember what it feels like when you WEREN’T in pain.
Seem familiar? Well thankfully, research over the years is beginning to show us the utter importance of breathing correctly.
You might be thinking, ‘Breathing?!? Really? Hell, my wife says I breathe too much, how hard can it be?’
Well, considering the multitude of effects breathing has on our bodies, I’d be remiss to say it wasn’t EXTREMELY important to be done correctly. Here are just a few things breathing has been linked.
Chronic Lower back Pain (1–3)
Headaches (4)
Reflux (4,5)
Posture (2,6,7)
Anxiety (8,9)
Stress and Pain Management (10–12)
I am going to explain to you not only HOW breathing affects a lot of things, but also WHY.
Easy Breasy Breathing Mechanics
The Process of Breathing · Anatomy and Physiology [Internet]. [cited 2017 Jan 26]. Available from: http://philschatz.com/anatomy-book/contents/m46549.html
As you can see from the above, this is what breathing SHOULD look like. Full use of your diaphragm and chest muscles in a 3 dimensional way. By using your diaphragm properly you should effectively be breathing into your abdomen and into your back.
In certain circumstances your body has emergency/accessory systems in place to help you breathe. In extreme circumstances you can see someone having an asthma attack using them in what is called Tripod Breathing. Now the problem arises, when these muscles become the main drivers of respiration, the chest and shoulders move Upwards towards the ears, the stomach draws inwards, the breathing becomes short, and shallow. The type of breathing you might see someone use in a horror film, whilst cowering in the corner.
Imagine doing mini shoulder shrugs 20,000 times a day; your neck and shoulders would be pretty sore wouldn’t they?
Unfortunately this type of breathing is the natural go to for a lot of people, especially once you take into account that the Diaphragm has more than one role in the body. In certain circumstances it becomes very difficult for your diaphragm to be efficient when challenged with multiple tasks. Although you will continue to use your diaphragm no matter what, that doesn’t mean it is being used to the best of its ability.
Poor breathing habits can be found in a multitude of problems, such as Lower back Pain(1–3), Headaches and Neck Pain (4), Anxiety, Stress and Chronic Pain(8,9,12). As a practitioner treating people everyday, let me tell you that more often than not, when people walk in with anything from shoulder problems to hip problems, there is always some aspect of breathing which can be improved.
That is because your Diaphragm and the other muscles, which help you breathe, are involved in a very complex process that allows us human beings to not fall apart as we exert effort to do something (thanks Diaphragm).
Breathing and Intra-abdominal Pressure (IAP)
Breathing is so damn important for pretty much most things in life minus saving money on your mortgage. One of those things is by its ability to create Intra-abdominal Pressure (IAP). IAP is the term for effectively creating an airbag in front of your spine (Body airbags, cool right?). This airbag if used correctly and efficiently provides added stability to the spine and protects it from the forces we apply to our spines during everyday activity, which can be a lot more than we realize (consider that sitting upright places 1.7 times your bodyweight of force through your spine). The diaphragm is essential for spinal stability and postural control(3,6,13).
In order to properly create adequate IAP to support the spine and to also breathe your diaphragm has to coordinate with a whole host of other muscles, which combine to form the Intrinsic Core. The Intrinsic Core are the muscles that work to give you ‘core stability’ and as Hans Lindgren a well-known Rehab Specialist says, core stability starts from the inside out. If you’re at all confused the basic answer is No IAP = poor core stability.
The diaphragm begins by pushing downwards into the abdomen and forcing air pressure in all directions. By doing so the diaphragm pushes against the muscles of the pelvic floor and Transverse Abdominis (One of your ab muscles, yes, YOU! You have abs). Along with the contraction of several other muscles the Intrinsic Core creates spinal stability, which stops us from falling apart as we move about. Albeit, during everyday activity, the actual activity of these muscles is very minimal, inefficient IAP can lead to an increased occurrence of back pain, as seen in several studies, which examined those with and without back pain. It has been shown that those withChronic Lower back Pain had inefficient activation of the diaphragm during even simple tasks such as lifting their legs or arms. (1,2).
A large proportion of people will hold their breath as they lift up the groceries or get in and out of their car, getting up and down from sitting most people will sigh as they sit down; sound familiar? That’s because you’re holding your breath as you move. My favorite would be looking around at the gym, watching people lift heavy weights and seeing their red faces, they do this either because the weight is extremely heavy or because they try to increased pressure in their faces due to inefficient IAP
Maybe your face isn’t as intense as this, but you get the idea.
Not having the ability to breathe and stabilize yourself will eventually lead something else to take over, some other area of the body will take charge, because our bodies are amazing machines of compensation. Most of the time people clench their jaw or they tense up in the shoulders, others may hold excess tension in their legs. This isn’t very efficient, and eventually this will lead to excess wear and tear and lead to a multitude of problems, as we’ve spoken about previously.
Breathing, Pain and the Mind.
Breathing has a profound link to your Mind and your Mind is what interprets Pain. Yoga and meditation are often seen as the spiritual arts of combining body and mind, and for the last 2000 years practitioners have been telling us about the link between breathing and the body and boy were they right.
If you have ever suffered from a panic attack, you would have probably learnt that other than medication one of the only ways to stop it is to slow your breathing. This is because controlled and efficient breathing can aid in reducing experiences of anxiety, pain and even depression, as well as aid in controlling your heart rate (8). In seasoned meditation practitioners, where there is often a focus on breathing, studies show that they experience less brain activity when they are exposed to painful stimuli (10). Breathing techniques have also been shown to reduce pain levels during birth (11).
In practice I see patients with Chronic Pain, Fibromyalgia, difficultly sleeping, difficulty relaxing and those with highly stressful lives. Most of them have poor breathing habits and at times it is not their fault, because our brains are wired to go through the Fight or Flight system in response to stress. Pain and Stress can cause changes in our nervous system to speed up and shorten our breathing, this is when the accessory breathing muscles take over, and this leads to more and more tension and pain until it becomes a chronic cycle of pain and stress. This inevitably leads to neuroplastic changes in the brain, especially in the centres, which respond to pain, making them more sensitive over time to even small stimuli. So in effect the problem keeps repeating over and over and getting worse over time.
Now, breathing incorrectly is only a small part of the picture when it comes to pain, but with the ability to control your heart rate, Blood pH and also to influence your state of mind, the way in which you breathe has a profound effect on the mind and body. It is in my experience that addressing breathing mechanics and working to correct them can have a profound effect on how we feel, move and even think. Adopting a practice of not only breathing better, but also being more mindful in your breathing can change your life for the better. It is your first step to being pain free. It will be difficult and maybe even boring to some to mindfully address your breathing but I can guarantee that it will be worth it! Just 10 minutes of practice everyday, can turn into something special and lead you on the way to feeling and moving better.
I have had great success in practice by emphasising this with many of my patients, and I wanted to share this with all of you!
What to do about it all?
Well now that you are more informed, you are empowered to help take the first step to improving your body by addressing your breathing mechanics. This video below goes through the very beginner phase of addressing breathing mechanics, so have a look and have a go at being more mindful about your breathing with this simple exercise.
I shall be writing more articles in the future that cover further steps you can take towards making yourself more efficient and moving closer towards a pain free life. If you enjoyed this article, please share it with your friends and family, shout it from the rooftops, sing it from the trees and also subscribe for more awesome tips and information in the future!
Khalil Hussein is a chiropractor, pain specialist and movement optimist. If you love what you read, please let me know below and let all your friends know.
References
- Individuals with Low Back Pain Breathe Differently than Healthy Individuals During a Lifting Task. J Orthop Sports Phys Ther. 2011 Mar 1;41(3):141–8.
- Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352–62.
- Hemborg B, Moritz U. Intra-abdominal pressure and trunk muscle activity during lifting. II. Chronic low-back patients. Scand J Rehabil Med. 1985;17(1):5–13.
- Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc. 2013 Jul 25;6:281–91.
- Bitnar P, Stovicek J, Andel R, Arlt J, Arltova M, Smejkal M, et al. Leg raise increases pressure in lower and upper esophageal sphincter among patients with gastroesophageal reflux disease. J Bodyw Mov Ther. 2016 Jul 1;20(3):518–24.
- Saunders SW, Rath D, Hodges PW. Postural and respiratory activation of the trunk muscles changes with mode and speed of locomotion. Gait Posture. 2004 Dec;20(3):280–90.
- Hodges PW, Gurfinkel VS, Brumagne S, Smith TC, Cordo PC. Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration. Exp Brain Res. 2002 Jun 1;144(3):293–302.
- Valenza MC, Valenza-Peña G, Torres-Sánchez I, González-Jiménez E, Conde-Valero A, Valenza-Demet G. Effectiveness of Controlled Breathing Techniques on Anxiety and Depression in Hospitalized Patients With COPD: A Randomized Clinical Trial. Respir Care. 2014 Feb 1;59(2):209–15.
- Cho H, Ryu S, Noh J, Lee J. The Effectiveness of Daily Mindful Breathing Practices on Test Anxiety of Students. PLOS ONE. 2016 Oct 20;11(10):e0164822.
- Salomons TV, Kucyi A. Does Meditation Reduce Pain through a Unique Neural Mechanism? J Neurosci. 2011 Sep 7;31(36):12705–7.
- Dengsangluri JAS. Effect of Breathing Exercise in Reduction of Pain during First Stage of Labour among Primigravidas. Int J Health Sci Res IJHSR. 2015;5(6):390–8.
- Surah A, Baranidharan G, Morley S. Chronic pain and depression. Contin Educ Anaesth Crit Care Pain. 2013 Oct 8;mkt046.
- Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol Bethesda Md 1985. 2010 Oct;109(4):1064–71.
- Frank C, Kobesova A, Kolar P. DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. Int J Sports Phys Ther. 2013 Feb;8(1):62–73.