Breathing has always been integral as part of a health professional’s training. With various modalities and understanding, each clinician has learnt different aspects and concepts of breathing. However, one thing has always been constant: breathing was never irrelevant.

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Of all the movement patterns & exercises that have come into vogue in recent years, none is more noteworthy in diagnosis, vital for performance, and powerful in correctives as the most fundamental movement pattern in human beings.... yet why is it overlooked, ignored, or downplayed? Not any more.

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We bring this post to you to share some things we do in the clinic that we found breathing to be truly crucial. There may be other concepts and philosophies out there and such, this may start a discussion among other clinicians.

A “good” breathing normally occurs at the diaphragm, most clinicians can agree with that. What happens when it’s “bad”? There are clinically diagnosed breathing problems such as Chronic Obstructive Pulmonary Disease (COPD) and asthma which results in breathing difficulty, however - breathing is ultimately vital for our wellbeing and survival.

The body prioritises breathing by compensating using other systems if necessary. When the diaphragm is not working well (dysfunction) to breathe, the body is very efficient in using other muscles to compensate for that dysfunction. This is commonly seen by using more traps, shoulder and neck muscles – known as apical breathing where the chest rises up first instead of the diaphragm during breathing. If that is unavailable or insufficient the body may also recruit hip and abdominal muscles to help with breathing. These compensatory mechanisms are very efficient as – unlike certain activities – it must not stop. This may cause problems; with the shoulder and neck muscles working to breathe, clients may start experiencing shoulder and neck symptoms and/or pain – similarly may be present for the abdominals and/or hip. Some clinicians may recognize this and it has been suggested that upper and lower cross syndromes may be contributed by poor breathing patterns.

Breathing is also important when we are trying to change movement behavior and patterns, and thus performance enhancement, of which the output is an expression of your nervous system. Breathing is the most fundamental movement pattern and is the first thing we do as babies after being born. As therapists, we try to change a movement pattern (an output) by putting an input (whatever it may be). The nervous system processes the input and puts out an output. In order for that to occur, the nervous system needs to accept the input. A good breath pattern allows and grants permission to accept what someone is doing to you (input). When the nervous system is in a more stressful environment, it cannot accept an input as easily and one of the signs the nervous sytem is under stress is a poor breathing pattern! This usually comes with a more apical breathing pattern with neck and/or shoulder muscles being involved, chest elevation, and minimum diaphragmatic breathing.

Who is at risk? – everyone. Everyone may develop a poor breathing pattern which is compensated well – hence no “symptoms/pain”. However, it exposes the person to greater risk of developing problems – when shoulder stabilisers are used to breathe – it can’t stabilise the shoulder as well. People being rehabilitated post-operatively are also more likely to have breathing dysfunctions. Poor breathing patterns as such can affect a great magnitude of areas: traps, neck, shoulders, hips, back, posture, and the list goes on.

What can we do? Breathe again! We learn how to breathe again from bottom up.

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From lying.....

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This exercise uses a small weight on the abdomen to direct an individual to push their belly upwards when they breathe in, letting it sag down when they breathe out. This action ensures the diaphragm muscle is used correctly. Using this drill can restore normal breathing mechanics, improve abdominal muscle coordination, neck muscle activity and gently mobilise rib and spine joints.

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To a suspended position.....

Dr. Quinn Henoch of Darkside Strength explains the importance of posterior rib expansion and a drill to improve it

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To a stacked position - kneeling...............

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To standing. From there, a still/static position, to more movement, and finally to continuous movement. The key when we do our corrective exercise is trying to maintain that good breathing while performing increasingly challenging tasks in a low stress environment, for patients to manage their mistakes at the edge of their ability. With assistance and cues and constructively building that ability to breathe well again. Ultimately the goal is to be able to keep a good breathing pattern in whatever activities you do, without needing to consciously focus on it.

We sometimes say the 3 hardest things your therapist may ask you to do are: exercise, relax, and breathe – this seems to be truer than we originally thought. We hope this has shed some light into some roles breathing may play in terms of rehab and injuries. The next time you see a shoulder – see the breathing, see the person – be better!

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