• Matthew Corbin D.C

Breath And Pain: Why breathing is essential for people with chronic pain.


Put one hand on your tummy and one hand on your chest. Take a deep breath. Which one raises first, your tummy or chest? If it’s your tummy was first then yay! You pass the test. If it’s your chest then, maybe we need to work on that a little bit.


Most babies from the moment they are born, breathe through their abdomen, it’s also how they can scream so damn loud! (intra abdominal pressure). Belly breathing tends to stop for many of us when we start school and start sitting down for long periods in class. We tend to slouch which is a lot harder to breathe through the tummy as the diaphragm is squeezed from the folding pressure of the torso. This makes us engage our chest more to get the oxygen we need to the brain and vital organs.

Here are some quick breathing facts to get the air flowing:

  • We breathe in roughly 13 pints of air per minute.

  • Good breathing helps the immune system as it clears out those bad little particles that cause infections.

  • The lungs float on water inside the body.

  • The lungs would fill a tennis court if they were spread out fully.

  • 70% of waste that is cleared by the body is done by the lungs.

  • The right lung is larger than the left.

  • “Most people can hold their breath for a maximum of 1-2 minutes but in 2010 Stig Severinsen from Denmark held his breath during a free dive for 22 minutes”.

  • “Psychologists have found that breathing practice is effective in fighting anxiety, depression, and stress. Physiological evidence has indicated that even a single breathing practice significantly reduces blood pressure”.

  • “Mouth breathing can actually change your face. Researchers found differences in the facial developments of children that breath through their mouths compared to children that nose breathe”.

  • “Your emotions change the way you breathe. Research has shown that our breathing pattern can influence the emotion we experience”.

Are you sold yet? Is good breathing the holy grail of pain relief?

Probably not because chronic pain is multifactorial, meaning chronic pain is not caused by one particular thing. It’s a combination of factors, improper breathing being just one, but an important one.


The CORE: Debunked, sort of.


The core is such a buzzword in the sports, therapy, healing, and woo-woo world. Many people think that a weak core leads to back pain. But there is plenty of science to show that is not true. Confusing for the clinician and confusing for the people doing their daily planks and crunches. What the science does show is that any movement or exercise is good for you, and it doesn't matter what that movement is. As long as you are not going beyond what your body is capable of.


The core is made up of the “pelvic floor muscles, transversus abdominis, multifidus, internal and external obliques, rectus abdominis, erector spinae (sacrospinalis) especially the longissimus thoracis, and the diaphragm”. Thanks Wikipedia. I personally think keeping everything strong is a good idea. It makes us resilient and reduces our chances of injury. Breathing controlled by the muscles and nerves, ones we don’t really see but are vitally as important as the ones we do see.


Many of my chronic pain patients I see here in Cardiff have faulty breathing mechanics. Shallow breaths, and breathing through their chest. Stooped posture too which compresses the diaphragm. Also, another symptom is breath-holding. When people are in a lot of pain, the holding of breath is very common. It is a reflex to pain, just like when you pull your hand briskly away as your hand brushes against a hot iron, oops. Unfortunately, breath-holding leads to more tension. When we hold our breath we stop air flow, and tighten all of the muscles that stabilise the spine. A muscular spasm of the lower back can also take our breath away, similar to being winded. Not pleasant, BUT it can get better.


If we go back to chest breathing, we can explain how this can be part of the problem. If we breathe through the tummy it is actually using up much less energy because it is what we are designed to do. Breathing through the chest uses different muscles. These are called the accessory muscles of breathing. These are muscles located in the chest wall, upper ribs, and necks. And these accessory muscles are only really meant to be used when under physical exertion like running. Now just a little deeper and we are there.

The sympathetic and parasympathetic nervous system:


As humans, we have many different states, emotional states, physical and chemical. Our nervous system is responsible for nearly every process that goes on in our body. The sympathetic nervous system is responsible for our fight, freeze, or flight system. For example, you are walking down Pontcanna fields in Cardiff, having a leisurely stroll, when you see a pack of lions coming for you. You have 3 options. Run like hell, freeze and die a miserable death or fight (I don’t recommend the latter). The sympathetic nervous system kicks in and can do the following:

  • Acceleration of heart and lung action.

  • Paling or flushing, or alternating between both.

  • Inhibition of stomach and upper-intestinal action to the point where digestion slows down or stops.

  • General effect on the sphincters of the body.

  • Constriction of blood vessels in many parts of the body.

  • Liberation of nutrients (particularly fat and glucose) for muscular action.

  • Dilation of blood vessels for muscles.

  • Inhibition of the lacrimal gland (responsible for tear production) and salivation.

  • Dilation of pupil (mydriasis).

  • Relaxation of bladder.

  • Inhibition of erection.

  • Auditory exclusion (loss of hearing).

  • Tunnel vision (loss of peripheral vision).

  • Disinhibition of spinal reflexes; and shaking.

Many people will have experienced a sympathetic response. It may have been giving a presentation in school, going on a first date, a panic attack/anxiety, bad news or even food poisoning. These are negative sensations but the sympathetic system can help us in dangerous situations too. Like heroic acts such as saving a life, the exhilaration of live music, etc.


The parasympathetic nervous system is a relaxed state. Being in a parasympathetic state is normal. Normal bodily processes are occurring, no lions on the horizon and everything is OK. What does this have to do with breathing? Near the end now.


When we breathe through our tummy, our heart rate drops, we breath slower and deeper and we are more relaxed. The stress hormones drop, and everything is more than ok. When we breathe through our chest the opposite is happening. The stress hormone is generally high in people with chronic pain. So breathing the right way can only have a good benefit for general health and of course pain. Yoga, Pilates, Buddhists, and many other cultures and practitioners have been practicing good breathing for thousands of years. Our Western culture seems to have been missing this little windy gem.

So imagine being able to sleep better, have more energy, better concentration, and less pain? Let's do it!


How many breathing techniques are there, and what is the best one?


100’s! But we don’t need to know all of them. Some are easy, some are hard and some if you are not careful can actually be dangerous (we won’t be teaching them). First, we need to be able to breathe from the tummy. If you have been a chest breather all of your life then it can feel odd, but totally worth it.


1. Lie flat on your back, a cushion under your head and your knees slightly bent under a cushion

2. Take a deep breath in. Notice where the air is going. Chest or tummy?

3. Now take a breath in with one hand on the chest and one hand on your tummy. Do you feel it in your tummy or chest?

4. This time close the mouth and suck in air through the nose and try to inflate your tummy. Feel your hands widen as your tummy inflates.

5. Give yourself a pat on the back. You have just done a belly breath.


I would practice this every day for 5 minutes. Just close your eyes and only focus on the breath and inflating the abdomen which the chest staying as still a possibility. When you have this down you can try this one truly fantastic breathing technique. It’s called the 4 7 8 technique, also known as the relaxing breath.


1. Inhale for 4 seconds

2. Hold for 7 seconds

3. Exhale for 8

4. Repeat this 3x every day.


Habits take time to form, both good and bad. If you stick with this then only good things can happen. Better health, lower stress, lower anxiety, more energy, and less pain! And it’s FREE!

I hope this helps and you can give this to someone who could also use it


Till next time!


References:

1. https://www.thebreatheffect.com/facts-about-breathing/

2. http://www.jointventurespt.com/blog/which-are-my-core-muscles#:~:text=Major%20muscles%20included%20are%20the,dorsi%2C%20gluteus%20maximus%20and%20trapezius.

3. https://en.wikipedia.org/wiki/Core_(anatomy)

4. https://courses.lumenlearning.com/boundless-ap/chapter/functions-of-the-autonomic-nervous-system/#:~:text=The%20sympathetic%20division%20initiates%20the,including%20respiration%20and%20cardiac%20contractility.

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