The Mighty Power of Breath
Bill Gallagher PT, CMT, CYT
Cultivating equanimity, vitality, and spinal stability through breath.
During the last decade, interest in tai chi chuan, qigong, yoga, and other disciplines that address breathing-pattern disorders has grown among health professionals and consumers of rehabilitation therapy. Eastern practitioners have long used systemic physical activity and mental practices as preventive and restorative therapy. Compelling scientific evidence is mounting that these engaging traditions deserve the attention of rehabilitation professionals. Patients increasingly seek rehabilitation clinicians who are able to integrate breath work from the East with cutting-edge Western rehabilitation. If we are not paying attention to how our patient breathes, we may be missing the boat. No matter where in the rehab continuum we work in, many of our patients could benefit from breath work. If you or your patient are experiencing back, neck, or shoulder pain that has not responded to therapy, this may be the “missing link.” Respiration is a multifaceted process that can cultivate (or discourage) relaxation, myofascial function, and lumbopelvic stabilization.
The Autonomic Nervous System and Respiration
Breath control is shared between the autonomic and somatic divisions of the nervous system. As such, it provides a way to consciously manipulate the sympathetic and parasympathetic drives. To elicit parasympathetic activity and the relaxation response: prolong exhalation, use a diaphragmatic pattern, and slow down the breath. To stimulate the sympathetic nervous system, increase alertness (and move toward a fight-or-flight response): prolong inhalation, use a thoracic or clavicular pattern, and breathe rapidly. Every psychophysiological process on which successful rehabilitation depends is hampered by a chronic stress response, such as:
• Muscle hypertrophy: This is dependent on growth- hormone secretion, which is decreased by the stress response. • Motor control: Mind chatter hinders attendance to critical features of the environment. • Wound healing: Blood flow to the skin is reduced, and blood sugar is elevated. • Pain management: The stress response increases muscle tension, which usually leads to more pain. • Energy conservation: The excess muscle activity wastes energy. • Cardiac: Arrhythmia, coagulation, blood pressure, and heart rate are increased.
Breath and the Mind
Breath can also be used as a focal point to facilitate an expansive mode of thought. Eastern philosophies see the mind as a powerful tool that, too often, is misused. Rather than letting the mind drag patients to lots of scary places, mostly imaginary, we can help patients focus on the breath to anchor themselves in the present moment. Most of our anxiety has to do with thoughts about the past or the future. By using the sensation of breath as a focal point and letting go of thoughts as they arise, the fact that, “my thoughts are not reality,” becomes clear.
Breath also has a strong effect on body mechanics and myofascial function. A key component of many head, neck, and shoulder pain syndromes is secondary inspiratory muscle overuse. These muscles, including the sternocleidomastoideus, scalenes, pectoralis major, pectoralis minor, serratus anterior, serratus posterior superior, and upper iliocostalis, are often used inappropriately for “relaxed” breathing. When these muscles are involved in every breath, breathing is far from relaxed. In a similar way, since the diaphragm does not move much in this respiratory pattern, the quadratus lumborum and the psoas will have a tendency to develop myofascial dysfunction. Since this mode of breathing spawns numerous trigger points throughout the body, it makes sense to directly address the myofascial dysfunction via manual therapy. It also makes sense to address the root cause of the disorder by teaching correct breathing mechanics.
Lumbar and pelvic stability appears to depend on optimal coordination between the diaphragm, the pelvic floor, and the transversus abdominus. If the diaphragm does not push down on the viscera on inhalation, then the transversus abdominus and the pelvic floor muscles are continuously in a position of active insufficiency. In other words, these key abdominal and pelvic muscles of stability are kept in too short a position to do their jobs efficiently. If you are teaching the transversus strengthening exercise without the foundation of a proper respiratory pattern, your outcomes are less likely to be positive. The diaphragm should not be thought of solely as a muscle of respiration. It is a muscle of stabilization as well. In the same way, don’t pigeonhole the pelvic floor muscles as simply muscles of continence. These muscles also play a key role in stabilizing the pelvis, which, after all, is the foundation of the spine. It is quite common for low back and sacroiliac pain to coexist with stress incontinence, and again, breathing patterns are the common thread running through these two disorders. Normally, the pelvic floor should move in coordination with the diaphragm. As the diaphragm pulls air into the lungs, it pushes down on the viscera, which, in turn, presses down on the pelvic floor to stretch it down. On exhalation, the diaphragm and pelvic floor both elevate. When thoracic respiration is the dominant pattern, the pelvic floor does not move. This lack of movement turns the pelvic floor into a “Johnny one note.” Rather than continuously moving through its range of motion, it stays in one position all day long. This tends to exacerbate myofascial dysfunction that drives trigger-point activation and lumbo-pelvic mechanical derangement. If we simply address the myofascial and joint dysfunction directly through manual therapy, we are really only doing half the job. To complete the job, we need to address root causes, which often include respiratory habits.
What causes non-diaphragmatic respiration?
• Surgery and Trauma When the diaphragm is pulled down to inhale, it presses down on the viscera, which, in turn, press down into the pelvis, back into the flanks and forward into the abdominal wall. Normally, this gentle pressure provides a mild massage that can improve digestion, elimination, and myofascial function. After surgery or trauma, the intra-abdominal pressure causes pain on a diaphragmatic inspiration. This noxious feedback encourages shallow breathing with minimal diaphragmatic excursion. Just as a limp can continue long after the foot has healed, this shallow pattern can become perpetual. • Sinus issues can also impact breathing patterns, since diaphragmatic respiration is facilitated by the resistance provided by the sinus passages. When mouth breathing is the only option, a thoracic pattern is likely to follow. • Vanity can also drive a pattern that avoids abdominal movement consciously. Tight clothing can prevent optimal breathing. • Poor abdominal tone can discourage diaphragmatic respiration by making it less efficient. • Chronic mental stress and anxiety, by increasing the sympathetic drive, can perpetuate a thoracic respiratory pattern.
Diaphragmatic respiration can improve outcomes by alleviating stress, improving myofascial function, and facilitating lumbopelvic stabilization. Chronic thoracic respiration with minimal diaphragmatic excursion slows or stops physiological processes that underlie progress in rehabilitation.
Bill Gallagher PT, CMT, CYT, is the director of the East West Rehabilitation Institute, Manhattan, NY where he sees patients at his office (88th & Broadway) and makes home visits. He is also a Master Clinician in integrative rehabilitation at the Mount Sinai Medical Center, New York, and instructor in clinical physical therapy at Columbia University, New York. He can be reached at (800) 297-3815 or Bill@EastWestRehab.com