Just Breathe

EBKids: Respiration inhale/ exhale jrespir021j4 390 by 300 pixels by Katherine D. Burgess 23rdof March 2006

There are at least 19 muscles (including groups of muscles) involved with respiration and we don’t really think about them unless we have been sick with a cough. Then we may find that our stomach muscles feel achy, our neck and shoulders feel tight, and it is difficult to take a deep breath without feeling a deep dull ache in our rib cage.

Imagine that you have COPD or asthma. Perhaps you have had open heart surgery or transplant surgery. Think about those times when you are under incredible amounts of stress. Do you shrug your shoulders? Does your neck hurt? Do you hold your breath? Do you take short shallow breaths? When we have some sort of physical or emotional trauma it can affect our bodies and result in dysfunctional breathing patterns and restricted range of motion (ROM).

Allow me to illustrate a common situation in my private practice and clinical work.

Let us assume that this patient has been thoroughly examined by his physician. After extensive testing and visits to specialists, there is no obvious cause to the source of his chronic neck pain in the modern western medical paradigm. He has been referred to an integrative medical clinic or to an integrative manual therapist by his healthcare provider for further evaluation.

John Smith walks into my office and says to me, “Heather, I don’t know where to begin. For three years or so I have been dealing with debilitating neck pain. I can’t turn my head without pain which makes driving very difficult. I don’t sleep well and am always waking up with pain. I get migraines and tension headaches at least three times a week, sometimes feeling dizzy or lightheaded. These interfere with my ability to do my job because I have to take time off from work. Nothing I have done has helped.”

While John has been telling me his pain story I am observing his movement. I notice that when he turns he is using his whole body. I see that at only 48 years oldForwardHdEv he has absolutely terrible head forward posture.

I ask John to turn his head in different directions and see that along with severely restricted ROM, he rotates his upper body and shoulder in the direction he is turning his head.  I also note that he appears to be breathing rather quickly and shallowly. I ask John if he ever has any chest pain.

John replies, “You know… now that I think about it, Yes. Sometimes when I take a deep breath it feels like I have a rod going from my chest straight through my body into my back.”

After again reviewing his medical history I explain to John that I have some thoughts as to what is going on but that I would like to start with a therapy session to actually feel all the soft tissues which will give me more insight. Our bodies tell our stories and through the power of touch we can receive information that can not be shared any other way.

With John comfortably on the treatment table, I notice that his chest and belly barely move when he breathes. In fact, it appears as if John forgets to breathe altogether! I remind him to breath and to try taking three slow deep breaths. This proves to be very challenging. As the session continues I note a variety of relevant restrictions in his soft tissues. John has multiple tender points in the Lung and Spleen acupoints (Traditional Chinese Medicine) in his chest as well as in his arms and legs. His scalene and sternocleidomastoid muscles are hypertonic with multiple trigger points. His shoulders are rounded forward and John is finding it difficult to lie his head in a neutral position on the table.

During treatment I ask John if he realizes that he is holding his breath and if it is because perhaps I am hurting him. John proceeds to tell me that he always seems to be holding his breath. I ask him what his stress levels are. John then tells me that three years ago his dad got very sick and that he was providing care for him. John’s dad then passed away 18 months ago. During that same time John started a new desk job and his wife had a baby. To me, this was the “Aha!” moment. STRESS! Increased respiration is the body’s natural response to immense stress which increases stress hormone production and results in muscle tension and long term can cause high blood pressure.

After John’s treatment we sit down again for a few minutes to talk. I tell John that I feel that his neck pain may be the result of the way he is breathing. Dysfunctional breathing is a very common problem that can be addressed through a variety of integrative approaches which may include physical therapy, pilates, cognitive behavioral therapy, massage therapy, and meditation.

I explain to John what happens when we don’t breathe into our belly. When we take shallow quick breaths the muscles involved with respiration aren’t able to lengthen and shorten the way they are supposed to. This leads to muscles that become tight and restrict our ROM, including the ability for our rib cage to expand which allows us to breathe effectively.

John and I then together come up with a treatment plan. We will start addressing the soft tissues involved with myofascial release techniques, stretching, TCM as well as Thai Traditional Massage (TTM), and movement re-education. However, the key to John’s improvement and possible recovery is rooted in his willingness to be an active participant in his healing journey. Certainly stretching and posture exercises will help address the muscle pain, but unless the underlying issue is addressed, these exercises will not yield long term results. John and I agree that breathing exercises and meditation will help address his stress as well as his breathing difficulties.

Over the next 5 treatment sessions John notices that he has less neck pain and is starting to sleep better. He is faithfully stretching and doing his breathing exercises. His headaches are occurring less frequently. After 3 months John notices that he does not have the sensation of a rod going through his chest anymore. I notice that John is no longer holding his breath and he is able to lie comfortably on the table with his head in a neutral position. John has a long way to go before the new movement patterns we are establishing become habit, but he is on the right track.


Would you like to try adding a breathing exercise into your daily routine? Try this deep abdominal breathing exercise where the individual breathes deeply into the belly allowing it to expand.

Place one hand on your chest and one on your belly. Inhale for a count of 5. Hold for a count of 5. Exhale for a count of 5. You will feel the hand on your belly rise if you are doing the exercise correctly. Repeat 5 times. This decreases blood pressure, slows the heart rate, and reduces muscle tension.