Respiration (or breathing) is the process of moving air in and out of the lungs to enable gas exchange.  We use the oxygen in the air to produce energy in our cells whilst carbon dioxide is produced as a waste product by the cells and we breathe it out.

Whilst we all know that it is important to breathe, we do not often consider THE WAY we breathe.

Breathing is an autonomic function, that is we do not have to consciously think about how we breathe.  However, it is one of the few autonomic functions we can consciously control and breathing practices can influence our individual autonomic pattern.

Our breathing is influenced by a multitude of factors, some creating short term changes, others longer term changes to breathing patterns.

Exercise, getting a fright, being sick, depression and anxiety, pregnancy, smoking, lung disease, age, asthma, obesity among other factors can all influence our breathing.

As well, posture, injuries and tension in the body can all influence how well the joints and muscles can move influencing how we breathe.

The way we breathe can influence our emotional state, tensions in the body and even contribute to pelvic floor issues.  So how we breathe, affects our body and our body affects how well we can breathe.

Let’s take a look at what a healthy breathing pattern is :-

1).        what are some of the common incorrect patterns of breathing

2).        how they might present

3)         and what are some exercises to help address these patterns

A healthy breathing pattern

At rest an average adult respiration rate is 15-18 breaths per minute, whilst a baby’s respiration rate is 30-40 breathes per minute.  The rate gradually decreases through childhood as lung size increases allowing for more efficient exchange of gases.

Our lungs do not actively draw in air, instead it is the change in pressure created by altering the thoracic cage that draws air into the lungs.  Muscles around the thoracic cage contract to create the change in shape of the thoracic cage, increasing the space (volume) inside.  This reduces the relative pressure in the lungs.  To balance the pressure, air is drawn in through the nose or mouth.

A passive exhale is where the muscles relax, reducing the volume of the lungs and air is expelled.

For normal respiration, the main muscle that contracts and relaxes should be the diaphragm.  The diaphragm is a large dome shaped muscle that attaches along our lower ribs at the front and sides and to the lumbar spine at the back.

When we inhale the diaphragm contracts and descends down towards the pelvis.  As the diaphragm descends it increases pressure into the abdominal cavity.  The increase in pressure in the abdomen can be accommodated by the body in different ways.  Ideally, as the diaphragm descends the pelvic diaphragm also has a passive descent.  However, depending on the health and tone of the pelvic floor and abdominal cavity this may or may not occur.  We will cover differences shortly.

On the exhale, the diaphragm returns to its domed position.  As the pressure decreases in the abdominal cavity the pelvic floor should passively recoil to its resting position.  This is important for a healthy functioning pelvic floor.

On a deeper inhale, the rib cage will be more involved.  In particular, the lower ribs expand out and up.  This movement is not just at the front of the body but should be felt all around the lower ribs and into the back of the body. Think of this as a 360 degree breath, with the diaphragm and surrounding structures expanding in all directions.

So where do we go wrong with breathing and what can we do to help?

Once we understand what a good breathing pattern is, we can assess how we breathe in different situations and how this may be contributing to Musculo-skeletal issues we may have.

Altered breathing patterns.

• Paradoxical breathing

In this instance when the person inhales, instead of the diaphragm moving down to create negative pressure in the thoracic cage, the upper ribs move up to assist the inhale.  In this instance the pressure does not increase into the abdomen and pelvic floor on the inhale, but instead increases on the exhale.  This leads to increased tension in the accessory muscles of respiration (mainly muscles of the neck and upper back) and can contribute to recurrent pain and tension in these areas.

As well, this can increase load forces on the pelvic floor and contribute to pelvic floor complaints.

• Breathing into the abdomen

Many times, people are told to breathe into their abdomen, particularly in yoga classes.  While in essence, the abdomen should expand a little with an inhale, it should not just be into the abdomen.

Allowing the abdomen to ‘pop’ up on an inhale can lead to weakening of the abdominal fascia and muscles.  The breath should create a small degree of expansion of the abdomen but also an expansion of the pelvic floor.  If you only feel the breath expanding into the abdomen and not into the pelvic floor, then this is likely to lead to weakness in the abdominal wall (fascia and muscles).  Balanced tone of the muscles and fascia of the abdomen (the core) help support the lumbar spine and trunk and are vital in protecting the back from strain and injury.

• Using paraspinal muscles to breathe

Another altered breathing pattern that is common is to see is when the back muscles are used to help breathing.  In this instance to help the chest volume expand, the back is extended and the lower ribs at the front open to aid inhalation.  This is a common adaptation in pregnancy but is also seen in non-pregnant individuals.  This pattern is often associate with increased tension around the thoraco-lumbar junction of the spine (this is the area a little below the bra line level) and generally tightness through the back.

• Exercises to aid breathing

The good news is that you can improve your breathing with awareness and breathing exercises and addressing restrictions and imbalances in your body.

The first exercise is to identify how you are breathing :-

You can do this in different positions, standing, sitting, lying down, to get a sense of how you breathe.

Take a breath in and feel how your body moves.

Do your shoulders and upper chest rise?

Does your tummy pop out? Do you feel the most movement through the tummy?

Do you extend through your back and your lower rib cage rise?

Do you feel your pelvic floor move ? (this can be tricky to be aware of, you can use your hand to feel the area, or try sitting astride a bolster or pillow to give you extra feedback)  If you can feel it move, does it move down and up? Or just in one direction? Does it feel even on both side?

What changes when you take a deeper breath in?

Do you feel the lower ribs in the back expand or move at all?  This is one of the areas that should move with the breath, but often doesn’t.

One of my favourite exercises for breath awareness and helping to bring  movement into the back body is child’s pose breathing.

You can take the position shown in the image above, or have hands flat on floor, palms facing down.  If you have issues with blood pressure  you can rest your head on a block or low stool to keep your head higher.

In this position the tummy is resting on the legs. ( If you have trouble getting the tummy lower, you can use a pillow between the legs and tummy to help.)

Our breath will follow the path of least resistance, therefore if we are compressing the abdomen it stops our tummy “popping” with the inhale.  This then encourages the back of the body to expand.  You should be able to feel the lower ribs and lower back expand as you breathe in. In this position the spine is more flexed (bent forward) and this helps to stop the paraspinal muscles assisting the breathing. In this position you may find it easier to feel the pelvic floor moving as well.

Taking 5-10 slow deep breaths in this position regularly can help build your awareness of breathing into the area.  Make sure you don’t hyperventilate.  If you feel lightheaded, stop and rest.

Whilst this article has focused on the breathing patterns in the thoracic cage, breathing starts in the head, with air entering through the nose or mouth.  These areas are just as important in influencing our breathing and tensions in our body.  This is accentuated by the recent rise in requirements to wear masks, that can alter our resting jaw and mouth positions contributing to issues.  But that’s a whole other article!

Need help with your breathing? Is it contributing to ongoing tensions in your body? Could your breathing be affecting your pelvic floor complaints?

Our practitioners can assess your breathing patterns and work with you to optimise your health.