My thoughts on breathing...
A bit more information as it occurs to me about how breathing impacts your health and well-being. If you have questions or want me to address a particular topic, please don't hesitate to contact me!
I have been working with a couple of pelvic floor physiotherapists lately, because we physiotherapists know about the connection between breathing and pelvic floor muscle function. But I realized, that likely most people don't realize there is a connection there. Think about it. What do you do when you really, really, really have to go to the bathroom, but you are stuck in traffic. Maybe hold your breath? Suck in your stomach? Perhaps a quick lesson on how the two systems work together can help you manage those extra minutes a bit better.
Our main breathing muscle is the diaphragm, a dome shaped muscle under the rib cage. When we breathe in, the diaphragm flattens out and pushes on our abdominal contents (stomach, intestines, bladder, etc), sending them down toward our pelvis. At the same time, the abdominal muscles tighten a little bit and the muscles of the pelvic floor, located between your pubic bone and tailbone, lengthen a little bit. This allows us to manage the increase in pressure in our abdomen that occurs when the diaphragm flattens out. When we breathe out, essentially the opposite happens: the diaphragm relaxes and goes back up toward the heart, the organs move up as well and the pelvic floor muscles contract.
Now if you have to cough or shout - something that requires us to breathe out forcefully, the abdominal muscles are going to contract more forcefully. This increases the pressure in our abdomen a lot. The pelvic floor muscles now have to contract a lot as well, to help prevent things from being pushed down.
For people that have issues with continence, it is often this coordinated movement that is disrupted. Muscles may be too tight (not relaxing enough) or too weak (not contracting enough).
One place to start to help engage the right muscle pattern is to focus on breathing. Try this exercise: lie on your back with a pillow under your head and one under your knees. Breathe in through your nose gently and feel the rise of your belly. Now exhale gently through your nose. Imagine the up and down motion of the diaphragm and the effects on the organs. Do this a few times. Now bring your awareness to your pelvic floor muscles. As you breathe out, see if you can engage them by squeezing them gently. This would be the same as stopping the flow of urine when going to the bathroom (do NOT do that as an exercise). The key is to not only contract when you exhale, but also relax when you inhale. As this gets easier to do, practice in a variety of positions.
And the next time you really, really need to go, but are still a few minutes away from the bathroom, focus on breathing out and contracting your pelvic floor muscles. Trust me, it will help a lot more than holding your breath or breathing in!
Just last week I was asked to speak to the Respirology Division at the Alberta Children's Hospital here in Calgary about some of the work I have been doing with treating vocal cord dysfunction. And it became quite clear that they are seeing many patients that have some sort of excerise induced vocal cord dysfunction (EIVCD). EIVCD is described as an inappropriate closure of the vocal cords on inhalation during strenuous activity. Usually, when we breathe in, the vocal cords widen, to allow for air to enter the airways and lungs. When we exhale they may close slightly, and when we talk they narrow more, and then they completely close when we cough and swallow. But sometimes, the reflexive opening and closing becomes dysfunctional and we see the vocal cords coming together on the in breath. As you can imagine, this makes breathing very difficult: symptoms of EIVCD are shortness of breath, inspiratory stridor (a hoarse wheezing on inhale), and tightness of the throat. Sometimes this can be quite alarming and may lead to hyperventilation and panic.
Often EIVCD is misdiagnosed as asthma, although it does tend to occur in conjunction with asthma. A few clues that the vocal cords may be involved is the report of throat tightness - usually in asthma it is chest tightness; inspiratory sounds - with asthma it is generally a wheeze on breathing out; and if symptoms do not resolve with taking a bronchodilator (like Ventolin) EIVCD should be suspected. Of note, it is three times more likely to occur in females than males.
So all that being said, where does breathing fit into this? Well, there is some evidence to indicate that the muscles that help open the vocal folds are linked to the movement of the diaphragm. That is, the downward motion of the diaphragm that occurs during inhale assists in the activation of these "throat opening" muscles. In all of the patients I have seen with complaints of EIVCD, they have demonstrated a breathing pattern that relies heavily on the accessory muscles of breathing located in the neck and chest, with very little activation of the diaphragm. We also know there is a link between tight muscles in the neck and tight muscles around the larynx (where the vocal cords are located).
Management of EIVCD generally includes education and breathing retraining. Patients who have an understanding about what is going are less likely to panic when experiencing symptoms. Learning new breathing patterns that help to relax tense neck muscles and activate the diaphragm assist in decreasing the frequency and severity of events. "Rescue breathing" exercises are also taught to help gain control in an acute episode. I also include postural retraining and manual therapy to address neck muscle tension. There is also some evidence showing that low load inspiratory muscle training assists in restoring reflexive opening of the vocal folds. I have certainly noticed clinically an improvement in breathing patterns when adding this modality to my treatment programs.
If you or someone you know has asthma, and struggles during strenuous exercise, take note of your symptoms and compare them to the ones mentioned here. If you are finding it has been hard to manage your symptoms to this point, perhaps you may want to consider if exercise induced vocal cord dysfunction is involved.
I'm a physiotherapist who is passionate about educating anyone and everyone about the impact breathing has on our health.