The Importance of Breathing in Rehabilitation

I often describe my approach to chiropractic medicine as “movement-based”. This means placing an emphasis on looking at individualized movement patterns to assess and diagnose how those patterns may be contributing to a patient’s pain experience. While patients will present with a wide variety of movement strategies, the path to providing alternatives to those strategies almost always starts at the same place: Breathing.

“If breathing is not normalized—no other movement pattern can be”—Dr. Karel Lewit

In order to begin to improve a painful movement, we first need to establish healthy, natural diaphragmatic respiration. Broadly speaking, humans have two different ways of breathing. The first is through utilization of the diaphragm. The diaphragm is a muscle located underneath our rib cage, spanning from the bottom of the sternum all the way to the spine. As we inhale, our diaphragm descends, decreasing pressure in our lungs and allowing air to come in, while simultaneously increasing pressure in the abdominal cavity. This increased pressure in the abdomen results in a uniform ballooning of the abdominal region as we inhale, resulting in the term belly breathing. Belly breathing has been shown to active our parasympathetic nervous system—the part of our nervous system associated with “rest and digest”. Breathing in this manner has been shown to have a wide variety of benefits, including decreased stress and anxiety, and down regulating pain receptors.

The second breathing strategy utilizes what has been termed our “accessory respiration muscles”—a series of muscles located over the base of the neck, shoulders, chest and ribs. In this second breathing pattern, we use these muscles to physically lift the ribcage up in order to create the needed pressure change in the lungs to bring in air. As our accessory respiration muscles contract, they lift our ribcage upward as we inhale, resulting in this respiration strategy being referred to as chest breathing. Unlike belly breathing, this form of respiration has been linked to our sympathetic nervous system—more commonly known as our “fight or flight” response. Activation of the sympathetic system is associated with increased stress, anxiety, and muscle tension, as well as decreased athletic performance and an increased pain response.

Ideally, we are performing diaphragmatic (belly) breathing a majority of the time and are only utilizing accessory (chest) breathing when we are exercising or are otherwise in need of additional oxygen. However, as our bodies are subjected to external stressors such as injury, movement repetition, mental stress, and fatigue, our nervous system will begin to adapt. These adaptations can often lead to the brain preferencing accessory breathing, resulting in overactivation of the sympathetic nervous system. Over time, we can lose our ability to properly utilize the diaphragm altogether.

So how does this relate to movement? The intra-abdominal pressure created as the diaphragm contracts acts as a keystone to provide activation, synergy, and control to our abdominal wall and pelvic floor, providng dynamic stability for all movements of the human body. From the head to the feet, every human movement is affected by this stabilizing function, and if diaphragmatic respiration is not functioning, all other functions of the diaphragm are affected, resulting in compensatory stabilizing strategies that often overload select segments of the body.

Here is a way to test your current breathing strategy: lay on your back with your knees bent. Place one had just below your belly button, and the other on your chest. Close your eyes. Take some slow, rhythmic breaths in and out through your nose. Try breathing in for four seconds, holding for one second, and breathing out for three seconds. Keep it comfortable. Allow your breathing to get into a rhythm and start to notice where your breath wants to go. Are you breathing more towards your belly or chest? Is one side easier to breath into than the other. Many of you will find it difficult to breath into your lower abdominal region, suggesting an inhibition of the diaphragm to properly decent. This can be corrected with practice, placing your hands on your belly and slowly breathing towards your hands while trying not to breath into your chest. It can take time and is often frustrating when starting out, so be patient with yourself. After some practice your nervous system will latch on to this preferred breathing pattern and over time it will become natural to breath into your belly.

Once diagrammatic respiration has been achieved to a satisfactory degree, the next step is to continue utilizing the diaphragm for respiration while simultaneously performing its stabilizing function. This is an important skill to master, as when forced to choose, the body will wisely sacrifice ideal stabilization to continue breathing.

Stay tuned for next week’s post for a more detailed look at this stabilizing function and how it works to support all our daily movements!