So you think breathing is simple?

The definition of breathing: “the passage of air into and out of the lungs to supply the body with oxygen.” It sounds such a simple a process but how many of you have thought about the mechanisms involved in this fundamental of human activities?

Michael J. I’Anson M.Sc (Chiro), D.C. Practice Director

As I sit here putting this article together, I ask myself if the way in which I breathe is important for my clarity of thought and the ability to be energetic with good health and performance to carry out my daily tasks as a Chiropractor. My aim is to show and explain to you that how we breathe profoundly affects both health and performance. As you read these words, consciously think about the way you are breathing and ask yourself the question, “how am I breathing?” Notice how you are breathing-in, is the air entering through your nose, your mouth or both.

If you are breathing through your nose, the air will be naturally warmed by its contact with the lining of your nose. Under this lining, close to the surface, circulating cells are carrying oxygen to the tissues through small blood vessels (called arterioles). These arterioles are made of smooth muscle (reacts via an involuntary stimulus) which responds to chemical triggers which tighten and relax. Is your breathing fast or slow, is it a big or small breath? Is your head, shoulders, chest or abdomen moving as you breathe in and out? Are there any breathing restrictions or associated pain? All important questions you can yourself about the state of your breathing.

Breathe in….

…and breathe out.

But first, some basic physiology behind the mechanics of breathing which involves the two processes of breathing in and out… As you breathe in, your diaphragm contracts causing it to flatten and move down. This increases the space in your chest cavity into which your lungs expand. The muscles between your ribs (known as the intercostals muscles) also help enlarge the chest cavity by aiding to pull your rib cage both upward and outward. As your lungs expand, air is sucked in (through your nose and/or mouth) and travels down your windpipe into your lungs.

After passing through your bronchial tubes, the air finally reaches and enters the alveoli (air sacs) at the base of the lungs. Through the very thin walls of the alveoli, oxygen from the air passes into the surrounding capillaries (blood vessels) where haemoglobin helps move oxygen from these air sacs into the blood. At the same time, carbon dioxide moves from the capillaries into the air sacs. Oxygen-rich blood from the lungs is then carried through a network of capillaries until it finally passes into the pulmonary vein. This vein delivers the oxygen-rich blood to the left side of the heart where it is then pumped out to the rest of the body. This type of breath stimulates part of the nervous system (the parasympathetic) that helps calm and cool the body creating a sense of mental clarity and attentiveness.

When you breathe out, or exhale, your diaphragm relaxes and moves upward into the chest cavity as do the intercostal muscles between the ribs. As this space gets smaller, air rich in carbon dioxide is forced out of your lungs and windpipe, and then out through your nose or mouth. Breathing out requires no effort from your body unless you have a lung disease or are doing physical activity. When you’re physically active, your abdominal muscles contract and push your diaphragm against your lungs even more than usual rapidly pushing the air out of your lungs.

The typical respiratory rate for a healthy adult at rest is 12-20 breaths per minute. However, respiratory rates vary with age which I have listed below:

Age | Respiratory Rates (breaths per minute)

Birth to 6 weeks: 30-60
6 months: 25-40
3 years: 20-30
6 years: 18-25
10 years: 17-23
Adults: 16-20
Elderly - 65 years old: 12-28
Elderly - 80 years old: 10-30

Hopefully, now you have a better understanding of your normal breathing pattern, you can assess your own breathing as to how good you think you are doing. Unfortunately, there is a situation called ‘life’ which can dramatically affect the so-called ‘normal’ breathing model described above which we need to consider next!

There are, of course, diseases which can alter the ability for us to breathe at a normal respiratory rate. These include: asthma, pneumonia, bronchitis, tuberculosis, shock, anxiety, panic attacks, pulmonary oedema, emphysema, cystic fibrosis, heart failure and cancer, to name but a few. In today’s world of high pressure, expectations and deadlines, anxiety and depression are on the rise causing sufferers to adopt incorrect posture which, in itself, can have a profound effect on their breathing as well as effecting the intensity of their anxiety/ depressive symptoms. If you correct a poor breathing pattern, anxiety levels will fall. It’s not a cure but evidence suggests it can be an enormous help.

However, there is one situation that is now being linked to the onset of certain diseases later on in life that is so often over-looked and that’s the effects of ‘poor posture’ and how it significantly alters your ability to breathe. Poor posture moves the body away from a normal state and induces the process of shallow breathing. But, before we get into the consequences of this, let’s first look at what we mean by a ‘shallow breathing’ pattern.

Shallow breathing: Thoracic breathing, or chest breathing

This is described as the drawing in of a minimal breath into the lungs, usually by inhaling air into the chest area using the intercostal muscles between the ribs rather than throughout the lungs via the diaphragm. Shallow breathing can result in or be symptomatic of rapid breathing and hypoventilation (which for other reasons can be a serious symptom). Most people who breathe shallowly do so throughout the day and are almost always unaware of the condition. In clavicular breathing (aka, upper lobar breathing) air is drawn predominantly into the chest by the raising of the shoulders and collarbone (clavicles), and simultaneously contracting the abdomen during inhalation. The maximum amount of air drawn into the lungs this way can only be maintained for short periods of time since it requires a lot of effort. When this breathing pattern is accompanied by poor posture, many muscles in the upper body lose their ability to properly function. The longer we sit during the day, the less our body is able to fight the forces of gravity and maintain a strong, stable core.

Tight muscles around the chest, (in particular the pectoralis minor in the upper chest and scalenes at the side of the neck) cause a rounding of the shoulders resulting in a forward head posture. This weakens the mid and lower back muscles by inhibiting the lattissimus dorsi, middle trapezius and rhomboids, as well as the quadratus lumborum (a muscle running between the pelvis and the lower back/lower ribs), which help us maintain an upright posture. These tight muscles can also cause shoulder instability and impingement syndromes by inhibiting the serratus anterior, biceps tendon, deltoid and infraspinatus, which allow us to freely move our shoulder blades into a variety of positions. Shoulder problems due to poor posture are the third most common predicament that people present with at the Practice. Also, headaches, migraines and neck pains are commonly associated with this type of problem.

At this point, there will be those of you who are thinking to yourself, “There is nothing wrong with me as I have a really good posture so therefore my breathing pattern is fine”. If that is the case then you will not mind doing a little experiment for me! Get yourself a balloon – what is the first thing you notice as soon as you start to blow it up. You sit-up straight! But why? It is simply because you are able to fill your lungs to their maximum to blow the balloon up. By slouching and inhibiting the muscles mentioned above, you cannot blow the balloon up effectively, if at all. What does this tell us? Restricting the lungs by squeezing them and making them smaller makes it harder to breathe which means less oxygen (and more carbon dioxide) in the system and, thus, less energy.

How much does your head weigh?

That depends on your posture!

A 2006 report by the American Academy of Physical Medicine and Rehabilitation showed some striking results based on posture. Using 70 able-bodied participants in wheelchairs, the study found that bad posture does indeed affect breathing and lung capacity. They tested a seated slouch, normal seating, standing and a special posture that imitates standing spinal alignment. (This special posture involved tilting the bottom of a seat with a lumbar support and the spine against the back part of the seat without any sitting bone support).

The report found that slumping produced the worst lung capacity and expiratory flow (no surprise there!) Normal sitting was better with the special posture being better still and in some cases, as good as standing in both lung capacity and flow. The report concluded that not only was slumping in a chair producing the worst results but interestingly, sitting or standing straight for a few minutes after slouching, had no effect on the results. This means your muscles, tendons and ligaments associated with breathing become trained by the constant slouch pose so therefore a person with this type of alignment and associated shallow breathing needs to be trained in an entirely new way to create a new “upright” posture.

Here is something to think about: If you put a large glass and clear plastic bag over a plant and seal it, the plants ability to breathe would be compromised (irrespective of whether you are watering it or not). What would happen? Due to the lack of oxygen, the leaves would start to droop and the plant would begin to wither. As time goes on, the withering worsens and the leaves go brown, die and fall off. Let’s look at this analogy and humans – the lack of oxygen affects our muscles, blood circulation, organs and overall well-being. Our bodies become physiologically ‘stressed’ with the result that we get sick.

Only recently, young people are being targeted at school, as diseases of old age actively begin when we are young. In early June, it was reported in the national press that a primary school in Stirling has instituted a ‘daily mile’, which involves the pupils walking or running for a mile every day. This takes place alongside the children’s regular PE lessons and is primarily a scheme to help improve childhood fitness and reducing obesity (one in 10 children now starting primary school is clinically obese). These children are not sitting all day, which reduces the levels of poor posture, but also it’s strengthening their muscles to help when they do sit in lessons. In other schools, children as young as three are being taught the importance of getting out and about to again educate them in preventing the diseases of old age. The ‘Active Movement Project’ has been teaching how to make exercise a natural part of their daily life and the dangers of a sedentary lifestyle.

Maintain good posture & develop a good breathing pattern

• Sleep in a good bed that’s not too hard or soft as it needs to support your spine. If it becomes misshapen by poor support then you will be inducing a problem from the beginning.

• Watch your weight! Excess weight across the abdomen means your body has to work harder to stay up straight. Your abdominal muscles will also weaken meaning you move into a slouched position and from what I have written above, you know what that means. In addition to that, your back muscles will also have to work harder to keep you upright which can lead to back pain and spasms. Simple leg-lifts while lying on your back can help strengthen your stomach muscles which will give your back a break.

• Regular exercise not only keeps your weight down but it will also tone your muscles and help keep you flexible so that a correct posture can be more easily maintained.

• Keep your spine healthy by seeing a chiropractor (or your chosen healthcare professional) for regular spinal health care. Any pain to the spine as well as other areas will make it difficult to maintain a correct posture and breathing pattern.

• Have a regular eye check-up because if you have problems seeing, it may well cause you to hunch over to look at the floor instead of looking out and forward.

• Have a good working environment at school and at work, as well as properly fitting clothing and shoes. All these things will help with your posture.

The big question remains, “how can I help myself and improve my breathing”? Below are some exercises you can practice. I have had some good success with these with my patients. Delivering the advice is easy but patient compliance means an individual must want to change to help themselves!

Breathing Exercises

1. Belly breathing exercise – This exercise helps deepen the breathing and cleanse the lungs. These exercises will also increase energy and decrease tension. Practice this exercise 5 minutes a day-

Lie flat on your back to get a proper sense of deep breathing. Have a small pillow tucked under the neck and knees to reduce any tension. The natural breath in this position will create a slight rise in the stomach upon inhaling and a slight fall upon exhaling.

Place your hands palm down on your stomach at the base of the rib cage with your fingers spread out. As the diaphragm pushes down, the stomach will slightly expand causing the fingertips to move giving some feedback that something is happening.

This movement indicates full use of the lungs, resulting in a full, deep breath rather than a ‘lifting of the chest’ type-breath. Chest breathing only fills the middle and upper parts of the lungs whereas belly breathing is the most efficient method. Infants and small children use only this method until their chests mature.

2. Complete breathing exercise – it helps if you can face a full-length mirror so to avoid abnormal breathing patterns like lifting the shoulders.

Sit up straight. Gently place one hand on your chest and the other on your abdomen. Exhale.

Inhale and, at the same time, relax the belly muscles. Feel as though the belly is filling with air.

After filling the belly, keep inhaling. Fill up the middle of your chest. Feel your chest and rib cage expand.

Hold the breath in for a moment, then begin to exhale as slowly as possible.

As the air is slowly let out, relax your chest and rib cage. Begin to pull your belly in to force out the remaining breath.

Close your eyes, and concentrate on your breathing.

Relax your face and mind.

Let everything go.

Practice about 5 minutes.

3. The ‘Humming Breath’ exercise - This is a serious exercise but can seem a little strange to begin with.

Follow the steps above for the ‘Complete Breathing Exercise’ for inhaling but as you begin to slowly exhale, make a ‘Humming’ sound. Keep making this humming sound as long as possible. Pull your stomach muscles in, squeezing out a few more seconds of humming.

Then relax.

Practice for 2 to 3 minutes.