While I was working on a presentation about breathing last spring, my two year old son ran into the room, fell and started crying. My five year old daughter tried to console him, repeating over and over, “Just breathe, buddy.” It was fascinating to me that even at her young age my daughter could appreciate the power of breathing to change our physical and emotional state.
It is something that we do an average of 15 times a minute, 900 times in an hour, and 21,600 times a day. Breathing is essential to sustain life but happens subconsciously most of the time. It is one of the only body functions that can either be completely voluntary or completely involuntary. Because it happens in the background of our daily movement, it is natural that we tend to overlook the importance of breathing in the treatment of movement dysfunction.
Evaluation and Exercise Implications
Evaluation of breathing can be challenging, because the simple awareness that breathing is occurring can change the performance. Similar to posture, there is no one “correct” breathing pattern, but rather a most efficient breathing pattern for performing a specific task. A diaphragmatic breathing pattern might be appropriate for a patient at rest, but a breathing pattern using accessory musculature is required to maintain respiration during activities involving high levels of effort. The correct breathing pattern is a mixture of these methods, and efficient breathing most effectively matches our activity.
The diaphragm is an amazing muscle, and like many muscles in the body has many different roles in addition to breathing. It has strong fascial attachments to most of the abdominal and lumbar muscles and can act to stabilize the lumbar spinal segments. It is closely linked to the pelvic diaphragm and has attachments to organs superiorly and inferiorly. The diaphragm forms the ceiling of the abdominal inner core and provides a crucial link between our muscular, nervous, circulatory and respiratory systems.
Efficient breathing patterns are an important foundational exercise, with many techniques and options such as crocodile breathing (Functional Movement Systems) or 90/90 bridge while blowing up a balloon (Postural Restoration Institute). It can be done before and during cervical stabilization and rolling patterns, and can be incorporated into exercise progressions. Remember to address cervical, shoulder, lumbar and thoracic cage mobility issues before retraining movement patterns.
Breathing can also be a biomarker for assessing performance during exercise. If a patient is able to perform a movement or maintain a position but cannot continue a normal breathing pattern, then we have to question competency during that activity. Focusing on breathing while performing the activity can promote internalization and provide feedback regarding posture and position in a way that verbal cueing cannot.
Functional Dry Needling
Some of the most important physical structures associated with breathing can be effectively treated with manual techniques: the diaphragm, psoas, scalenes, ribs and thoracic spine. Many accessory breathing muscles and muscles with strong fascial attachments to the diaphragm can be safely addressed using Functional Dry Needling® Level 1 and Level 2 techniques. Level 1 muscles include: upper trapezius, pectoralis major, latissimus dorsi, lumbar and cervical paraspinals, and multifidus (paying specific attention to C3-C5 segments due to innervation of the diaphragm by the phrenic nerve). Level 2 muscles to assess and treat: serratus anterior, quadratus lumborum, iliopsoas (distal attachment), abdominals, thoracic paraspinals, SCM, and pectoralis minor.
Monitoring breathing patterns can also be a way to assess a person’s response to Functional Dry Needling techniques and to provide feedback for dosing. Shallow breathing, hyperventilation or breath holding can indicate distress or discomfort. Deep and controlled diaphragmatic breathing may be an indication that the patient is actively relaxing and can tolerate further treatment.
It is not a coincidence that many of our oldest movement systems such as yoga and martial arts incorporate breathing as a foundation of practice. It is central to many meditation and stress reduction techniques. Breathing is one of the only physical processes that can consciously influence our nervous system. So next time you are addressing someone with movement or pain issues, remember this advice: “Just breathe, buddy”.
Bordoni, B & Zanier, E. (2013) “Anatomic connections of the diaphragm: influence of respiration on the body system”. Journal of Multidisciplinary Healthcare. 2013:6 pg. 281-291.
Calais-Germain, B (2006). “Anatomy of Breathing”. Seattle, WA: Eastland Press, Inc.
Marcello, B. “Breathing: Is it that impactful to performance or just a bunch of hot air?” (PDF Document). Retrieved from http://www.functionalmovement.com