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SECTION 5

BREATHING PATTERNS

5.1: STRESS RESPONSE RE-CAP

​Remember breathing alterations in Section 3: The Stress Response? If so, feel free to go straight to 5.2, but if not, here is a recap: ​

  • FIGHT RESPONSE: Feeling confident that you can overcome the trigger by facing it and fighting it.

  • FLIGHT RESPONSE: Perceiving the trigger as too difficult to fight but feeling confident that you can safely escape it.

  • FREEZE RESPONSE: The stimulus can neither be defeated, or safely escaped from, leaving you paralyzed in fear[i]. Can be described as being “overwhelmed” by the trigger.

 

ALTERED BREATHING PATTERNS:

PICTURE: more related to breathing patterns to change the one above

Enterochromaffin Cells (ECs) monitor low circulating levels of oxygen, initiating aspects of the SWI/SNF (SWItch/Sucrose Non-Fermentable) to be recruited to a HIF-1α (Hypoxia-Inducible Factor-1 alpha) target, increasing the number of REPC (Renal EPO-Producing Cells), and thus, increasing EPO (Erythropoietin) levels.

Circa 90% of EPO is produced in the kidney, with circa 10% produced in the liver (vice versa during fetal gestation)[ii], and is the leading regulator of red cell production, promoting their development and initiating the synthesis of haemoglobin[iii]. So, there is a reason why the Adrenal Cortex can be found on the kidney and not the brain!) REPC are predominantly found in the renal cortex, particularly the juxtamedullary region, and outer medulla[iv].

 

Successfully Overcoming the Trigger

Homeostasis returns to normal, noting the bigger perception of threat and duration of stress can impact future responses.

 

Unsuccessfully Overcoming the Trigger/Chronic Stress

PICTURE

Chiang et al. (2013)[v] found that the pathogenetic alteration of hypoxia depends on the interactive signals of both the HIF and the endoplasmic reticulum (ER) in the liver and kidneys via the unfolded protein response (UPR). The UPR being the ERs response to cellular stress, activating a surge of signals to maintain homeostasis, of which “failure to regain homeostasis causes the UPR to activate cell death pathways”[vi].

Increased circulatory cortisol levels influences Glucocorticoid Recepter (GR) binding and relatively recently it has been found that glucocorticoids produce feed-forward mechanisms at the amygdala during the stress responsev[vii], providing the potential for a ‘fast nongenomic feedback system’. Serotonin can also take a hit with stress induced serotonin dysfunction being linked to conditions such as PTSD, Depression, and Fibromyalgia.

NOTE: The last point, “Unsuccessfully Overcoming the Trigger/Chronic Stress” discusses the negative impacts ‘stressed’ breathing patterns can have on the body, not only risking hypoxia (too little oxygen in the body) and hypercapnia (too much carbon dioxide in the system), but creating a butterfly effect which impacts all the systems of the body. From this perspective, mindful breathing is one of, if not the only way, in which someone can directly benefit both mentally and physically without much physical exertion and at no cost. It is that simple, and for some reason, it gets overlooked a lit

5.2: DIAPHRAGMATIC BREATHING 

This could have been Section 2, however, having now considered biotensegrity and fascial connections, it makes more sense to put it here as Section 4 as not only will you gain a deeper insight, but will be able to read it with a better understanding.

 

Ever thought about how you breathe? And if you are an adult, ever wondered if you breathe differently now compared to when you were a child?

TAKE 60 SECONDS TO JUST CONCENRTATE ON YOUR BREATHING – ANALYSE WHAT PART OF YOUR BODY MOVES THE MOST, AND DOES THIS CHANGE BETWEEN SHALLOW BREATHS AND DEEP BREATHS.

Did you know there are 6 common dysfunctional breathing patterns? And do know what a functional breathing pattern is?

FUNCTIONAL BREATHING PATTERN:

  • DIAPHRAGMATIC BREATHING

The diaphragm should move down towards the gut on an inward breath producing an eccentric contraction (lengthening under load), and moving back up on the outward breath producing a concentric contraction (shortening under load), the load being internal soft tissue and organs. Consequently, the gut should therefore move in accordance with the diaphragm, the extent of movement depending on the strength of the diaphragm, the strength of the abdominals, and the quality of biotensegrity throughout the torso.

  • With a weakened diaphragm, it will not be able to move much regarding eccentric and concentric, and thus, there will be minimal gut movement.

  • Strength in the abdominals can be both functional and dysfunctional. Functional strength will allow the gut to move elastically, meaning it will absorb diaphragmatic pressures with ease and thus minimal movement on average breathing levels (neither shallow or deep). Dysfunctional strength in the abdominals however will not be able to absorb diaphragmatic pressures due to muscular hypertonicity (MCH), thus, the abdominals hold too much tension, making diaphragmatic breathing strained and therefore difficult.

  • Quality of biotensegrity throughout the torso takes into consideration the tension vs elasticity relationships which make you ‘you’. Having discussed Anatomy Trains, you are now aware that all 6 trains are connected in some way to the torso, that they impact each other, and that these trains are different in everyone due to their nature and nurture. For example, any Lateral Line tension will directly reduce diaphragm mobility, but there can also be indirect impact, such as tension in the right hip for example can create tension in the right thoracic cavity due to the Spiral Line and Functional Lines. Focusing more on posture, dysfunctional postures including kyphosis (curvature of the upper spine) and lordodis (curvature of the lower spine) will increase difficulty when trying to breathe through the diaphragm due to increased Front Line compression in kyphosis and increased Front Line strain in lordosis.

  • The diaphragm is closely related to the Pericardium which encases the heart, with them both being continuous from the central tendon of the diaphragm. Whilst there is still relatively little research, it is difficult not to think that lack of true diaphragm movement will negatively impact the heart, particularly long term, and furthermore, that this lack of movement potentially impacts elasticity and thus health of the pericardium to which strength and rhythm is vital. Hopefully this will at least help inspire more research on the matter, and it broadens the mind into the potentials of breathing patterns.

When stressed, anxious or feeling extreme emotions, you will find that your breathing changes. It becomes quicker as your senses become more alert. Now there can be positive and negative stressors, noting the line between the two can be very thin, with some people perceiving events differently meaning they have different feelings. In essence, thoracic breathing patterns (breathing with the rib cage) and clavicle breathing patterns (breathing with the collar bones and shoulders), can be beneficial when you need to do something fast and efficiently, however, held for too long and it can become detrimental.

5.3: DYSFUNCTIONAL BREATHING PATTERNS 

NOTE: DO NOT ATTEMPT TO DIAGNOSE YOURSELF, THIS IS PURELY FOR MINDFUL AWARENESS. IF YOU FEEL YOU HAVE ANY OF THESE BREATHING PATTERNS, IT IS NOTHING TO WORRY ABOUT, AND RATHER BOOK IN WITH A REPUTABLE PHYSIOTHERAPIST OR OSTEOPATH WHO CAN HELP.

 

  1. Hyperventilatory: Rapid-breath pattern (averaging 20 breaths/minute) uses accessory muscles and restricts diaphragmatic movement being predominantly (thoracic patterns) in nature. Sometimes produced from poorly managed anxiety, this pattern manifests as very shallow, very rapid, and compounded by sputtered sighs (periodic patterns) and gasps (clavicular patterns).  Panic, anxiety, and shock habituate this common phenomenon.  People exhibiting this pattern immediately imperil their health.

  1. Thoracic: These “chest-breathers” lack significant abdominal movement, with shallow and costal breaths. Enlarging thoracic cavity creates a partial vacuum by lifting the rib cage up and out through external intercostals muscles. Although the lungs do manage to be expanded by negative pressure, it is not enough to ventilate the lower lobes. This reduces pulmonary ventilation, since the lower lobes receive the greatest blood volume due to gravity.

  1. Periodic: This pattern demonstrates rapid-shallow breathing, followed by a holding of breath, followed by a heavy sigh due to excessive CO2 concentrations in the bloodstream. This pattern flushes the CO from the bloodstream, which causes the brain’s autonomic system to shutdown respiration until the CO2 level raises to appropriate gas mixture. In the Periodic pattern, this cycle perpetuates. This is not to be confused with true Apnea, and can be diagnosed by witnessing that the pattern does not cause a change in color, such as no blueness of the lips, and the individual resumes shallow, rapid breathing without intervention, following the sigh. This pattern can be created through sustained anxiety, or by post-traumatic stress syndrome.

  1. Clavicular: This pattern exhibits chest-raising that elevates the collarbones while drawing in the abdomen and raising up the diaphragm. People who are “open-mouth breathers” attempt to increase intake through oral inhalation, but this provides minimal pulmonary ventilation. Worse still, the accessory muscles used in this pattern consume more oxygen than it provides. In exercise, these individuals fatigue quickly.

  1. Paradoxical: Often called “reverse” breathing, this abdominal pattern contracts during inhalation and expands on exhalation (using the muscles for the opposite purpose for which they were intended, thus, paradoxical/reverse.)  Paradoxical breathing associates with the expectation of exertion, sustained effort, resistance to flow, and stress.  Through stress, shock and fear, people can condition themselves to inhale (often married to clavicular and thoracic patterns), followed by hypoxic breath-retention and periodic sighs. As a result, this pattern causes very rapid fatigue.

  1. Hypoxic: In preparation of perceived exertion, this pattern comprises an inhalation, withholding of exhalation (breath retention) until the perceived exertion concludes. Holding the breath dramatically increases intra-thoracic pressure, causing health risks such as, fainting associated with vagal nerve stimulation, increase in blood pressure, and hypoxia (reduced oxygen levels). Chronic baseline hypoxic breathing is very common, especially in "athletes”, due to conditioned exertion. Hypoxic patterning connects with the "flight-fright-freeze" response, predominantly more "freeze", the defense mechanism of “bracing” caused by anxiety.

 

NOTE: Around January 2016 with the help of an excellent Physiotherapist, I discovered I had paradoxical breathing patterns. Since finding this out, I have done extensive amounts of research and breathing training, and whilst I sometimes forget (we are all human), I cannot tell you how much better I feel physically and mentally. I often used to get overwhelmed by situations and end up having a panic attack, the more stressed I was the more frequent they were, but now they are very rare, and I have the tools are awareness to come back quickly when I do have them. So it can be done, no matter the excuse.

CLINIC NOTE: Unless someone is trained in breathing patterns such as yoga and pilates, very rarely do I meet people who are aware of how they breathe and why being aware of this is important. So if this is the first time you are hearing/reading this, then you are not alone. As mental health awareness is increasing, more and more people understand that breathing can help, but without understanding how and why can make it difficult to remember (especially when feeling extreme emotions, when it is most helpful). So the concept is to become more mindfully aware, not just ‘do it’ – without being mindfully aware, you will not feel the true benefits and your body will not remember it is as much.

5.4: BREATHING MECHANICS

NOTE: Primary breathing muscles refer to breathing muscles used at rest, where as Secondary or Accessory breathing muscles refers to muscles used in forced breathing.

INHALATION

PRIMARY BREATHING MUSCLES:

  • Diaphragm: Isotonically contracts forming a dome into the gut, whilst elevating the lower ribs.

  • Interchondrial aspect of Internal Intercostals: rib elevation

  • Extermal Intercostals: rib elevation

  • Levatores costarum: rib elevation (back portion)

  • Scalenes (anterior, middle and posterior): elevates upper ribs

SECONDARY/ACCESSORY BREATHING MUSCLES:

  • Sternocleidomastoid: elevates the sternum

  • Upper Trapezius: aids upper rib elevation at the back by elevating the scapula

  • Serratus Posterior Superior: rib elevation (back portion)

  • Iliocostalis Thoracis: rib elevation (back portion)

  • Subclavius: clavicle elevation (albeit limited movement allowed)

  • Omohyoid: Tightens fascia of the neck, also arguably the oddest muscle of the body

due to its anatomy

  • Serratus Anterior (when arms are elevated): rib elevation

  • Latissimus Dorsi (when arms are elevated): rib elevation

EXHALATION

 

PRIMARY BREATHING MUSCLES:

  • Elastic recoil of lungs causing recoil of diaphragm, Intercostals, Levatores Costarum,

and Scalenes.

SECONDARY/ACCESSORY BREATHING MUSCLES:

  • Interosseous Internal Intercostals: depresses ribs

  • Abdominal muscles: aids diaphragm recoil

  • Transversus Thoracis: depress sternum and ribs

  • Subcostales: depresses ribs

  • Iliocostalis Lumborum: depresses ribs (lower ribs, back portion)

  • Quadratus Lumborum: depresses ribs (lower ribs, back portion)

  • Serratus Posterior Inferior: depresses ribs (back portion)

  • Latissimus Dorsi: depresses ribs

  • Internal and External Oblique: depresses ribs

(Chaitow, L., Bradley, D., & Gilbert, C. (2014). Recognizing and Treating Breathing Disorders E-Book. Elsevier Health Sciences. Page36)[i]

 

[i] Chaitow, L., Bradley, D., & Gilbert, C. (2014). Recognizing and Treating Breathing Disorders E-Book. Elsevier Health Sciences. Page36

IMPROVING YOUR BREATHING MECHANICS

Take a moment to try breathing with your diaphragm, your gut moving accordingly, and compare in standing, sitting, lying down (if you want, you could try lying on either side, front and back), and see if you find any more difficult and others easier. Generally, when trying to learn, diaphragmatic breathing patterns can be easier when lying down as there is reduced gravitational pressures interacting with the body. Everyone is different so there are a variety of techniques to try out and (combine if you feel it could help), so take your time and explore:

NOTE: If you have mental health conditions or symptoms, please seek professional advice and input. Your GP, Physiotherapist, Psychologist and Soft Tissue Therapist can all work together to make sure you get the best treatment for you. It is important to practice breathing patterns mindfully to ensure your body does not take over autonomically, and rather lets you remain in control. To start, you can simply focus on counting 4-5 beats on the inward breath, hold for 1-2 beats, and breathe out for 5-6 beats. This is a common technique to help someone during a panic attack as it helps divert attention away from the trigger and back to themselves. You can call this Internal Listening – listening to your body, and practice at your own pace with no short cuts as your body will remember them.

  • Pot Belly: Stick your belly out and create a ‘pot belly’, do not try and hold it in. Then place one hand on your chest and one hand on your gut/abdominals. Now slowly breathe in and down into your belly, and as soon as you feel your chest moving, breathe out whilst pulling your tummy in. This can create a vacuum effect meaning repeating it should become easier the more it is done, with the gut moving more and the chest less. Slow breathes in and out is important to prevent hyperventilating, so stay in control and focus on relaxing and practicing it calmly. If you find this difficult, do not worry and rather try one of the other techniques, as said above, everyone is different.

TIP: The easiest to implement of all the techniques, can be used anywhere at any time. Requires you are your attention alone, thus, no product, position, or person to help.

(Sitting, standing, lying down)

 

  • Weighted: Due to the mechanisms of this technique, it can only be done when lying down on your back. Place a weight on your gut between your rib cage and belly button. Make sure the weight is not too heavy or too light – a bag of sugar can be a great household  alternative. Place both hands on the chest. Focusing on the weight and the slight compression it gives to the gut, slowly breathe in and down to the gut, and in doing so, lifting the weight. As soon as you feel your hands on your chest move, slowly breathe back out allowing the weight to drop down and compress the gut one again. This technique works with the weight offering more proprioception, thus, the pressure from the weight requires more muscular engagement for the movement and gets more feedback in the process. For those who find it difficult to move the gut to breathe down through the diaphragm, this can be a helpful technique.

TIP: Put a cushion under your knees to reduce pelvic and lower back pressure. You may find placing a small cushion under the glutes (bum) helpful also but requiring this can also be a sign that your weight is too heavy.

(Lying down)

 

  • Resisted: Requires a resistance band large enough to wrap around the rib cage. Wrap the resistance band around your lower ribs so that the ends cross over at the front, and hold the ends with your hands, palms facing upwards. Hold the band so that it offers slight resistance to the rib cage, it is important to not wrap the band too tightly as the whole concept of this exercise is mobilising and strengthening weakened muscles – therefore holding too tightly can increase risk of worsening pressures and dysfunctions. When ready, slowly breathe in and down, feeling the resistance on the rib cage from the resistance band, ensuring that you focus on using the bottom of your rib cage and gut, rather than breathing above the resistance band. As soon as you feel your chest wanting to move, stop, take a second, and slowly breathe out feeling the resistance band loosening once more.

TIP: Moving against the compression of the resistance band requires increased musculature engagement, so it is important not too use one with high level resistance to reduce risk of further dysfunction. It is important to use your diaphragm in this technique, rather than relying on your rib cage to solely power the movement, so combining this with the feeling of the ‘Pot Belly’ technique above can be helpful, or the ‘Weighted’ technique when lying down.

 

  • Therapy: Any highly qualified therapist should be able to help you with any breathing pattern questions, problems, curiosities, and will be more than happy to help. Take your time to consider which therapist you want to see, listen to recommendations from people you trust and research to make sure they are the right one for you and your questions/problems/curiosities. A highly qualified and experienced Physiotherapist, Osteopath and Soft Tissue Therapist are all good places to start, with Strength and Conditioning/Personal Training and Chiropractic work being very good complimentary techniques.

TIP: It is important to research, I have seen a lot of professionals in my time already and have learnt off them all, both what to do and what not to do. Every therapist works differently depending on where they studied, any further qualifications, how much research they do, and their passions and interests. Therefore, no matter what, there is a therapist out there perfect to treat you, you just need to look!

5.4: BREATHING, GRAVITY AND POSTURE

Mentioned above in the discussion of Anatomy Trains, there has been a great amount of research to support how posture can impact mood and memory. Diaphragmatic breathing can help this, not only through biotensegrity, but can also impact stability within gravity. In general, the centre of a person’s gravity usually resides just above the navel/belly button, but dysfunctional biotensegrity can impact this. Diaphragmatic breathing patterns requires the diaphragm to mobilise the Central Tendon, and the diaphragm working similarly to a pump with regards to it moving up and down. With its close relationship to the spine, this mechanism promotes spinal stability, helping to release pressure throughout the spine:

  • hunched over with a kyphotic spine reduces how much the gut can move to accommodate diaphragm pressures through compression, so diaphragm breathing helps reduce kyphotic pressures by helping to open up the gut and create elasticity and mobility once again.

  • leaning back with a lordotic spine reduces how much the gut can move to accommodate diaphragm pressures through stretch and strain, so diaphragm breathing helps to reduce lordotic pressures by helping to re-connect balance between the thoracic and lumbar spines (with indirect impact on the cervical and sacral spines).

If someone consistently breathes with thoracic and/or clavicular patterns for example, the more tension begins to store in the gut through lack of mobility, and most of the air pressure is held in the rib cage. Moreover, with such breathing patterns restricting the diaphragm’s pump mechanism to work efficiently, the spine is mobilised less with regard to balancing within gravity. Consequently, with the centre of gravity storing tension, the spine less mobilised, and most air pressure being stored in the rib cage, the centre of balance becomes weaker and moves higher towards the rib cage.

 

Diaphragmatic breathing therefore helps maintain biotensegrity in the torso and also overall biotensegrity, enabling us to hold ourselves and move better against gravitational pressures.

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