Breathing is the primer to all human movement. When breathing is altered due to stress or prolonged periods of stress, the cycle of anxiety and poor breathing can significantly alter a person’s well-being.
BPD – Breathing Pattern Disorders:
Breathing pattern disorders (BPD) – the most extreme of which is hyperventilation – are surprisingly common in the general population. Dysfunctional breathing is described as chronic or recurrent changes in breathing pattern causing respiratory and non-respiratory symptoms that can impede performance and optimal movement. Most often it is an umbrella term that encompasses hyperventilation syndrome and vocal cord dysfunction; which can be further broken down into specific dysfunctions.
Diagnosed dysfunctional breathing affects 10% of the general population. However, we see a high number of the general public with altered breathing patterns due to stress, poor postural habits and pain. Despite decades of research BPDs, together with a range of the resulting pathophysiological biochemical, psychological and biomechanical effects, remain commonly under-recognized and under addressed by health care professionals as contributing to pain, fatigue and movement dysfunction in general. The physiological consequences of unbalanced breathing can be profound. The body starts to adapt both structurally with a range of systemic symptoms (raised shoulders, upper chest breathing, jaw tension, headaches, chest tightness and reduction in thorax expansion); as well as physiologically (the body struggles to maintain chemical balance, deep sighing, restless sleep, exercise induced breathlessness, frequent yawning and hyperventilation, and fight or flight reactivity). Both mind and body are affected by ‘poor breathing’.
Some of the most common dysfunctional breathing patterns are hyperventilatory, apical, thoracic, paradoxical, periodic, respiratory alkalosis, hypocapnia and hypoxic. These may appear exclusively or in combination depending upon the state and level of the individual’s respiratory dysfunction.
- Hyperventilatory: is the state in which breathing occurs in excess of metabolic requirements, leading to an acute reduction in partial pressure of carbon-dioxide (PaCO2) and a predictable set of physiologic changes. This rapid-breath pattern uses accessory muscles and restricts diaphragmatic movement being predominantly situated at the thorax.
- Apical Breathing: It refers to a pattern of breath that contains most movement to the upper chest. Breathing plays a major role in both posture and spinal stabilization. Some of the symptoms with this pattern can exhibit chest-raising that elevates the collarbones while drawing in the abdomen and raising up the diaphragm. Those who are “open-mouth breathers” attempt to increase intake by breathing through the mouth vs nose, but this provides minimal pulmonary ventilation resulting in the accessory muscles used in this pattern consume more oxygen than it provides. In exercise, these individuals fatigue quickly. Bio mechanical compensations can include rib head fixations or classic lower/upper crossed patterns of muscular imbalances.
- Thoracic: Closely related to apical breathing, these “chest-breathers” typify aggressiveness. This pattern lacks significant abdominal movement, being shallow and costal. Enlarging thoracic cavity creates a partial vacuum by lifting the rib cage up and out through external intercostals muscles. When our breathing movement is kept to only part of the chest or thorax, fewer muscles are engaged. Those muscles that are used have to undergo more stress and more movement to facilitate breathing rhythms. This reduces pulmonary ventilation, since the lower lobes receive the greatest blood volume due to gravity.
- Paradoxical: Often called “reverse” breathing, occurs when the abdomen contracts during inhalation and expands on exhalation. Paradoxical breathing associates with the expectation of exertion, sustained effort, and resistance to flow, and stress. Patients with chronic airways obstruction also show in drawing of the lower ribs during inspiration, due to the distorted action of a depressed and flattened diaphragm As a result, this pattern causes very rapid fatigue.
- Respiratory alkalosis: This involves a rise in pH of the blood, from its normal levels of ~7.4 due to excessive CO2 exhalation during rapid breathing. An immediate effect is smooth muscle constriction, narrowing of blood vessels, the gut etc, as well as reduced pain threshold and feelings of anxiety, apprehension (Leon Chow 2014)
- Periodic: This pattern demonstrates rapid-shallow breathing, followed by a holding of breath, followed by a heavy sigh. It is an over-responsiveness to CO2 concentrations in the bloodstream. This “airy” panting “blows off” or flushes out 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 pattern can be created through sustained anxiety, or by post-traumatic stress syndrome (Sonnon 2014).
- Hypoxic: Otherwise known as breath holding. This is often seen in swimmers, as well as clients who push too hard and cannot control breathing through exertion. This results in a reduction of oxygen (O2) supply to tissue, below physiological levels. 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 and intra-abdominal pressure, causing health risks such as, fainting associated with Vagal nerve stimulation, increase in blood pressure, and hypoxia (lack of oxygen). (Sonnon 2014)
- Hypocapnia: Deficiency of Carbon dioxide (CO2) in the blood resulting from over-breathing/hyperventilation (HVS), resulting in increased pH, respiratory alkalosis (Naschitz et al 2006). (Leon Chow 2014)
Changes in Breathing, Causes Changes in Movement:
As a clinician or doctor diagnosing this would be your specialty, but as a movement coach, this is outside our scope of practice. However, most often through screening breathing techniques, I can most often determine if someone’s is an apical breather, if their diaphragm is dysfunctional, and or most often, using more of one side of the rib cage or the other. In association with this there are two major areas affected by dysfunctional breathing; they are optimal thoracic spine mobility, and optimal lumbo-pelvic control. In BDP the thorax and hips most often becomes stiff. Why?
Stiffness and sloppiness alternate when we consider the joint by joint approach. It is a present and observable phenomenon producing many common movement pattern problems. Often if you don’t have the necessary core stability, the T-spine will get stiff and this also works in reverse. If the T-spine is too stiff, the core stability will be compromised. Logically we must make sure these areas are mobile, because if the hips and T-spine aren’t mobile, the lumbar stability we create is synthetic and it will not stick outside the session. Most of us make the mistake by assuming sloppy knee, stiff ankle, stiff T-spine without considering the potential problems above and below.
How about the diaphragm? How often do you assess breathing? If the posterior aspect of my diaphragm attaches to my pelvis and I do not breath well, or I apical breathe… my hips and lower back can become tight, thus, my hip flexors can become tight because they transverse through my diaphragm. Or how about blood flow to my lower limbs? The aorta also transverse’s through the diaphragm. Breath is critical to well-being.
It can work either way. It’s not about finding what came first, the chicken or the egg—you have to catch both or you can’t manage either.
I always start by addressing and screening a client’s breathing, as well as addressing their stress. Most often clients are told to breath deeper or practice deep diaphragmatic breathing, and in some cases this can improve proper breathing mechanics as it does encourage the biochemical release of relaxation hormones. However, most often this can result in a client feeling anxious, dizzy, nauseous etc.
Why? We often incorrectly attribute this to O2 saturation, when actually the ratio of CO2 to O2 permits the release or retention of O2 from the blood (Sonnon 2014).
Changing your breathing pattern is critical to optimal health and wellness. Increasing CO2 retention, can utilize more O2 from each breath, which in turn leads to better circulation and oxidation for tissue health, as well as prevention of disease and injury.
Screen the breath first I usually will screen in standing, supine or prone,
Supine: have the client lay on their back, knees bent and if possible, place your hands on either side of the ribcage. Ask them to breathe normally, and then into your hands. This a great way to see if a client breathes more with one side vs the other.
Prone (crocodile breath): Client lays on the floor on their stomach. Place one hand on their lower back and upper back and ask them to breathe into your hands. Watch for rises in just the chest, both hands should move together.
Standing: I ask the client to close their eyes and breathe normally. I place on hand on the upper chest and one hand on the back. As the client breathes I lower the hand in the back to the mid back and then lower back to determine if they breathe fully. Then I place one hand on the belly to see if the client can belly breath.
I use all of these when screening, especially if I feel breathing is compromised.
In the first early stages of coaching, address exertion and watch a client’s physiological adaptations. With the help of a team, working with other health practitioners, below is a list of suggestions for re training proper breathing mechanics:
1. Reduce the synergistic inputs to the pain process (i.e. modify adaptive demands)
2. Deactivate trigger (or tender) points
3. Remove noxious input from scars
4. Enhance spinal and general joint functionality
5. Improve muscle recruitment, strength, flexibility
6. Pay attention to exacerbating factors in diet, lifestyle and habits (sleep, exercise, posture, balance, breathing)
7. Consider emotional/psychological factors and lifestyle stressors
8. Your corrective strategy should include breathing techniques and corrective exercises to help strengthen the diaphragm and re pattern/re train the ribcage for adequate activation of breathing mechanics.
Gray Cook – http://graycook.com/?p=35
FMS – Functional Movement Systems – http://www.functionalmovement.com/
Scott Sonnon – 6 Dysfunctional Breathing Patterns – http://www.rmaxinternational.com/flowcoach/?p=443