The leading specialists in the treatment of complex and persistent pain and spinal conditions

BREATHING

We need to start a breathing revolution. You are about to start something which could and most probably will, change your life.  Get your family and friends doing it too.

Apart from the beating of our hearts, breathing is the most fundamentally important function of the body and its mechanism is driven almost entirely by the brain and musculoskeletal system. 

The rate and depth of breathing (10 – 14 breaths per minute at rest) is governed by our central nervous system and is ‘hard wired’ from birth. This connects with the ‘dome’- like muscle inside our chests which is the diaphragm. On inspiration (breathing in) the diaphragm contracts and its dome shape flattens using very little energy. As it does it increases the volume of the chest  cage and by physics alone, air rushes into our lungs. Each breath should be slow and deep; following the cycle nose, belly rhythmical and flowing. This is the pattern we are designed to follow throughout life. For many however, this pattern of breathing has been lost for a variety of reasons both physical and emotional. 

Believe it or not, research has shown that in women, the hormone Progesterone which is part of the menstrual cycle, actually increases breathing rate. It peaks in its concentration around the 22^nd  day or a week after ovulation. Women are more prone to anxiety and it is thought that this hormonal effect makes matters worse.

Children are also very often affected by poor breathing so watch out for it, often in the form of sighing or breath holding. They can be just as anxious as adults with their busy and intense lives. As adults we fail to appreciate that children are very sensitive to stresses and strains in the household, like sponges, they absorb the family tension, even when we think we are protecting them from it. They are also no less susceptible to muscular aches and pains from poor breathing mechanics with headaches and tummy ache being a common complaint. The breathing sessions can be fun to do together as a family and can be a focus of quality time. A session together at bed time can often zonk them off to sleep in no time. As a parent, practice putting your hand over theirs on their tummies as they breathe and feel the connectedness as you do it together. The current coronavirus scare is terrifying children not only about their own health but also a fear that they will lose a parent or family member.

Our busy lifestyles induce a low constant level of stress on us. Add in higher levels of emotional trauma; including bereavement, relationship problems, moving house to name a few, and we begin to breath in a way consistent with when we were roaming the plains being chased by predators.  

There is a subtle balance in our Autonomic nervous system between the parasympathetic side which governs all of our ‘vegetative’ functions, such as digestion, heart rate and kidney function .i.e. when we are relaxed and at rest, and the sympathetic nervous network which mobilises all our fright/flight responses; the side we engaged when we were fleeing a predator.

The stress under which we find ourselves pushes us more onto the sympathetic side of the ‘see-saw’. Therefore, amongst other things we begin to breathe in a fright/flight manner i.e. fast and shallowly. The effect of this is to change the exchange of oxygen and carbon dioxide across our lungs, with numerous other physiological effects. Interestingly we actually take in enough oxygen, but ‘puff off’ too much carbon dioxide. 

Mechanically, we shut down the diaphragm and the larger, stronger lower ribs and begin to breathe by elevating the smaller upper ribs which should only be used in extreme circumstances such as extreme exertion/exercise or asthma attacks! This leads to significant changes in posture of the head and neck, tooth grinding/ clenching as well as changes in cognitive function (our ability to think!) 

 As an example: If you work in a corporate or stressful environment, how often have you noticed, that when you go into a pressured meeting / presentation you seem to lose your normal degree of articulation when speaking; you just can’t think of the words or your memory for facts disappears? That is because as you breathe faster and more shallowly, the ‘cognitive’ (thinking) forebrain switches off and your more primitive hindbrain kicks in. This is the area related to running and self-preservation, not talking and debating!  

The benefits of good breathing: 

• Circulation of immune and inflammatory cells both in and out of the deep parts of the lungs. If this becomes inefficient then microbes particularly viruses are free to infect the lung tissue. So you really can support your own immune system to be in the optimum condition to fight infection.
• Postural stability: Creating a mobile, supportive spine that leads to correct posture, fluid movement, agility and correct locomotion
• Health of the nervous system. The brain and nervous system is the biggest user of oxygen in the body and is extremely sensitive to changes in oxygen and carbon dioxide balance. It is also house in the spinal column which is pumped by breathing movements
• Removal of waste products: 70% of the body’s waste products of respiration and muscle function are eliminated through exhalation! When we lose weight the carbon from the fat we lose is actually excreted as carbon dioxide through our breath
• Lymphatic pump: Essential for maintaining the health of our immune system  
• The ‘Relaxationresponse’: this is the conscious use of breathing to induce relaxation and to dispel feelings of anxiety and panic
• Breathing removes and maintains Carbon dioxide (CO2) levels, which is just as important as oxygen levels, and regulates the Autonomic nervous system
• Breathing regulates the body’s pH i.e. the acid-alkaline balance. Many of our organs can only function optimally under the right pH environment.

So you can see, breathing is the ‘governor’ function of the body and most of us are doing it wrong!

Schematic shows how ‘bad’ breathing turns into musculo-skeletal and myriad other symptoms 

Chronic (long term) hyperventilation (CH) also known as Hyperventilation Syndrome (or over-breathing)

Disrupted breathing patterns mean that not only the breathing muscles are working at a terrible disadvantage but also the neck and shoulder muscles pull on the spine, collarbones and base of the skull. Upper chest tension leads to aches and pains. CH involves running more air through the chest than the body can deal with at rest, as well as puffing off too much CO2. At its worst it can initiate episodes of feeling panicky, rapid pounding pulse rate and cold sweat, tingling and light headedness as well as disequilibrium ( not feeling quite at one with the world). This often occurs at night or in tense environments (presentations, tense meetings or confrontation) . At night, we use sleep to rationalise and work through our worries and concerns, dreaming is vital to that process. Sometimes we wake up with panic attacks ( just a hyperventilation episode) because a dream has reminded us of or placed us in a threatening situation. Sufferers of PTSD (post-traumatic stress disorder), hypermobility, ADD/ADHD to name a few, commonly and particularly suffer with hyperventilation. During the day, common markers of hyperventilation are breath holding, yawning and sighing regularly.

Common symptoms of Hyperventilation

Pins and needles or tingling (in the face or hands)

Frequent deep sighs or yawning

Neck pain and chest wall pains

Palpitations

Light headedness and feeling spaced out

Tiredness, weakness, broken sleep, nightmares

Sexual problems

Irritable bowel syndrome or bloating

Achy muscles or joints

Tremors

Clammy hands, flushing, anxiety and phobias

TEST YOURSELF 

An easy test is to place your right hand on your tummy at any time, without thinking about it, quickly and simply close your mouth and ‘sniff’!

 If you are breathing correctly, as you sniff, your abdomen should come out and expand momentarily. Most likely you are not, and it will go inwards:- an inverted breathing pattern- not good!

How to breathe properly 

 Lying on your bed or the floor, place one hand Hi on your chest and one hand Lo on your tummy-

-the HiLo position.

Close your mouth completely and breath in AND out only through your nose!

It does not matter if you have a cold or sinusitis the airway will clear as you do it.

NB many people think that having a deviated septum (old broken nose) will make a difference to whether they can do the nose breathing. This is not true in the majority of cases- keep doing it.   

In the HiLo position,

Take one of your usual breaths and you will realise that the hand on your chest not only moves first but much more than the tummy hand. It should be the other way round!

On the next breath, imagine the air going in through your nose, down your windpipe and straight into an inflatable ‘bag’ in your stomach.

As you slowly inhale, try to prevent the Hi (‘chest hand’) from moving at all. Instead, feel the air inflate your abdomen, lifting the Lo hand until you achieve a ‘Buddha’ tummy. You should also be aware of a stretch sensation deep inside your chest, this is your diaphragm firing and stretching. It is a good thing!

So.. imagine that the Hi hand inhibits the chest upper chest and the Lo hand activates the tummy

For some it helps to imagine that you are filling a balloon and lifting the weight of a brick as it fills.

The ‘in’ breath should take 5 seconds and the ‘out’ breath 7 seconds

Carry out 10 of these breaths but no more, it will get easier each time. Then return to a more normal depth of breathing but make sure it is coming from the belly not the chest.

By the end of the 10, you may feel a little light-headed, like when you blow up a balloon. Again this is normal and is due to the change in gaseous exchange in your lungs. It shows how your body has got used to the dysfunctional ‘bad’ breathing. 

You will need to achieve 50 of these breaths a day! Do them in sets of 10. First set when you wake, last set when you lie in bed before sleep. That’s only 30 to find in the day!

 Don’t underestimate the improvements you will see.

You will sleep better and feel recovered and rested in the morning. Slowly you will reverse all of the symptoms we have already discussed.

Anxiety and Stress as a cause of bad breathing

Just some of the symptoms anxiety and stress can cause

The world is becoming an ever busier and connected place in which to live. Working environments are more and more demanding, deadlines shorter, bosses more aggressive and less understanding; and the cost of living rises but wages don't.

All of these things create stress in our lives.

We are designed as animals to be able to respond, adapt to, as well as cope with, quite high-level is of stress, so long as they are relatively short lived and sporadic. These days our lives often place us under lower but constant levels of stress, to which we have to adapt. We do this through real physiological, physical and chemical processes which affect our whole body. We produce various hormones in response to stress; the main ones are adrenaline and cortisol. These chemicals produce profound changes in our brains and bodies. These changes were designed to help us to prepare for flight from predators and then revert to our normal vegetative functions, such as feeding, digesting, growing etc. once out of danger.

Every day we absorb stress almost subconsciously. We also bury it, particularly in corporate environments where showing stress is seen as a weakness. Even the language which employees are required to use, suppresses any sign of emotional response. We don't say ‘problems’ we say ‘issues’. We haven't had a ‘bad’ day we have had a ‘challenging’ day.

These daily stresses force us to adapt to them using all of our primitive physiological responses as if we were about to be chased by a predator.

One of the major responses we make is to change our breathing patterns to become shorter, quicker and shallower. This we call hyperventilation.

This change in pattern causes us to use our upper chest muscles too much in a way they were not designed to be used at rest. Physiologically, this type of breathing forces extensive changes in our lungs, brain function as well as our kidneys and hearts.

We have discussed where most of our current anxieties originate from societally but there are also other sources.

One of the unique abilities of the human brain is to be capable of fear and anticipation; when we were roaming the plains they kept us alive. Both of these elements rely on memory of past events to determine how we see the future and to try and predict it. Furthermore, our childhood and past experiences both positive and negative set the filter through which we see the world. They literally create our reality. As a result, the degree to which someone will be stressed by a situation or their environment can differ enormously from another person.

For some, there is a mismatch between the potential probability of something happening and the chance of it actually doing so. For example, if someone has had a bad experience in their childhood their perception is that it is much more likely to occur again. This makes them much more hypervigilant to any potential situation where that bad experience could recur. They are literally anticipating the worst thing happening. Being in that hypervigilant state, can effectively become a habit, as does the physiological state in which they find themselves. It is almost easier to remain stressed than to come out of it. Being relaxed is not a place of safety for them.

The problem with this state, particularly psychologically, is that the individual loses the ability to think rationally out of any potentially risky situation.

Breathing is the only physiological parameter which we can monitor and measure and which will give us an indication as to the psychological state of the person. Therefore, teaching them to spot when their breathing is dysfunctional and more importantly how to change it, restores an element of control to them and also re-activates the frontal cortex where they should be doing their rational thinking. They should breathe their way out of panic rather than thinking their way out of it.

Research has shown that it is not the stressor itself which necessarily causes anxiety but the individual's perception of it. The first most stressful thing to people is their perceived inability to escape the situation i.e. their control over it. As humans, control is everything to us for it kept us alive. That is why uncertainty in the world makes people particularly anxious. That is why many people whilst waiting for a potentially life changing blood test result, often state that it is the waiting and not knowing that is most stressful. Even if the outcome of the test is bad, at least they know what they are dealing with and can do something.

This is very much the situation we all find ourselves in currently with the threat of the Coronavirus pandemic. It is also a particularly good example.

Most of us have never had to deal with a potentially life-threatening situation which is also seemingly inescapable. We are extra sensitive to it, as previously we have never had to deal with or come to terms with such a threat. There is a triple uncertainty- that of catching it, the outcome of being ill, all compounded by the uncertainty of a possible personal and global economic meltdown.

It is interesting to note here that the section of the population who are most threatened (the over 75’s) seem to be taking the most acceptant and fatalistic approach to the outbreak. It could be posited that many of them remember the war and post-war time periods when other global threats confronted them. Their fear and anxiety is couched by their previous experiences. “ We came through all that so the chances are we will probably come through this too”

This leads us to the second most researched and proven cause of stress and anxiety in humans- that of isolation. Here too, we find COVID19 excels in its threat. All of our existing uncertainty is further exacerbated by another definingly human trait, that of the need for socialisation. We are social animals and as Homo sapiens, collaboration gave us the planet. It is ironic and tragic that one of the only ways to fight this pandemic is to separate ourselves from each other and prevent the sharing of worries and concerns. Thank God for technology and social media we cry. Here we must be cautious too, as the same technology which helps to connect us all now, also brings us unfiltered and often inaccurate facts and news, deliberately designed to get our attention and to escalate fear.

So what can we do to improve our situation or at least our perception of it?

First, we can use our breathing as an indicator of where we are in our heads, even when we are not aware of where that is. We can practice daily the breathing techniques to return us back to an even keel and also to keep us there. For when we are in a state of calm, we can think rationally and sensibly as well as consider more fully whether our knee-jerk response to situations is an appropriate one. We can look back and understand why certain elements of our past, whether in our career, childhood or other experiences, are biasing our view of the world and causing us to over react a little. We can pause and set things out in front of us as well as balance them up against our own experiential context and ask ourselves whether things are really as bad as we thought. We can embrace the fact that most probably we will come through any crisis if we put our minds to it and try to balance up how much greater any existing threat is than those we face in daily life. We can be grateful for and take solace in our family and friends and find a common purpose in helping others who are alone and afraid. Isolation is the only true and predictable killer.

We can choose to whom we listen, deciding on where we will get our facts and the sources we will trust, even taking time to check those facts. We can switch off our notifications and check our feeds only every 2 hours or so. We can limit our exposure to friends and colleagues who seem to revel in the negative and enjoy sensationalising. We can watch and enjoy humour even in the face of adversity, laughter is powerful medicine in trying times.

Breathing for lung health

Now we have covered the basis of poor breathing and how to change it, we need to talk about the other positive effects of best breathing on not just the mechanical side of your respiratory system but also the effects on the health of your lungs.

In these frightening times, it has become clear that coronavirus (COVID 19) seems to prey particularly on the elderly and those with poor cardiovascular and respiratory systems. Those who have had it, with the characteristic cough, may be left with a degree of fibrosis in the affected lung tissue. This involves thickening/ scarring of the lung. The result is similar hyperventilation (short, shallow, rapid breaths) to when we are stressed as we have discussed. All of the same muscle, neck and chest tension symptoms can occur. Feeling breathless or oxygen deprived, particularly when doing light exercise (even just climbing the stairs) can make you feel anxious and so a vicious cycle develops.

People who have either pre-existing fibrosis or post infection fibrosis can improve their lung function through breathing exercises/training. The lungs actually have a very large surface area which many of us never even use properly. The exercises help you to:

• Recruit previously underused parts of the lung and oxygenate better.
• To activate the very powerful and underused diaphragm 
• Mobilise the fluids which tend to gather in the deeper recesses of the lungs. The fibrosis stiffens the walls and reduces the natural pumping mechanism of immune cells in and excretory products out, allowing microbes and fluid to congregate in the lungs
• To expand the volume of the chest cage and activate the intercostal muscles of the ribs which get lazy. These muscles help to ‘jack open’ the lungs if they have become stiffer. 
• Relieve anxiety and tension in the neck, back and chest.
• Relieve snoring at night and mouth breathing

The ‘Lung-health’ exercises 

(It should go without saying, but if you have any doubts consult your doctor first before starting this programme)

Start doing them lying down on your back with your knees up, feet on the floor. You should try and do three sessions daily at first.  If you can’t lie down, sitting back in a chair and relaxing is fine.

NB: If you get up from lying, do it slowly as you may feel faint. Go to a seated/ upright position first and let any giddiness pass before you stand.

After completing these exercises your blood pressure will drop, which is a good thing but the gases in your lungs will change too, also a good thing. The combination is something that you will adapt to over time with practice. But please be careful.

SET 1

Follow the steps for belly breathing as previously described above. Do 10 breaths using the HiLo hand position and getting the diaphragm going, master this first.

Do 10 of these breaths to get a baseline then breathe easy for 1 min.

SET 2

Now do a second set of 10, breathing into and expanding the lower ribs as well as the belly, always only in and out through the nose. Remember to be mindful of still not allowing the Hi hand to rise. On completion, breathe normally for 2 minutes. Don’t worry if you feel a little high or giddy it’s normal.

Alternate this with doing the breaths lying on your front with your forehead resting on crossed forearms. This has been shown to improve lung oxygenation. 

SET 3

Repeat set 2, but this time breath in through your nose but on the outbreath, you are allowed to breath out through your mouth but with pursed lips only. Try and really force the air out to the very end of your breath. If after a couple you give a little cough, that’s not only normal but a good sign. It will pass as you continue. Breathe easy after 10 repeats for 2 mins.

SET 4

For this set you will need a drinking straw or a hollowed-out ball point pen barrel.

Repeat 3, but this time blow the air out through the straw/pen. Again, maintain the outbreath to the very limit of your breath and beyond if you can. So cycle is… Nose in…straw out. You may feel quite high/giddy after this- all good it will pass. Breathe easy for 2 mins.

SET 5 

Again 10 breaths. This time in through the nose and out through the mouth and no straw. BUT.. as you go to breathe out, force it out as hard as you can in an exaggerated HUFF! Almost like a cough. This forces your diaphragm to work harder and will mobilise the fluids lower in the lung. For some, after this exercise, you may find it brings up phlegm. Let it come up and spit it out into a tissue and dispose of it, best of all in the loo.

You can repeat this or do it in a standing position. If you do, put both hands on your head whilst doing so. This opens the ribs up better.

Finally, once you have mastered the diaphragm breathing, do it whilst going for a brisk walk. Really practice expanding the lower ribs as well. You will realise how it reduces your breathlessness on each walk.

Give it a go and enjoy it, do it with your partner or children too. You have nothing to lose. Good luck.

Nick Potter B.Sc.(Ost),MRO, Dip.Myo Ac.

Consultant Osteopath, Princess Grace Hospital