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Every breath you take, every move you make...

This isn't just a great song but summarizes a relationship that I see every day in my practice. Almost each of my clients who comes to see me because of pain issues has an underlying breathing dysfunction that they are unaware of.

Most people today are shallow chest breathers who have never learned to use their primary muscle of inhalation - the diaphragm. Being in a constant state of stress is one reason for shallow breathing, but what makes matters worse is that many people (especially women) have actually been taught to suck their belly in at all times to look skinnier. This reinforces the compensatory use of the neck musculature (such as the Scalenes) and can lead to core instability, neck pain or headaches.

Getting the breathing right is my number one priority in rehab as it forms the base of EVERYTHING in the body. You need a stable platform to move from and if you don't have that you will develop problems and more often than not pain and weakness in other areas of the body.

The goal is to achieve full 360 degree breathing where you first fill the belly, then the lateral rib cage, and finally the posterior rib cage with your in-breath. This type of breathing creates the adequate intra-abdominal pressure needed for optimal movement and function.

Although it sounds basic, for someone who is a chest breather this isn't an easy thing to do and may require a bit of coaching. It also takes repetition to get it right and I recommend practicing deep belly breathing as often as possible (e.g. before going to sleep or after waking up in the morning).

Below is the step by step list that I send home with clients for them to work on their 360 degree breathing:

a) Lie on your back with your knees bent and your feet flat on the ground (or bed).

b) Take a couple of 3 normal breaths, like you always do. Don't pay attention to any details yet.

c) Then switch to taking your in-breath through your nose and breathing out through your mouth.

d) Place one hand on your chest and the other hand on your belly. Continue to breathe normally and pay attention to which hand moves. If it is your upper hand it means that you are using your neck muscles too much.

e) Try to make your upper hand NOT move first as you continue to breathe in through your nose and out through your mouth. Visualize sending your breath into your belly. Imagine a balloon inflating in your abdomen with every breath you take.

f) Let's add some counting to get into a good rhythm. Breathe in for a count of 3, hold your breath for a second, then breathe out for a count of 3. Do this for 10 breaths in and out.

g) Now, I'd like you to put your hands on the side of your rib cage. As you breathe in, picture yourself pushing out your ribs with your in-breath. You should feel this under your hands. Practice this for 10 more breath cycles.

(If you cannot feel any pressure on the side of the ribs yet, keep your focus on breathing into your belly. You will progress to side and back breathing later)

h) Finally, put your hands on the back of your rib cage. Breathe in and try to reach this area of your body within the final moments of your in-breath. As before, picture yourself pushing into your hands. Visualize to inflate the balloon even further. This is the most challenging part and may require quite a bit of mindful practice.

There will be progressions from here (like breathing in a sitting position instead of lying down, prolonging the out-breath, etc.), but this is a good way to get them started.

How is your own breathing? Test yourself as described above. Feel your breathing pattern, then improve it and move better from a more stable core.


As usual, for questions, call me at (425) 236-9900 or shoot me an email.

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