As many of you know, at Inspire Chiropractic we spend a lot of time talking about the importance of re-establishing appropriate breathing patterns. It’s an idea that was important enough to me that I based the name of our clinic in part on that – Inspire, Inspiration. Generally we focus on this concept as a means of stress management and functional core conditioning. But of course the effects of improper breathing go much deeper, down to the cellular physiologic level, and that effect is very profound.
The diaphragm is a large thin dome-shaped muscle muscle that basically divides your trunk into an upper portion and a lower portion, separating the chest cavity from the abdominal area. It has muscular and connective tissue attachments to the sternum,lower ribs, thoracic and lumbar spine,abdominal muscles, psoas (hip flexor) muscle,and the quadratus lumborum muscles (a very important multi-function muscle that is attached to your spine, ribs and hip bone). It’s meant to be used as the main muscle for breathing. When you take a deep breath in, allowing your belly, sides and back to expand, the diaphragm contracts, flattening out from its normal upside down bowl shape, creating negative pressure inside the chest cavity which draws air into your lungs and allows them to maximally fill. As you breathe out it regains its dome shape and the air is pushed from the lungs. Here’s a quick clip of the diaphragm at work:
Many of us while at rest dysfunctionally utilize muscles in the chest and neck that are not designed to be the primary muscles of respiration,but rather accessory muscles. These muscles are mainly meant to be engaged for breathing purposes when we are strongly exerting ourselves such as in intense exercise or, god forbid, if we are physically trying to avoid a serious threat to our health and well-being. During these periods of time the upper chest and neck muscles kick in more strongly than at rest, elevating and expanding the ribcage to allow for maximal chest-cavity volume. An adult typically takes about 12-15 thousand breaths a day. If you are using your accessory breath muscles as your main muscles of respiration, think about how much these accessory muscles in the neck and chest are getting over-used day after day after day. These muscles will develop increased tone which can cause dysfunction and pain in your head, neck, chest, and shoulders, even causing symptoms into the arms and hands. As we forget how to use the diaphragm appropriately we also lose the ability to engage the diaphragm as part of our core stability. The diaphragm is an important component of the “inner core”. Dr Perry Nickleston DC fromStopChasingPain.com wrote a great description of the inner core:
“The inner core is like a cylinder made up of the pelvic floor as the base, the diaphragm as the top, the transverse abdominis muscle as the anterior border and the lumbar multifidus muscles as the posterior border. The function of the inner core is both physiological and mechanical as its main role is to provide the muscle activation required to sustain respiration, continence, and segmental spinal stabilization. Think of the inner core as your ‘reactive core’, meaning it should engage without thought in order to support outer core function. It acts as a stabilizer. Very critical point here, the inner core must engage, activate, or ‘fire’ prior to outer core or else abnormal compensation patterns develop in movement resulting in possible injury.”
So you can see from a movement/strength perspective just how important having good control of the diaphragm is. But as I mentioned the consequences of using your upper chest instead of your diaphragm to breathe goes much deeper than that. As we increase our respiration rate we tend to blow off too much carbon dioxide (CO2). Dr Leon Chaitow ND, DO recently wrote about this issue.
“Did you know that the physiological consequences of hypocapnia (low CO2 due to shallow/upper-chest breathing) include: Reduced cerebral blood flow (See brain scan image with thanks to Peter Litchfield) constriction of the blood vessels in the brain and heart, decreased gut motility, reduced placental perfusion, airway constriction, diminished oxygen to the brain and heart; low sugar to the brain (which it needs to function), magnesium-calcium imbalance in muscles (cramping), over-activity in your sympathetic nervous system (fight or flight), reduced ability to maintain acid/base balance in the body and more. In this image, oxygen availability in the brain is reduced by 40% as a result of about one minute of over-breathing. In addition, glucose critical to brain functioning is markedly reduced as a result of constriction of the blood vessels in the brain.”
That’s a pretty impressive visual. Just one minute of rapid shallow breathing can significantly alter the blood flow to the brain and if allowed to continue, cause this cascade of events in the body. Contemplate what an hour, a day, a month, a year, and for some, a lifetime of dysfunctional breathing could do.
Here’s another interesting point brought up by Dr. Chaitow – symptoms typically related to premenstrual syndrome are very similar to symptoms experienced by someone with a hyperventilation syndrome such as is found with a breathing pattern disorder. “A 2006 study suggested that most PMS symptoms may be caused directly by over-breathing.They note: “It has been known for more than 100 years that women hyperventilate during the second half of the menstrual cycle [and] symptoms of the chronic hyperventilation syndrome are remarkably similar to the symptoms observed in some women with PMS.” “In women with PMS the sensitivity of the respiratory center (in the brain which regulates breathing) to CO2 is increased more than normal by progesterone, or some other secretory product of the corpus luteum, resulting in pronounced hyperventilation with the associated clinical signs and symptoms.”” The graphs here show that as estrogen and progesterone levels increase, carbon dioxide levels fall off likely as a result of an increased respiratory rate which causes one to blow off more carbon dioxide than they should, the resultant alkaline state in the body producing a tendency to cramp, diminished tolerance to pain, and an increased sympathetic nervous system arousal (fight or flight, “stressed out”).<photo id=”4″ /> So with the estrogen spike just prior to ovulation followed by the resultant surge of progesterone leading up to menses, the respiratory control center in the brain becomes hypersensitive to carbon dioxide. This causes an increased respiratory rate which produces the effects we have described already, including what many would describe as PMS.
So what do you do now? If you watch little kids breathing you can see their little Buddha belly pushing in and out as they breathe – this is our objective. Just like any other dysfunctional movement pattern, you can train the brain to repattern the mechanics of breathing. There are a number of breathing exercise that can be performed to slow the breathing rate and increase activity of the diaphragm. One point that should be made is that often it is more productive to focus on the exhalation phase of the breath rather than the inhalation.
Dr Chaitow explains, “In my experience the focus of breath-work should be on exhalation, with no attention drawn to the inhalation phase. If you breathe out adequately, and slowly, your subsequent inhalation will automatically be diaphragmatic. But if you ask a person with a breathing pattern problem to ‘breathe deeply, down to the abdomen’ you are likely to provoke a sense of panic. So the golden rule is – learn how to breathe out and rest takes care of itself.”
I typically use 2 methods: the 4-7-8 breath to get my patients to slow their breathing rate down and crocodile breathing to help re-pattern their breathing mechanics. Dr Andrew Weil MD explains the 4-7-8:
“It is utterly simple, takes almost no time, requires no equipment and can be done anywhere. Although you can do the exercise in any position, sit with your back straight while learning the exercise. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.
- Exhale completely through your mouth, making a whoosh sound.
- Close your mouth and inhale quietly through your nose to a mental count of four.
- Hold your breath for a count of seven.
- Exhale completely through your mouth, making a whoosh sound to a count of eight.
This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.
Note that you always inhale quietly through your nose and exhale audibly through your mouth. The tip of your tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; but the ratio of 4:7:8 is. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply. Practice at least twice a day. You cannot do it too frequently. Do not do more than four breaths at one time for the first month of practice. Later, if you wish, you can extend it to eight breaths. If you feel a little light-headed when you first breathe this way, do not be concerned; it will pass.”
Crocodile breathing is so named because of the visual image one gets when they think about what a crocodile looks like when they breathe. You can see the back and sides of the crocodile moving in and out just as we should see and feel in our trunk when we breathe diaphragmatically. To crocodile breathe, lay on your stomach with your hands supporting your forehead. As you take a breath in feel your stomach pushing out into the floor.
As you can see in this video, with chest breathing there is a lot more movement up through the shoulders and upper back. Diaphragmatic breathing will minimize the upper back movement and you will see the lower back moving more with the breath. if we were to view this individual from above you would hopefully also see his sides just above his hips also moving in and out. The benefit of performing this breathing exercise on your belly is the brain gets a little more information on how to take the breath as it can feel the pressure from the floor on your belly as you breathe deeply. This feedback helps to pattern the movement a little more easily.
These are exercises that I would have a patient perform for a couple of minutes throughout the day, as often as they can remember or are able. Once there seems to be a consistent re-patterning of the movement, and one is able to breathe easily in this way at rest, the next step would be to take that into different situations: diaphragmatic breathing while in a trunk rotated position (as we often lose the ability to breathe well in this position), while walking or exercising, and whenever we feel stress.
Again as stated by Dr Weil,
“Most people do not know how to breathe so as to take full advantage of the nourishing, health-giving properties of the act of breathing. Knowing how to perform simple breathing techniques can help lower your blood pressure, calm a racing heart, or help your digestive system without taking drugs. Breathing has direct connections to emotional states and moods – observe someone who is angry, afraid or otherwise upset, and you will see a person breathing rapidly, shallowly, noisily and irregularly. You cannot be upset if your breathing is slow, deep, quiet and regular. You cannot always center yourself emotionally by an act of will, but you can use your voluntary nerves to make your breathing slow, deep, quiet and regular, and the rest will follow.”
Breathing exercises are a wonderful way to reduce anxiety, agitation and stress, while promoting relaxation, calm and inner peace. They will help to restore balance in the body as well as improve core stability and support functional movement. It may take some practice – and requires some commitment on your part to achieve results. However, the long-term benefits are well worth the effort – a calm and relaxed body and mind are less prone to health issues.