Patients can lead a pain-free and active lifestyle by learning proper deep-breathing techniques
Taking breathing into account during rehabilitation exercises promotes more efficient and coordinated use of muscles, as well as a better awareness of muscle tension or relaxation.1 It can also help patients develop healthier movement patterns and help focus awareness on the status of other muscle groups.
The integration of full, easy diaphragmatic breathing and reduced muscular effort provides a foundation on which patients can begin to move toward a more mobile, pain-free, and active lifestyle.
Chronic-pain patients often develop excessive sensitivity, which can make even moderate physical contact feel painful.2 This appears to be likely months or even years after serious incidents of trauma, such as a whiplash-type spinal injury.3 Many chiropractic patients have conditions that are aggravated by spinal muscle tension and restricted breathing. This includes many post-injury victims who have a fear-arousal stimulus from having recently been injured. Any treatment program for patients with these types of problems should include breathing and movement awareness exercises for the thoracic spine and rib cage.
Breathing 101
Pulmonary oxygenation with full, diaphragmatic breathing is a cornerstone of health and well-being. During this process, the diaphragm moves downward into the abdomen during inhalation, pressing on the viscera and causing abdominal expansion. This massages and mobilizes all of the abdominal organs, squeezing and releasing them like sponges. All of the organs of digestion, assimilation, and elimination lie below the diaphragm and can be stimulated during full respiration. This contributes directly to their effective functioning, and full breathing is essential for complete digestion and elimination, and for the processing of toxins.
When restricted breathing results in organs receiving insufficient compressive stimulation, including reduced flow of blood and nutrients to the tissues, they are subject to deterioration.4 Sensory nerves flood the spinal column with irritative stimuli, causing overactivation of motor nerves, and inflammation of nearby muscle and fascial tissues.5
Tension in the Air
If the diaphragm’s expansion and contraction processes are restricted, the accessory respiratory muscles must come into play. As the muscles of the chest and neck take on more of the work of breathing, chronic tension develops in the muscles of the upper back, rib cage, neck, and jaw. The systemic tension that is produced fosters a vicious cycle of chronic muscle tension that reduces blood flow, causing localized ischemia, which in turn results in further irritation of the muscle and further pain exacerbation. Chest breathing is also one of the chief characteristics of the flight-or-fight response; it is a hallmark of hyperarousal of the sympathetic nervous system.6
Don’t Hold Your Breath
In addition to providing better tissue oxygenation, relaxed breathing automatically promotes a reduction of excess muscle tone, since it requires the torso muscles to release chronic muscle-holding patterns. All rehabilitation exercises should emphasize full, diaphragmatic breathing, and discourage breath-holding. For many people, this will initially require a significant amount of conscious effort. Eventually, this breathing awareness becomes ingrained, and little to no effort is required to maintain it.
A good example of the use of diaphragmatic breathing in spinal rehabilitation is during the pelvic tilt exercise. Although this maneuver is usually performed while lying on the floor, it is even better when practiced in the standing, upright posture.
The first step is to ask patients to pay attention to the muscles they are contracting while they perform the exercise. They should try to determine which muscles are working and tensing. Specifically, are they using muscles in their legs, buttocks, back, shoulders, or neck? This is an exercise for the abdominal muscles, and primarily the transverse abdominis muscles when done correctly. So if they notice other muscles in other areas working, they will start to recognize some of their inappropriate muscle-tension patterns.
Patients should then do a relaxed pelvic tilt exercise while breathing fully and evenly. Many will have been holding their breath, or will have restricted their breathing. They must decide to make diaphragmatic breathing a priority, and not sacrifice the breathing pattern to the exercise. The breath cycle should be on a different rhythm and timing than the pelvic tilt exercise, to foster independence of the two muscle patterns. Try doing two tilts to one breath cycle, and then also holding the tilt for two breath cycles.
Figure 1: An example of walking in the pelvic tilt position.
Once patients can readily perform a relaxed pelvic tilt with little accessory muscle tension and while breathing deeply and independently, they should begin to walk around in the pelvic tilt position (Figure 1). This will help to retrain the deep neuromuscular coordination that is necessary for spinal stabilization, so the leg muscles and diaphragm can function as needed while the pelvic posture is maintained. Finally, the addition of resistance in the form of exercise tubing will help stimulate a greater training response for the neuromuscular pattern. This must still be done with muscle-relaxation awareness and with proper deep breathing, to achieve maximum results. CP
Kim D. Christensen DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Wash. He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs. He is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition, and can be reached via email: kchristensen@peacehealth.org.
References
1. McConnell AK, Romer LM. Respiratory muscle training in healthy humans; resolving the controversy. Int J Sports Med. 2004;25:284-293.
2. Koelbaek-Johansen M, Graven-Nielsen T, Olesen AS, Arendt-Nielsen L. Generalised muscular hyperalgesia in chronic whiplash syndrome. Pain. 1999;83:229-234.
3. Sterling M, Treleaven J, Edwards S, et al. Pressure pain thresholds in chronic whiplash associated disorder: further evidence of altered central pain processing. J Musculoskeletal Pain. 2002;10:69-81.
4. Chaitow L. Fibromyalgia and Muscle Pain. New York: Harper Collins; 1995.
5. Upledger J. Craniosacral Therapy II: Beyond the Dura. Seattle: Eastland Press; 1987.
6. Farhi D. The Breathing Book. New York: Henry Holt; 1996.
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