Because it is something that occurs whether we think about it or not, the majority of us typically don’t pay too much attention to our breathing, especially the mechanics of our breathing. This will likely change, however, if you are about to embark on a corrective exercise or functional rehabilitation program with a chiropractor, physical therapist, or personal trainer. Even if you aren’t, it’s time you start paying attention to how you breathe because it has a wide-reaching influence on the rest of the musculoskeletal system.

Breathing, or respiration, has been described as the most important movement pattern in the human body and according to Karel Lewit, the late Czech neurologist who is commonly referred to as the father of manual medicine, “If breathing is not normalized, no other movement pattern can be”. In the first three months of life, the diaphragm is primarily involved in respiration, however after that and throughout the rest of life it also plays a vital role in spinal and torso stabilization. As we mature and become adults, we tend to lose our proper breathing stereotype because of mechanical factors (e.g. sitting for long periods), emotional factors (e.g. stress) and societal factors (e.g. hollowing or ‘sucking in’ our mid-sections in order to appear slimmer or train core muscles).

These factors often lead to a pattern of chest breathing as opposed to diaphragmatic (abdominal) breathing. Ideally the diaphragm descends to initiate inspiration, then the lower ribs expand in a lateral (side-to-side) and posterior (backward) direction, and finally the upper rib cage expands. This gives the appearance of the abdomen distending with inhalation, similar to what is observed in an infant. The most common fault seen with respiration is lifting the chest instead of distending the abdomen during inhalation. In more extreme cases, the abdomen will actually draw in during inhalation, inhibiting normal descent of the diaphragm. From a musculoskeletal perspective, this abnormal breathing stereotype results in overactivation of the muscles of the neck and shoulders required to lift the rib cage, decreased spinal and core stability, as well as altered movement patterns, contributing to a variety of pain syndromes.

When you breathe properly, there are certain things that should occur:

  • 360 degree expansion of your abdominal wall. You want your belly to expand like a balloon, front, back, and side to side.
  • Lateral and posterior expansion of your lower rib cage. This should look like the movement path of a bucket handle.
  • Parallel orientation between your lower rib cage and pelvis. If your chest lifts during inhalation, your low back extends and the axes of your rib cage and pelvis lose this parallel orientation.
  • Relaxation of your neck and shoulder muscles.
  • Symmetrical movement of your rib cage and abdomen.

These patterns should stay consistent whether you are standing, sitting, or lying down.

When teaching proper breathing mechanics, it is important to start with the basics. You want to breathe through your nose, which has been shown to activate the diaphragm and promote relaxation, as well as to start in less challenging positions and work into more functional postures. This progression is how we developed as infants, and when relearning how to breathe properly it makes sense to follow the same sequence. While a lot of the focus is on the inhale, it is also important to make sure you breathe all the way out during the exhale.

A good starting place is to lie face down. This is termed crocodile breathing. The goal is to breathe into your abdomen and lower back. You should feel your belly expanding into the floor. Normally your hands rest on the floor under your forehead, but you can place them on the sides of your waist and feel your breath expand into this region. In addition, you can place a small weight on your lower back to serve as feedback instructing you where to breathe.

From there, you can progress to lying face up with your hips and knees bent 90 degrees and your feet resting on a surface (e.g. a chair). You can place one hand on your belly and the other hand on your chest. You want to feel your belly hand move while your chest hand remains relatively still. Again, imagine your belly as a balloon and you are filling up the front, back and sides of the balloon. In this position, it is also helpful to imagine breathing into your pelvic floor to promote proper descent of your diaphragm.

Once you have mastered these two exercises in order to gain better awareness of the breath, you can start to incorporate movement along with breathing. Begin in the quadruped position, with your hands under your shoulders and your knees under your hips, keeping your spine flat. The same rules apply as with lying. You want to breathe into your abdomen and pelvic floor and fill all sides of the balloon. From here, you can sequence your breath with the Cat-Cow exercise (also known as Cat-Camel). Descriptions of this exercise can be found all over the internet, but as it applies to breathing, you want to inhale with the flexion phase (rounding the back upwards) and exhale with the extension phase (dropping the abdomen to the floor).

From here, the sky is the limit. I would suggest mastering proper breathing mechanics in standing and sitting, incorporating your hands on your belly and chest or on the sides of your waist to reinforce proper abdominal expansion, but mastering the breath in a variety of postures and movements is crucial in order to make it second nature.

If breathing is asymmetrical, for example you have difficulty breathing into and expanding one side of your abdomen, you can correct this fault by breathing in a side-lying position. If you have difficulty breathing into your left side, for example, you can lie on your right side, place your left hand on the left side of your waist, and breathe into this hand.

When you are not able to place your hands on your belly or waist, for example when walking or doing another functional activity, there are great options that you can use for biofeedback to reinforce the correct breathing stereotype. There are specialized breathing belts, for example the Core360 belt, that you can wear around your waist that cue you to expand your abdomen into the belt in all directions. Another option includes wearing a weight belt around your abdomen, the firmer the belt the better. You can even tuck small rolled up towels between the belt and your body in areas that you aren’t activating as well. This serves as an additional cue to breathe into these under-activated areas. Kinesiology tape, wrapped around the abdomen, can also serve as a feedback tool for proper abdominal expansion. It should be noted that, given the concerns regarding increased blood pressure and heart rate, all candidates for belt wearing should be screened for cardiovascular risk by a medical professional.

Just like learning any other skill, proper breathing requires practice. The majority of our breathing throughout the day is involuntary, therefore ingraining this movement pattern through repetition is important so that it becomes habitual.