Breathing & Why You Should Care
If you have ever worked with me or know someone who has, they will tell you I love talking about BREATHING! I find it one of the most interesting topics I did not learn about in physical therapy school. About two years ago I took an online continuing education course from HomeCEU called, Altered Breathing Patterns and Disorders: Their Impact on Health, Posture, Pain and Stress, by Debra Dent BPT Dip Manip PT OCS FCAMPT. This course started to change my entire mindset about breathing and how I evaluate and treat patients. Hopefully, reading this blog post will take your breath away and inspire you to think about how your breathing may be impacting your life.
According to the Lung Association, when resting, the average adult breathes around 12 to 20 times a minute. This means we breathe in and out about 22,000 times a day! Now imagine if you have even a small amount of breathing dysfunction and how that might impact many areas of your body.
But how does breathing work? Breathing is the process of moving air into and out of the lungs to facilitate gas exchange with the internal environment, mostly to bring in oxygen and flush out carbon dioxide. This series will focus on breathing patterns and disorders so if you are interested in learning more about breathing physiology head over to Khan Academy.
Function and dysfunction of the diaphragm, the principal muscle of respiration!
The diaphragm is a dome-shaped, muscular and membranous structure that separates the thoracic (chest) and abdominal cavities in mammals (Britannica 2019). During inhalation (lung expansion, air coming into the body), the diaphragm contracts and moves inferiorly creating something called intra-abdominal pressure. During exhalation (lung elastic recoil, air moving out of the body), the diaphragm relaxes and moves superiorly back to its resting position. With inhalation and exhalation, we should also see equal rib movement in the chest, lower lateral ribs and belly.
Unfortunately, many of us are “chest breathers,” “breath holders,” “shallow breathers” which can cause breathing dysfunction contributing to:
Pain
Poor postural and movement patterns
Balance and walking impairments
Anxiety and depression
Pelvic floor pain (i.e. pain with sexual activity) and dysfunction (i.e. bladder and bowel impairments)
Gastrointestinal motility: Pressure changes in the diaphragm improves function of the esophagus which improves motility and prevents gastro-esophageal reflux (B. Bordoni 2013)
Venous return and lymphatics: The cardiovascular system uses the pressure changes between the thorax and abdomen to improve venous return and optimize blood pressure and circulation
Inspiration
According to MRI Studies, the diaphragm precedes any movement by lowering and establishing increased abdominal pressure. For proper activation of trunk stability through increased abdominal pressure the lower ribs must be in an expired position and breathing must be lateral costal and diaphragm will contract both anteriorly and posteriorly, only then will the diaphragmatic function be smooth and effective.
A study performed by Kolar in 2010 found that healthy research subjects have increased diaphragm excursion versus pathological subjects. Decreased diaphragm excursion causes other respiratory muscles to be recruited to compensate for limited diaphragm movement in the pathological group (Volstatek) as well as increased respiratory rate in the pathological group (Kolar 2012).
Postural Control
Have you ever been told to, “stand up straight!” Well what if instead of quickly moving into a military like posture when you hear this, instead consider “how am I breathing right now?”
In 2012, Kolar found that the diaphragm was 30% for posture and 70% for respiration, with the ratio changing as postural demands increase for the body. So as abdominal pressure increases via diaphragm contraction (remember this is also known as inhalation!) this contributes not only to moving oxygen into your body but to creating stiffness and stability of the lumbar spine and activation of the abdominal muscles (Kolar 2012). So by starting with a good inhale we can already start to improve our posture in a little as one breath!
Kolar’s research shows that altered breathing patterns exist with postural tasks in individuals with low back pain (Kolar 2012). This is important as low back pain and poor postural control can cause changes in rib cage movement and thus increasing the sway of the trunk and contributing to balance impairments (Grimstone and Hodges 2003).
It is normal to experience some natural joint deterioration throughout our lifetimes, it is possible for our body tissues and structures to adapt. However when too much adaptation potential is exhausted, dysfunction occurs. “Dysfunction of the co-operation among diaphragm, abdominal muscles, pelvic floor muscles and the deep back muscles is the main cause of vertebrogenic disease and structural spine findings such as hernia, spondylosis and spondyloarthritis” (Vostatek 2013).
So let's do a self assessment!
What is the position of your head right now? What about your shoulders? Back?
Are you breathing or holding your breath?
Are your shoulders elevated by your ears?
Do you notice tightness in the muscles of your neck, shoulders or back?
Place your hands on your chest, ribs, belly. What area moves the most when you inhale?
Make sure to check out my post on how to diaphragmatically breath to practice improving!
References:
Britannica, The Editors of Encyclopaedia. "Diaphragm". Encyclopedia Britannica, 26 Nov. 2019, https://www.britannica.com/science/diaphragm-anatomy. Accessed 24 January 2021.
“Breathing.” The Lung Association, 12 Oct. 2016, www.lung.ca/lung-health/lung-info/breathing#:~:text=We%20breathe%20in%20and%20out,our%20body's%20life%2Dsustaining%20gas.
Kolar, P., Sulc, J., Kyncl, M., Sanda,J., Cakrt, O.,Andel, R., Kumagal,K., Kobesova, A (2012) Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. Journal of Orthopaedic and Sports Physical
Lee LJ., MPA .(2013) Thoracic Ring Control: A Missing Link? In Touch magazine, an official publication of Musculoskeletal Physiotherapy Australia, a national group of the Australian Physiotherapy Association. Issue 4;13
Vostatek P, Nova ́k D, Rychnovsky ́ T, Rychnovska ́ Sˇ (2013) Diaphragm Postural Function Analysis Using Magnetic Resonance Imaging. PLoS ONE 8(3):e56724. doi:10.1371/journal.pone.0056724
Dimitriadis, Z., Kapreli, E., Strimpakos, N., & Oldham, J. (2016). Respiratory dysfunction in patients with chronic neck pain: What is the current evidence? Journal of Bodywork and Movement Therapies, 20(4). https://doi.org/10.1016/j.jbmt.2016.02.001
Chaitow L. (2014) Recognizing and Treating Breathing Pattern Disorders. A Multidisciplinary approach. Churchill Livingstone.
Chang-Beom Kim, PT, MS,1 Jin-Mo Yang, PT, MS,1 and Jong-Duk Choi, PT, PhD2,*. The effects of chest expansion resistance exercise on chest expansion and maximal respiratory pressure in elderly with inspiratory musc
Donrawee Leelarungrayub (2012). Chest Mobilization Techniques for Improving Ventilation and Gas Exchange in Chronic Lung Disease, Chronic Obstructive Pulmonary Disease - Current Concepts and Practice, Dr. Kian-Chung
Jackson, M. L., & Bruck, D. (2012). Sleep abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a review. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 8(6), 719–28. https://doi.org/10.5664/jcsm.2276
Bordoni, B., & Zanier, E. (2013). Anatomic connections of the diaphragm: Influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, 281–291. https://doi.org/10.2147/JMDH.S45443
