Doctor's Blog

The importance of proper breathing.

“Breathing dysfunction is frequently associated with common musculoskeletal problems and is present in approximately 60% of active, healthy adults. It is also a contributing factor in movement dysfunction and can lead to decreased pain thresholds and impaired motor control and balance.” (Kiesel)

The diaphragm – the primary muscle used in breathing – is a large muscle situated at the bottom of the rib cage, that when it contracts, the air pressure in the lungs is lowered, allowing air to enter. Then, when the diaphragm relaxes, the air pressure in the lungs is normalized with the outside air allowing excess to escape. The diaphragm is controlled by the Phrenic Nerve, which originates from the C3-5 nerve roots in the cervical spine (neck). There are also accessory muscles that can assist the diaphragm with breathing, including the intercostals, scalenes, transverse abdominis etc. In addition to respiration, the diaphragm also plays an important role in core stabilization.

It forms the lid of what is occasionally referred to as the core “box” – which is the muscles in your lower torso that have the function to stabilize your lumbar spine and pelvis. When your lumbar spine and pelvis are not stable or subluxated, you are a back injury waiting to happen – especially if you lift weights or play sports. These muscles that form the core box include the internal and external obliques, QL, the pelvic floor muscles, transverse abdominus and the diaphragm. The diaphragm is essentially the lid to this box. In order for this box to function properly, ALL sides need to be functioning properly.

It is impossible to say for sure, but a very large percentage of the adult population can/do not properly recruit their diaphragm muscle as the primary muscle to breathe, and instead, they recruit the muscles that attach to their shoulders and upper rib cage. Much of this widespread dysfunction is likely due to the extended sitting that has become all too common in society today – you sit in your car to get to your office, where you sit at a desk all morning, then go sit at a table for a “power lunch” meeting, then return to your office to sit at the desk until the end of the work day, only to sit in your car to get home so that you can sit in the recliner in front of the television until it is time for bed, and you repeat it all again the next day. Sound familiar?

Over time, the diaphragm becomes inhibited because it isn’t being regularly used. When the diaphragm becomes inhibited, it is dysfunctional which then causes the core to become dysfunctional – remember, for the core box to function properly, ALL sides need to be functioning properly. When the core is dysfunctional, the lumbar spine and pelvis are unstable, which puts you at greater risk for sustaining a low back injury.

So, how can you test your diaphragm to ensure that it is working properly? At home, lie on the floor face up with the knees slightly bent. Place a small pillow under the head if that is more comfortable for you. Place your hands lightly on your stomach, with your fingers interlaced. Take a deep breath in, and really focus on whether your hands rise toward the ceiling first, or if your chest/ribs rise first. If your hands and belly rise first and your fingers separate slightly, congratulations, your diaphragm is likely functioning properly. If your hands do not raise first, or this is challenging for you, schedule an appointment to have your breathing evaluated to determine what is causing the dysfunction, and the best way to correct it.

Here is an exercise that you can do to train your diaphragm if it is already functioning well, and needs some improvement. Just like the test, lie on the floor face up with knees slightly bent. Place your hands lightly on your stomach with your fingers interlaced. Concentrate on breathing using the diaphragm, not using the chest, and feeling the stomach rise as the lungs fill from the bottom. Let the stomach fall naturally when breathing out by relaxing the diaphragm. Repeat for 10-15 breaths. Progress this by placing a small weight on the stomach, such as a book or small dumbbell, on do it all again. The next stage is to stand up and place your hands on your stomach again, feeling how you breathe. Surprisingly, you may find this step requires some concentration initially. Finally, once you’ve mastered breathing while standing, work on proper breathing using the diaphragm on a rower or stationary bike.