So, why is this an important topic?

You’re likely aware that breathing functions regulate the relationship between oxygen and carbon dioxide in an effort to maintain a balanced pH in our bodies. Did you know that normal breathing can positively impact your posture, stability, and motor control? Most of this is due to the all-important diaphragm muscle.

The diaphragm performs both postural and breathing functions, disruption in one function could negatively affect the other. The diaphragm is able to influence core stability because it regulates intra-abdominal pressure needed for the stability of the spine

For example, research shows that individuals that suffer from chronic low back pain have issues with dysfunctional breathing. So, dysfunctional breathing plays a role in the development and perpetuation of musculoskeletal pain. Last but not least, breathing regulates our mental and emotional states.

But what happens when your breathing becomes dysfunctional? And who is susceptible to becoming a dysfunctional breather?

First, Let’s define what is normal breathing. Normal breathing is diaphragmatic breathing that involves synchronized motion of the upper rib cage, lower rib cage, and abdomen. Nasal breathing is a preferred method of breathing in comparison to mouth breathing. Lastly, normal breathing involves a shorter inhalation followed by longer exhalation that is two to four times longer.

So, what is abnormal or dysfunctional breathing? Dysfunctional breathing is inappropriate breathing that is persistent enough to cause symptoms with no apparent organic cause. Those who suffer from dysfunctional breathing may have the following symptoms:

• Dyspnea (shortness of breath)

• Chest tightness

• Frequent sighing/yawning “air hunger”

• Persistent Musculoskeletal pain (like due to tissue hypoxia)

• Hyperarousal (constant sympathetic state)

• Depression/anxiety

• Sleep disturbance

How do we identify dysfunctional breathing? Unfortunately, there is no gold standard diagnostic test for dysfunctional breathing but there are several assessments that are effective at identifying those with dysfunctional breathing:

• First, you can perform an observational analysis to identify certain physical traits that are present in those with dysfunctional breathing. Simply look for a rib outflare. A rib outflare is can be found by placing your hands on either side of your lower ribs and you are attempting to observe whether one side is more prominent than the other. You may find that one side points up and out which is indicative of those with dysfunctional breathing. Also, you can palpate to see if the infrasternal angle is no greater than 90 degrees. To find the infrasternal angle simply find where the last two ribs (left and right) intersect and note this angle. This angle should be approximately 80-90 degrees.

• High-Low breathing test – This test should be done while lying on your back. One hand on the chest and the other on the abdomen. You are attempting to identify where the movement of your thorax is occurring. You should feel more movement in your abdomen rather than the rib cage. So, the test is positive for dysfunctional breathing if there is more movement in your chest.

• Breath hold test –you want to take a normal breath in and then out. Then hold your breath until you experience some sort of reaction (i.e. twitching, swallowing etc). Anything under 20 seconds would be positive for some component of dysfunction.

• Palpate for the presence of an elevated 1st rib. Place each hand slightly above the collar bones and try to determine if one side is more elevated. If you find one side that is elevated this is indicative of dysfunctional breathing.

Aside from a physical examination, you can complete a Self-Evaluation of Breathing Questionnaire (SEBQ). The SEBQ consists of 25 items. Each item is scored from 0-3. A score of 25 or higher is indicative of dysfunctional breathing.

So, how can one treat dysfunctional breathing?

Your first strategy should be to practice a nasal breathing pattern. To do this rest your tongue at the roof of your mouth which opens your airway and prevents clenching of the teeth. Next, an easy inhalation followed by an exhalation that is 2-4 x longer and a pause in between the inhalation and exaltation which allows the diaphragm to return to its normal resting position. During this breathing exercise try not to use your neck muscles and avoid extending your lower back.

The second treatment technique would be to bring your fingers up and under the rib cage. During the longer exhalation phase bring your fingers up and under the diaphragm to mobilize the soft tissue structures.

During the third and final treatment strategy, rest your fingers cross your collarbone and slightly bring your fingers down. As you inhale look up at the ceiling while drawing the skin down. You should experience a slight stretching or pulling sensation. This exercise can be progressed by adding rotation as you look upwards. This is a handy exercise to perform while sitting at your desk.

These exercises should be performed twice a day for 5-10 min in a relaxed environment.

In closing, effective breathing strategies can help reduce the risk of persistent musculoskeletal pain and improve our physical and mental states.

If you have any questions, please feel free to reach out to me at Kenneth@FitToMovePT.com.