January 2019 “Breathing”

As a physical therapist for thirty-seven years, I have become more aware of how poor posture along with poor alignment of the human, skeletal structure affects breathing. Dr. Karel Lewit states, “Respiration is our primary and most important movement pattern…and also the most dysfunctional.”

The diaphragm which is the primary muscle of respiration plays a major role in patterns of dysfunctional breathing. This dome-shaped muscle is located just below the lungs and heart separating the abdomen from the chest. As you breathe in and out, the diaphragm contracts continually generating a negative intra-thoracic pressure. In fact, the diaphragm will lower and establish increased abdominal pressure before any of your daily, functional movements. During inhalation, the rib cage increases it anterior, posterior, and lateral dimensions at the same time giving the diaphragm the room to fully contract. With MRI studies, researchers have found that when the diaphragm does not have the room to fully contract, intra-abdominal pressures are affected. As a result, other respiratory muscles or accessory breathing muscles have to be recruited more in order to compensate.

When you breathe in, the diaphragm should be able to fully contract and move inferiorly. This action flattens the dome-shaped muscle causing a decrease in pressure within your thorax or chest and an increase in air taken into the lungs. As you breathe out, the diaphragm relaxes restoring its dome-shape decreasing the air space in your lungs causing you to push air out.

This involuntary action of breathing works in close coordination with the thoracic spine, rib cage, and “core” muscles. Because of this close relationship, when your thoracic spine and rib cage become limited in their mobility, the diaphragm will not be able to fully contract with each breath and becomes weak affecting your breathing pattern. In addition, if your “core” muscles are not fully engaged, the diaphragm loses its ability to fully contract. The resultant weakness again affects not only your breathing, but also makes you more susceptible to musculoskeletal dysfunction and pain. According to a MRI study done in 2013 by Vostatek, “Dysfunction of the cooperation among the diaphragm and abdominal, pelvic floor, and deep, back muscles is the main cause of vertebrogenic disease and structural spine findings such as hernia, spondylosis, and spondyloarthrosis.”

The rib cage, “core”, and spine should work as a unit. Altered rib mobility can not only cause a dysfunctional breathing, but also limited shoulder mobility, reactive muscle guarding, and referred pain to other areas. The “core” which has become the focus of fitness and rehabilitation programs not only consists of diaphragm, but also pelvic floor muscles, transverse abdominis, quadratus lumborum (iliocostal), internal and external obliques, rectus abdominis, and deep, posterior back muscles including the multifidus and erector spinae. Other muscles that are considered “minor core muscles” include the gluteals, tensor fascia lata, adductors, and lateral hip rotators. The engagement of your “core” muscles is not only important in breathing, but vital in maintaining the vertical, upright, human posture. Without the engagement of the “core” muscles, the intra-abdominal pressure is not adequate enough to prevent distortions and compensations of your spine and can lead to the spines collapse as in osteoporosis and other pathological situations. The result is a compensation in your posture that further decreases your breathing capabilities.

It can’t be overemphasized enough how poor postural alignment, limited thoracic spine and rib cage mobility, and weakness of “core” strength affects your breathing. Think about it! The diaphragm, “core, and accessory breathing muscles of the neck and shoulder girdles produce upward of 21,000 breaths each day. When the diaphragm is without restriction when contracting, these accessory breathing muscles will not have to work as hard remaining soft and supple. However when the contraction of the diaphragm is compensated in anyway, increased resting tone of the accessory breathing muscles will occur. These accessory breathing muscles include the scalenes and sternocleidomastoid of the neck as well as the levator scapulae and trapezius of the scapula. In addition, the tone of shoulder girdle muscles including the latissimus dorsi and pectorals will be affected.

The main characteristic of a dysfunctional breathing pattern is that the abdomen will move in on inspiration and out on expiration. Just the opposite of what should happen causing shoulder girdle protraction, forward head position, and alteration of the spine’s normal curvature. The result is that these areas are now asked to bear excessive loads that over time cause musculoskeletal dysfunction and pain.

As you age, it is a given that your thoracic spine and rib cage will stiffen, your core will get weaker, and a dysfunctional breathing pattern will progress making you more susceptible to pneumonia and other lung related ailments. We take our breathing for granted so we usually do not focus on how we breathe. However, you can do something with specific exercises and postural modification no matter your age to change how you breathe and slow this progression. Learning the proper way to breathe with the emphasis on the diaphragm is an essential for optimal health and longevity.