Cultivating Equanimity, Vitality & Spinal Stability Through Breath

Over the last decade, interest in Tai Chi Chuan, Qigong, Yoga and other disciplines that address breathing pattern disorders has grown among health professionals and consumers of rehab therapy. Eastern practitioners have long used systemic physical activity and mental practices as preventative and restorative therapy. Compelling scientific evidence is mounting that these engaging traditions deserve the attention of rehabilitation professionals. Consumers increasingly seek rehab clinicians who are able to integrate breathwork from the East with cutting edge Western rehabilitation.

If we are not paying attention to how our patient breathes, we may be missing the boat. No matter where in the rehab continuum we work in, many of our patients could benefit from breath work. If you or your patient are experiencing back, neck or shoulder pain that has not responded to therapy, this may be the “missing link”. Respiration is a multifaceted process that can cultivate (or discourage) relaxation, myofascial function, and lumbopelvic stabilization.

The Autonomic Nervous System & Respiration

Breath control is shared between the autonomic and somatic divisions of the nervous system. As such, it provides a way to manipulate the sympathetic and parasympathetic drive consciously. To elicit parasympathetic activity and the relaxation response:

1) Prolong exhalation.

2) Use a diaphragmatic pattern.

3) Slow down the breath.

To stimulate the sympathetic nervous system, increase alertness (and move toward a fight or flight response):

1) Prolong inhalation

2) Use a Thoracic or Clavicular pattern

3) Breathe rapidly

Every psychophysiological process that successful rehabilitation depends on is hampered by a chronic stress response:

1) Muscle hypertrophy: dependent on growth hormone secretion which is turned down by the stress response.
2) Motor control: mind chatter hinders attendance to critical features of the environment.
3) Wound healing: blood flow to the skin is reduced, blood sugar is elevated.
4) Pain management: the stress response increases muscle tension which usually leads to more pain.
5) Energy conservation: the excess muscle activity wastes energy.
6) Cardiac: increased arrhythmia, coagulation, blood pressure and heart rate.

Breath and the Mind

Breath can also be used as a focal point to facilitate an expansive mode of thought. Eastern philosophies see the mind as a powerful tool that, too often, is misused. Rather than letting the mind drag us (or our patient) to lots of scary places, mostly imaginary, we can focus on the breath to anchor ourselves in the present moment. Most of our anxiety has to do with thoughts about the past or the future. By using the sensation of breath as a focal point and letting go of thoughts as they arise, the fact that, my thoughts are not reality becomes clear.

Myofascial Function

Breath also has a strong effect on body mechanics and myofascial function. A key component of many head, neck and shoulder pain syndromes is secondary inspiratory muscle overuse. These muscles, including sternocleidomastoideus, scalenes, pectoralis major, pectoralis minor, serratus anterior, serratus posterior superior and upper iliocostalis, are often used inappropriately for “relaxed” breathing. When these muscles are involved in every breath, breathing is far from relaxed. In a similar way, since the diaphragm does not move much in this respiratory pattern, Quadratus Lumborum and Psoas will have a tendency to develop myofacial dysfunction. Since this mode of breathing spawns numerous trigger points throughout the body it makes sense to directly address the myofacscial dysfunction via manual therapy. It also makes sense to address the root cause of the disorder by teaching correct breathing mechanics.

Mechanical Function

Lumbar & pelvic stability appears to depend on optimal coordination between diaphragm, the pelvic floor and transversus abdominus. If the diaphragm does not push down on the viscera on inhalation, then transversus abdominus and the pelvic floor muscles are continually in a position of active insufficiency. In other words, these key abdominal and pelvic muscles of stability are kept in too short a position to do their jobs efficiently. If you are teaching transversus strengthening exercise without the foundation of a proper respiratory pattern, your outcomes are less likely to be positive. The diaphragm should not be thought of as solely a muscle of respiration. It is a muscle of stabilization as well. In the same way, don’t pigeon hole the pelvic floor muscles as simply muscles of continence. These muscles also play a key role in stabilizing the pelvis which, after all, is the foundation of the spine.

It is quite common for low back and sacroiliac pain to coexist with stress incontinence and again, breathing patterns are the common thread running through these two disorders. Normally, the pelvic floor should move in coordination with the diaphragm. As the diaphragm pulls air into the lungs, it pushes down on the viscera, which in turn, press down on the pelvic floor to stretch it down. On exhalation, the diaphragm and pelvic floor both elevate. When thoracic respiration is the dominant pattern, the pelvic floor does not move. This lack of movement turns the pelvic floor into a “Johnny one note”. Rather than continually moving through its range of motion it stays in one position all day long. This tends to exacerbate myofascial dysfunction that drives trigger point activation and lumbopelvic mechanical derangement. If we simply address the myofascial and joint dysfunction directly through manual therapy, we are really only doing half the job. To complete the job we need to address root causes, which often include respiratory habits.

What causes non-diaphragmatic respiration?

1) Surgery & Trauma When the diaphragm is pulled down to inhale, it presses down on the viscera which, in turn, press down into the pelvis, back into the flanks and forward into the abdominal wall. Normally, this gentle pressure provides a mild massage that can improve digestion, elimination and myofascial function. After surgery or trauma, the intra-abdominal pressure causes pain on a diaphragmatic inspiration. This noxious feedback encourages shallow breathing with minimal diaphragmatic excursion. Just as a limp can continue long after the foot has healed, this shallow pattern can become perpetual.

2) Sinus Issues can also impact breathing patterns since diaphragmatic respiration is facilitated by the resistance provided by the sinus passages. When mouth breathing is the only option, a thoracic pattern is likely to follow.

3) Vanity can also drive a pattern that avoids abdominal movement consciously. Tight clothing can prevent optimal breathing.

4) Poor Abdominal Tone can discourage diaphragmatic respiration by making it less efficient.

4) Chronic mental stress and anxiety, by increasing sympathetic drive, can perpetuate a thoracic respiratory pattern.

Conclusion

Diaphragmatic respiration can improve outcomes by alleviating stress, improving myofascial function and facilitating lumbopelvic stabilization. Chronic thoracic respiration with minimal diaphragmatic excursion slows or stops physiological processes that underlie progress in rehabilitation. Consumers who have been exposed to Yoga, Tai Chi and other disciplines that address respiratory patterns tend to seek out clinicians who can “speak their language”, so in addition to improving outcomes, breathwork can improve your bottom line.

Bill Gallagher PT, CMT, CYT

-Director, East West Rehabilitation Institute

-Advanced Clinician in Integrative Rehabilitation, Mount Sinai Medical Center

-Instructor in Clinical Physical Therapy, Columbia University

Bill Gallagher has developed a uniquely integrative approach to help people suffering from pain and disability. By integrating the rehabilitation traditions of the East with cutting edge therapies, biomechanics and motor learning theory of the West, Bill helps his clients maximize function and minimize pain. Through meditation instruction, guided imagery, biofeedback and other disciplines that work with the Mind-Body-Spirit, clients are further empowered to optimize function and comfort. Bill is recognized as an authority on Integrative rehabilitation and teaches his visionary synthesis to practicing PT’s and OT’s as well as to students at several professional degree programs.

Bill Gallagher can be reached at (212) 781-2626 or Bill@EastWestRehab.com