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 am very excited to have just booked a course with Mary Massery, a physical therapists out of the United States, who would arguably be the leading expert in breathing and movement. Her main focus is the influence of breathing on posture mechanics and how if you can't breathe, you can't move. And she is quite right. I am often referred people whose main complaint is that they seem to get out of breath quite quickly with activity. They aren't able to coordinate both movement and breathing. Sometimes when I am working with patients with low back pain, I see them hold their breath to move. They haven't got the right stabilization pattern, so use their breath to create pressure within the abdomen to create that stability.
Mary points out some interesting things with regards to breathing and movement. And the funny thing is, is if you are paying attention, it's quite obvious how we regulate breathing and movement. Try this first example. Stand up from your chair. We are going to sit back down in the chair, so make sure you can do that safely. So, again, stand up. Breathe out (like a sigh) as you sit down. Now, if I had yelled out "oh, don't sit there, there's gum on the chair!" would you have been able to reverse direction easily? Likely not. With that sigh out, you were sitting down without much control. This time, stand up. Take a breath in, hold it and start to sit down, just before you sit down, let your air out. Once again, you probably plopped down in your chair, and there was no way you were going to stop part way down. Now this time, stand up. We are going to use breathing and vocal management to provide a bit more stability to your movement. Take a breath in, and as you lower yourself down, count quite loudly to seven. What did you notice this time? A bit more stable and controlled, right? If I shouted not to sit down, you would have been able to reverse your direction, right? And the only thing we changed was breath control.
Here's another interesting trick. Stand up again. Raise your arms up over your head. Bring them down. Repeat this a few times (your elbows should remain straight through this). What do you notice happens with your breathing? That's right, as you raise your arms up, you breathe in. Now this time, breathe out as you raise your arms up. Repeat it a couple of times. What happens now? Not nearly the same range of motion is there? And it probably feels a bit stiff to do so. Again, all we changed was the way we were breathing.
So for those of you who think breathing issues are only for those who feel short of breath, maybe breathing issues are also for those of you who are having trouble with moving. Yep, that means you with the sore back. And you with the chronic shoulder pain. And you with the stiff neck. And you...
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'll be stressed for Christmas,
You can count on me.
Too much snow and shovelling,
Leaves no time for the tree!
Christmas Eve will find me,
Chugging nog and 'Beam'
I'll be stressed for Christmas
Can't find that toy of their dreams
Are you feeling a bit stressed out this Christmas season? It's not surprising really, with the the pressure to produce the "perfect" Christmas that seems to flow out of every commercial, billboard and Facebook share. Perfectly decorated gingerbread, perfectly quaint stockings hung under a perfectly accessorized mantle. And of course, "just found the perfect gift for my second cousin's niece!" Really? I'm lucky remember gifts for my in-laws!
From parties to shopping, decorating to baking...there just seems to be a never-ending list of things to do to prepare for the holidays. Add on top of that, regular life goes on - so there is still work, school and taxiing the kids here and there and everywhere. Little chance to just stop and take a breath.
The trouble is, if we don't stop to take a breath, we end up paying for it later. Who hasn't experienced the immune system break down on the first day of Christmas vacation? Finally, the hustle and bustle slows and you wake up that first morning to a scratchy throat and achey bones.
We know that too much stress isn't good for us. It weakens our immune system, disturbs our sleep and takes our bodies away from precious rest-and-repair phases. So this holiday season, instead of letting stress carry you from one task to the next, try these tips for a happier, healthier Noel!
1. Stop and smell the gingerbread. That's right, use your nose. Nose breathing stimulates our diaphragm, our main breathing muscle, to work. Simply using your diaphragm can help activate our rest-and-digest side of the nervous system and put the brakes on the fight-or-flight response. Bonus: belly breathing is good for the digestive system and will help "massage" some of that holiday baking through the system!
2. Enjoy your cup of tea. Or coffee, or hot chocolate. Pour yourself a cup, sit down and enjoy it. Wrap your fingers around the warm mug and take that time to hit the reset button. Focus your attention on the sensations of breathing, the warmth and smell of your drink, feel supported in your chair. Put your "to do" list away and simply enjoy the moment.
3. Breathe. Seriously. When we get busy and flustered, sometimes we forget to breathe. Or sometimes we just breathe poorly. So every time you sit back down in your office chair, or get behind the wheel of the car, or find yourself sitting in some other new space, take a moment to reset. Place your feet on the floor to ground yourself. Close your mouth and breathe softly in and out of your nose. Feel your belly expand gently as you breathe in, and then let go of any tension on the exhale (hint: the tensions probably in your shoulders so let them drop). Do 5 breaths, then move on to the task at hand. These mini-breaks throughout the day will do wonders for your mood and energy.
4. Go for a walk. Park at the other end of the parking lot at the mall. Park an extra block away from work. Take a brisk walk at lunch. Studies have shown, time and again, that walking is beneficial to both our physiology and our psychology. I know for me personally, I come up with my best ideas when I'm exercising!
5. Get some zzz's. I know, I know, always easier said than done. But stick with your sleep schedule and try not to stay up late fitting in that last minute batch of cookies. To settle an excited mind at night, focus on your breathing. Again, softly in and out through the nose, allowing your belly to expand on inhale and letting go of tension on exhale. See my previous posts about sleep tips to help you find a restful sleep.
Make this holiday season one to cherish, not one to "just get through."
Wishing you the best this holiday season! Breathe well and be well!
Last week I talked about how dysfunctional breathing and sleep disturbances are linked and gave you a few exercises that may help with easing tension to facilitate a better night's sleep. Using the breathing exercises as a way to access and then ease muscle tension helps to turn off the ever-active "flight or fight" response we have to our everyday stresses and allows our bodies to spend time in "rest and digest" mode for more restful sleep. But for some, simple breathing exercises aren't enough. This is when we start to introduce behaviour changes to encourage better sleep hygiene. Described by Dr. Peter Hauri, sleep hygiene refers to "the habits, environmental factors, and practices that may influence the length and quality of one's sleep." The concept of sleep hygiene is to allow for a smooth transition between the hectic demands of your day and sleep. If you are dealing with stressors (work, family, etc) right up until the light's go off, it's unlikely you will have smooth transition to sleep. You simply cannot flip a switch and drop into blissful sleep. By establishing a pre-sleep ritual to break the connection between stress and sleep, we may limit the amount of time spent tossing and turning, waiting for sleep to come. We all did this with our kids when they were younger, right? Bath time, story time...everything meant to be done calmly and quietly to get them ready for bed. Why not offer ourselves the same courtesy? Here are a few tips to improve your sleep hygiene for a better night's sleep:
And don't forget to breathe! A nice, relaxed belly breathing pattern with an effortless exhale helps to settle that busy brain as you rattle through your "to-do" list. And if you struggle with finding that pattern, do try to find a physiotherapist with skills in treating dysfunctional breathing to help you find a pattern that works for you!
You're lying in bed, eyes squeezed shut, breathing maybe a bit too quickly; you can definitely feel your heart beating and in your mind you are thinking "go to sleep. Big day tomorrow. Need to feel rested. Don't forget you have to pick up the kids early. Oh, and don't forget to mention to your boss about that meeting. Gosh, when will I fit a workout in do you think? What's the weather supposed to be like?..." And you open your eye, just a little bit, peek at the clock and realize you are STILL not asleep. Sound familiar? You're not alone. A 2011 study, found that over 40% of a sample of 2,000 Canadians had at least one symptom of insomnia. Insomnia is typically defined by the inability to fall asleep, stay asleep or the presence of "poor quality sleep." So if you are lying in bed at night, waiting and waiting and waiting to fall asleep, or you wake up in the middle of the night and can't fall back to sleep, or if you just feel exhausted when the alarm goes off, you may be experiencing insomnia.
The consequences of chronic sleep deprivation are quite serious. Among the greatest health risk is the increase in the risk of accidents: those with insomnia are 2.5 to 4.5 times more likely to have an accident. Not enough sleep has been linked to impaired mood, memory and concentration and has even been shown to dampen immune systems. Yet despite the frequency of insomnia and the severity of side effects, few people are seeking adequate treatment: in the same study mentioned above, the authors noted that only 13% sought help from a health professional and 10% had used medication. Perhaps it is because this is such a common problem, that we have just grown accustomed to this being the new reality (I know you new parents out there are thinking that!). Among many of the treatment options out there, there is evidence to support both biofeedback and behavioural changes as an effective solution to insomnia.
In my practice, where people come to me for help with dysfunctional breathing, there is often an underlying component of poor sleep. The story is almost always the same, in addition to breathing problems, there are issues with "busy brain" - those that think and worry all the time - and difficulties either falling asleep or staying asleep (or both). And what I have found is that for these people, they haven't experienced true rest for a very long time. Sure, they lay down, watch TV, read a book, maybe even meditate. But they very rarely, "let go." Tension in the jaw and neck, upper chest persists. Breathing rates stay high. The chest heaves up and down with each breath. There is no way the body can relax and let go if this is the pattern that dominates. I use a combination of biofeedback and breathing behaviour changes to try to restore what we call "physiological calm" - the true state of rest and relaxation. And more often than not, one of the responses I will get from my patients is that they are experiencing better sleep.
The next time you find yourself lying in bed, mind chattering away at you, heart racing, try this simple exercise to bring your body back to a state of physiological calm:
I can't take full credit for the title of this post...it comes from a colleague of mine at Breathing Works in Auckland, NZ. She was going to use it as the title of a book on breathing pattern disorders, but her publishers advised against. Which is a shame, because that phrase is exactly what came to mind as I ran at Melissa's Road Race in Banff this past weekend as part of a team building event with the good people at the Running Injury Clinic. There was so much panting, huffing and grunting going on that it was disrupting my own breathing! Sure we were in a running race, so you expect breathing to be laboured a bit, but this was excessive! I was genuinely concerned for a few people. So if you find you can't manage running and breathing, read on...
When we exercise, our body requires more energy (oxygen) but also produces more "waste" (carbon dioxide). To keep up with these changing demands, our breathing rate and volume increase, as we move more air in and out of lungs. Often, we switch to mouth breathing to accommodate. But that means we use really inefficient, little muscles in the neck and chest and it generally takes more effort to do so. Thus breathing becomes a bit laboured. But then, some people take it to another extreme and breathe more than they need to. They work really hard! I used quotations around the word "waste" earlier when referring to carbon dioxide, because it is not really just a waste gas. It's an important regulator of pH (acid-base balance) and oxygen distribution. Seems weird that a "waste" gas would help regulate how much oxygen you get, but oxygen and carbon dioxide trade places on red blood cells so without CO2, you don't get O2! Anyway, for those heavy breathers out there, not only are you working too hard with your muscles, you are likely overbreathing and huffing out too much carbon dioxide. This means your body can't work optimally and your poor working muscles might actually be getting LESS oxygen. And it makes you feel short of breath - or more precisely like your breathing isn't helping, so you breathe more....and that creates a vicious cycle of breathing too much, feeling out of breath, breathing more, getting less oxygen, breathing more....You get the idea.
If this sounds familiar to you, then you will likely benefit from a breathing assessment and tips on how to fine tune your breathing. A few tweaks here and there and you can stop sounding the the big, bad wolf out there and find new energy for a personal best!
Sweaty palms, heart racing, dry mouth, butterflies in stomach. Maybe its a big presentation at work. Maybe its your first competition. Or your 20th. Whatever it is, you chalk it up to nerves and hope you can overcome them to finish strong. Whether delivering the presentation or sitting at the start line, those "nerves" you feel is your body preparing your for "flight or fight." It's the body's natural stress response and it has been with us since the days of running from sabre-tooth tigers. Only the presentation or race isn't life or death (thankfully) - unfortunately our bodies don't know the difference. It's easy to get caught up in the cascade of sympathetic nervous system overload - it starts with those little thoughts of doubt that creep in, the breathing rate speeds up, the heart follows, and palms (and underarms) start to sweat. You try to focus with a few deep breaths, but that only makes it worse. Now you are light-headed and the start gun has gone off - or the mic has been passed to you. So how can you break the cycle and boost your performance? The answer of course is to breathe to succeed! By spending a minute or two focusing on a calm, relaxed breathing pattern, you can settle that fight or flight response, clear your head and allow your body to absorb all the oxygen your breathing in. Rapid, panicky breathing leads to altered respiratory chemistry which ultimately leads to decreased oxygen delivery to the places that need it most - the brain, the gut and muscles. Leaving you feeling weak, foggy in the head and lacking confidence. The next time you feel a case of the nerves coming on, try this exercise and you too can breathe to succeed!
1. Sit (or stand) with your body in neutral - wiggle your toes, your knees, your shoulders a little bit to unlock them
2. Rest your tongue behind your top teeth (say the letter "n" to yourself) to relax your jaw
3. Place your hands on your belly
4. Breathe gently in through your nose and into your hands; feel your belly expand slightly as you do so. Keep your chest still
5. Exhale effortlessly through the nose, keeping your breath silent
6. Allow for a brief pause before you breathe in a small, gentle breath again
7. Repeat until you feel your pulse settle and your mind clear
Feeling stressed? Have a headache? Stuck in traffic and late for an appointment? Kids screaming in the background? It's okay, relax take a deep breath or two. Feel better? Maybe, but maybe not. Well, that's because "taking a deep breath" doesn't always translate into a good breath. I know, I know, the benefits of taking a deep breath are everywhere these days...seems everyone has the same idea: doing deep breathing increases oxygen uptake and provides clarity and helps settle your nerves,etc, etc. And they are right...just only partly right. Breathing is actually quite variable, and different styles of breathing benefits different people, differently. It's kind of like giving a blanket prescription for someone with a sore back - "here, do this exercise because it worked for me." Well, that person's cause of back pain could be completely different from the next, so offering up a generic exercise program might prove to be detrimental. The same is true with breathing.
You see, most people, when instructed to do a deep breath, will actually do a "big breath." They breathe in sharply (and loudly), the chest rises and all sorts of effort goes into doing this so-called relaxing deep breath. Neck and shoulder muscles that are already tense and tired, work a bit more to lift the chest. Too much air goes through the lungs. Too much air? Can you breathe too much? Yes! And when you do, it disrupts the body's natural breathing rhythm and deregulates respiratory chemistry (meaning the balance of oxygen AND carbon dioxide). Ultimately, there is less oxygen available, not more. Try it yourself right now. Sitting there, spend a minute taking deep breaths as I described above. Breathe in purposefully through the nose and fill your lungs up all the way and breathe out, maybe even through the mouth....
Now how do you feel? Lightheaded? Foggy? Tingling in the lips? If so, that's an indication that you were breathing too much. If you feel better, two things might be the case. One, you have mastered deep breathing (yay!). Or two (which is more likely), your perception of your own breathing is influenced by what you think deep breathing should do for you. That is, you've been told that deep breathing is good for you, so therefore when you do "deep breathing" you assume you feel better after, no matter what the sensation is.
For many people, there is a lot of difficulty separating a deep breath from a big breath. When I say deep breath, I mean a nice slow, effortless inhale using the diaphragm muscle; the belly expands and the chest stays still. But for those that have adopted an upper chest breathing pattern - maybe through posture issues (are you hunched in front of the computer as you read this?) or because of poor stress management, trying to do that belly breath is nearly impossible. And so when they practice deep breathing exercises that they've been taught from various sources (friends, yoga instructors, internet sites, etc), they move right through into big breathing, which ironically, stimulates the flight or fight response, not settles it!
The key to deep breathing is to re-establish the natural deep pattern of breathing, but also match that with your own body's unique breathing rhythms and respiratory chemistry requirements. When we can match that up, we get optimal respiratory fitness. And what you might find, is that instead of needing to take a deep breath every time the tension ratchets up a notch, you can actually manage to keep things on track by maintaining a natural breathing pattern to keep stress at bay.
To find that optimal zone with my patients, I use observations of breathing patterns, monitoring of muscle tension and respiratory chemistry analysis using a CapnoTrainer to be as accurate as possible. Because while there are lots of ideas out there about breathing, it is important to note that breathing is a science, not an art!
Next time you are feeling rushed or stressed and you go to take a deep breath - check in with yourself to see if it truly makes you feel better. If you can hear your breathing or feel your chest rising sharply, chances are it's not helping. Which means it might be a good idea to restore your natural breathing pattern so you actually get the benefits of "deep breathing" that you are looking for.
I'm a physiotherapist who is passionate about educating anyone and everyone about the impact breathing has on our health.