How Do You Breathe and Are You Doing It Correctly?

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.

Standing Posture

Stand with your feet shoulder width apart as this gives you a larger base of support.

Allow the weight to be transmitted though your heels, then find a balance point in the centre of the foot.

Your bottom should be tucked under so that there is not a large curve in the back. There should still be a small curve in the back. The stomach muscles should be drawing in.

Your chin should be tucked in (not up in the air). This is a rotational movement, so as the chin goes in, the back of the head goes up. Think of a balloon attached to the back of the head lifting it up. If you pull the chin straight back, you will get the double chin look (not so good!).

Your shoulders should be relaxed and down, with the bottom of the shoulder blades drawing slightly together. You should feel a lengthening through the front of the body.

From side on, your ear, shoulder, hip and ankle should all be in alignment.

If you are standing in the one place for long periods, like when ironing, place one foot on a raised box or stool in front of you. Alternate the feet to help decrease the strain on the back.

When bending forward over an object (e.g. when bending over the sink to shave, or wash dishes) where possible try to stand with one foot in front of the other. This widens your base of support and helps reduce the strain on the back.

Sleeping Positions

  • It is generally best to sleep on your side. A pillow under your head should keep your neck and spine in line. If the pillow is too high or too low, you will be bending your neck to one side and straining it.
  • When sleeping on the side, bending the knees will help to stabilise the body. A pillow between the knees may be comfortable.
  • Alternatively, you may like to have the top knee bent with the bottom leg straight. A pillow under the top knee in this position can reduce twisting on the low back and may be more comfortable for you.
  • If you wish to sleep on your back, a pillow under the head will help stop you from extending your neck (bending it backwards). You should also have a pillow under your knees to help take the strain off your low back.
  • Sleeping on your stomach requires full rotation of your head and neck, and is thus very stressful on your neck. If you do lie on your stomach for any reason, NEVER have a pillow under your head. Extension and rotation is extremely bad for your neck if maintained for a period of time.
  • Remember that you should be comfortable. Your body will tell you what it likes. so listen to it.


  • Your bed should be firm enough to keep your spine straight and give even support.
  • It should have enough cushioning so that there is not excessive pressure on your shoulder and hips (if side sleeping).
  • Most of all it should be comfortable for you.


  • The aim of the pillow is to keep your head in line with the spine.
  • We recommend Dentons Pillows.
  • Contoured pillows are good, but there is not one perfect pillow for everyone.
  • Remember if you are changing your pillow, give yourself several days for your body to adjust before you decide if you like it or not.

Sitting Posture


  • Sit as far back in the chair as possible, do not sit on the edge.
  • Your feet should be flat on the floor. This can be done by either lowering your chair (if possible) or “raising the ground” by using a foot rest or even old telephone books. This helps you transfer the body weight to the ground.
  • Your knees should be at hip height or slightly lower. A small wedge cushion may be used, which helps tilt the pelvis forward maintaining the lumbar lordosis (the natural curve of the lower back).
  • Adjust the back of the chair to a 100°-110° reclined angle, if possible.
  • Adjust any back support in the chair to support your upper and lower back. If the chair does not have good back support, then a separate back support or small pillow can be used to help support the back.
  • Some chairs have an active back mechanism that allows you to change the angle of your back. If your chair has this, use it to make frequent position changes.
  • Your chin should be tucked in (not up in the air). This is a rotational movement, so as the chin goes in, the back of the head goes up. If you pull the chin straight back, you will get the double chin look.
  • Gently draw your shoulder blades together and down. Adjust the armrests (if fitted) so that your shoulders remain relaxed and down. If your armrests are in the way, remove them.
  • If writing or drawing at a desk, a slanted work surface prevents you slouching over the desk and helps maintain good posture.


  • If working on a computer, the keyboard height should be set so that the elbows are slightly open (100°-110°) and wrists relaxed and straight.
  • The keyboard and monitor should be situated directly in front of you, with items used frequently (e.g. the telephone) should be close at hand.
  • The monitor should be positioned so that your eyes are level with the top one third of the screen. The monitor should be at least an arms length away.
  • Position the monitor to reduce glare.


  • If you are sitting at your desk or computer for an extended period of time, it is important that you take regular breaks. Your body is not designed to sit still for long periods, no matter how good your workstation and posture are.
  • Every 20 to 30 minutes you should stop and rest for 1 to 2 minutes. Stretch your neck and shoulders and allow them to relax again. Cover your eyes for 15 seconds to avoid eye strain. Check your seated posture.
  • Every hour you should take a 5 to 10 minute break from your desk. Get up and move around, why not grab a glass of water?

Lifting Correctly

  • Before lifting an object, stand back and assess it.
  • Don’t be too proud to ask for help.
  • Then get close to the object, place your feet shoulder width apart.
  • Bend down using your knees, not your back. The back should remain straight.
  • Consciously pull the stomach muscles in.
  • Take a firm grasp of the object, holding it close to your body.
  • Lift by straightening the legs, allowing the big muscles in your legs to do the work.
  • DO NOT use your back. Your back should remain straight and your stomach muscles should still be working. When carrying the object, turn by moving your feet, not your waist.
  • Put the object down by bending the knees.


  • An alternative to bending both knees in a squat to lift is to bend down and have one knee on the ground with the other bent. The body is still directly facing the object.
  • As you lift using your leg muscles, one leg will be behind the other.
  • Remember to still use your abdominals to help support the back.
  • This is a good option for people with knee problems or other issues which limit their ability to lift from a squat.


When lifting out of a car or other difficult area where you have to reach forward to reach the object, it is important to hold the stomach in and bring the object as close to your body as possible. Try to keep your feet wide to give you a good base of support and thus help with balance.

If you have to bend or twist for unusual locations, you must be very careful. It is important to know that you should never twist and straighten your spine at the same time. Your spine has different mechanics for twisting when it is bent and when it is straight. If you twist your back, always untwist before bending or straightening your back.

Osteopathy Research

Listed below is a range of research relating to Osteopathy.  Studies vary in size and findings.  Ongoing larger scale research is required in many areas to support Osteopathic treatments.  Please use this information as a guide only and not as a guarantee to the benefits of Osteopathic treatment for your condition.  Please contact us should you have any questions regarding this.

Gert Bronfort, Mitch Haas, Roni Evans, Brent Leininger, Jay Triano

Published on PubMed

Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.

Following a review (by the UK government’s independent Advertising Standards Authority  of the Bronfort et al Review in 2010) they accept that Osteopaths may claim to help a variety of medical conditions, including:

  • generalised aches and pains
  • joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
  • arthritic pain
  • general, acute & chronic backache, back pain (not arising from injury or accident)
  • uncomplicated mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)
  • headache arising from the neck (cervicogenic) / migraine prevention
  • frozen shoulder/ shoulder and elbow pain/ tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
  • circulatory problems
  • cramp
  • digestion problems
  • joint pains, lumbago
  • sciatica
  • muscle spasms
  • neuralgia
  • fibromyalgia
  • inability to relax
  • rheumatic pain
  • minor sports injuries and tensions.

Below is a link to the Acupuncture Evidence Project: Plain English Summary