Building Stronger Bodies: Introducing Solid Foundation Physical Therapy & Wellness

Discover the Power of Your Breath: Diaphragmatic Breathing

Written by Dr. Anne Perez, PT, DPT | Dec 18, 2023 10:00:00 PM

The breath is essential to life. It’s innate in every living organism, something that we’ve known the moment we are born. It is an automatic involuntary process of the body, just like your heart pumping, digestion, blood pressure regulation, any function that is essential to life. But what’s really cool about breathing is that it is also something that we can control. It is a really neat way to be able to tap into our nervous system! 

 

There are major muscles that are  involved in normal quiet breathing. And those are your diaphragm and external intercostals. The diaphragm is a dome shaped muscle that sits at the base of the rib cage and external intercostals are the muscles in between the ribs. On top of the diaphragm is the thorax where your lungs and your heart lives, and beneath the diaphragm is your abdomen and all the internal organs.

As we inhale, the space in your thorax expands, your diaphragm contracts and flattens out, changing the pressure in the thorax and air flows in. The diaphragm then pushes on to our gut and all of our internal organs move down onto the pelvis and are being caught by your pelvic floor. Exhaling is basically just a passive recoil of everything— your pelvic floor lifts, your organs go back to their resting position and your diaphragm relaxes back into its dome shape, your rib cage gets smaller and the air flows out. No muscle is really active during normal exhalation. 

 

If you are curious about the physics and biomechanics of breathing, watch this video here.

 

But what happens when we are stressed, anxious, nervous, in pain or afraid. How do those emotions change the way we breathe?

 

We hold our breath, hyperventilate, shallow rapid breaths, we become chest breathers, we use other larger muscle groups like your neck accessory muscle and your abdominals. This is a sympathetic response, more commonly known as your fight or flight response. And it is not necessarily a bad thing, it’s a survival response and that is, the major role of our sympathetic nervous system is to help us survive if there’s an actual danger. Like, if you have to run away from a lion in the jungle, you need as much oxygen as possible and you need those large muscle groups to be helping you breathe. In reality, we are not going to be in that situation. But many of us are in chronic stress, like the majority of people in America, or if you are constantly in pain or anxious, maybe you’ve had some type of trauma in your life, we can get stuck into this type of dysfunctional breathing. 

 

By controlling how we breathe, we can tap into our parasympathetic nervous system, which is the opposite of the fight or flight response, it’s what’s commonly known as the rest and digest. We are basically switching modes by using techniques that can help us be in a more relaxed state through our breath. Diaphragmatic breathing is a way to not only tap into relaxation but it also helps workout the diaphragm. Because the diaphragm, just like other muscles in our body, can also get weak or tight. 

 

Some of you may have heard of diaphragmatic breathing, maybe someone has taught you how to do it before. There are some misconceptions about diaphragmatic breathing that I wanted to clear up today. 

  • Diaphragmatic breathing is not belly breathing 

It should be a 360 deg multidirectional expansion during inhale and compression or contraction during the exhale, but none of it should be forceful. Many instructors will cue hand on your chest and hand on your belly and then they will say breathe into your belly and don’t allow your chest to move. I’ve been guilty of this myself in the past and that’s because we try to overcompensate for chest breathing. But in fact, the rib cage should be moving and expanding in order for us to have a more efficient amount of air flowing in. 

  • It is not a magic pill or a quick fix
If you are dealing with pain or stress or anxiety, practicing breathwork alone will not make them go away. It will certainly help reduce some of your symptoms but it is only a tool that must be used with other lifestyle changes, exercises, physical therapy, counseling or for some people, even medications. 
  • It’s not only meditation or sitting in a quiet room

It can be used with meditation but it is not exclusive to that. I’ve had people who when I introduce breathing exercises to them, they dismiss it right away and say things like oh yea I’ve done that didn’t really work or yea that’s not for me, I’m not really the zen type of person. And most of the time, these are people who need it the most

  • You don’t have to always use diaphragmatic breaths

Normal quiet breathing, the ones we do subconsciously 24/7, is different from diaphragmatic breathing. But practicing diaphragmatic breathing regularly will help promote a more efficient diaphragm, it’s working out that muscle.

 

So what does diaphragmatic breathing look like?

360 deg multidirectional expansion during inhale, contraction or compression during exhale, slow long quiet inhale thru the nose, ab and chest wall should get bigger and slow long exhale out to the mouth, ab and chest wall would get smaller and nothing should be forced. It’s a relaxed movement. 

The Stack

A good stack position promotes a more synergistic action of your diaphragm and pelvic floor muscles as you breathe in and out.  Some postural dysfunctions can make breathing more difficult. Practicing the stack with deep diaphragmatic breathing exercises can help improve posture as well as your muscle’s ability to lengthen and shorten.

*photo from zaccupples.com

Check out this video by Zac Cupples about troubleshooting the stack

Breathing Drills

Hooklying Breathing: practicing deep diaphragmatic breathing
  • Lie on your back with your knees bent and your feet flat on the ground. 
  • Three points of contact to keep with the ground: bony part of your pelvis in the back (PSIS), inner heel and the ball of the big toe
  • Do not roll the foot inwards or bring the knees together, the pressure should be straight down
  • Silent slow inhale thru the nose, multidirectional 360 expansion in the rib cage, the chest and the abdominal wall should get bigger but do not force it
  • Exhale out to the mouth, slow and long as the abdominal wall and chest gets smaller. Place your hands in the lower abdomen below the belly button, you should feel this part contract or get smaller as well, do not force it. 
  • Keep all 3 points of contact to the ground and repeat 5x
  • 5 reps, 1-2x/day

 

Side Lying Reach Rotation: for rib cage and spine mobility
  • Lie on your side with your head supported by either a pillow or your bottom arm
  • Knees and hips are bent to a comfortable position
  • Keep knees together, you may place a yoga block or a ball between your knees
  • As you take a quiet inhale thru the nose, reach your top arm forward
  • You should feel a stretch or an expansion to your posterior rib cage as you reach forward
  • As you exhale out to the mouth you will reach back sliding your hand to your chest as your elbow bends and points to the back, at this point your torso will start to rotate backwards
  • Your hips and knees can slide in and out slightly but majority of the movement will be in the torso
  • This should also feel relaxed, do not force the movement. 
  • Repeat for 5 breaths
  • 5 reps x 1-2x/day

 

Wall Squat Elbow Reach: for practicing the stack and slight stretching of the neck muscles
  • Stand against a wall with your feet about a foot forward, feet about hip distance apart
  • Your point of contact on the wall should be the bony part of your pelvis (PSIS), if it’s not touching, bend your knees slightly to allow the PSIS to touch
  • Put pressure on the inner part of your feet without rolling ankles in or bringing the knees together
  • Bend your elbows and keep the elbows relatively close to the body, upper back is also touching the wall
  • As you take a slow quiet inhale, reach your elbows downward gently, do not force the movement
  • Relax back to the starting position as you exhale 
  • You should feel a slight stretch in the upper shoulders and neck
  • 5 breaths, 1-2x/day