Have you been experiencing chronic pain for years on end? Perhaps you’ve been in and out of physical therapy, tried injections, massage, and even surgery with minimal relief and generally a lot of frustration. Maybe you’ve even given up important and meaningful activities like picking up your toddler or going for a morning jog. If this is the case, it’s possible that there has been a critical gap in your rehab treatment. One area commonly overlooked is the importance of healthy breathing mechanics.

The typical respiratory rate for a normal, healthy resting individual should be about 12-18 breaths per minute. That adds up to at least 17,280 breaths a day. With that amount of repetition, you can understand how crucial it is for this system to be functioning on point! Having optimal breathing mechanics is required for balanced alignment of the spine, ribcage, and pelvis. It is also necessary for maintaining physiological homeostasis for the rest of the body with direct roles in digestive, neurologic, and cardiovascular health.

Normal Breathing Mechanics

Every muscle in the body has an ideal length it likes to operate at most effectively: not too long and not too short. The diaphragm, one of the most important inspiratory muscles, is like any other muscle in this respect. For normal breathing capabilities, it must be at an optimal length.

The diaphragm is a muscle that sits like a dome or umbrella in the lower portion of the ribcage. When we inhale, the “umbrella” diaphragm pulls down into a flattened position, creating a negative pressure in the chest to pull air into the lungs. The lower ribs are forced upwards and outwards as it contracts. During inhalation, the abdominal and pelvic floor muscles are more relaxed to allow for the diaphragm to push our abdominal contents downwards.

When we exhale, this motion happens oppositely. Abdominal muscles, particularly internal obliques and transversus abdominis, are more active in order to compress the abdominal contents and to anchor the lower ribcage downwards. The diaphragm then goes back into its umbrella-like state and passively forces air out of the lungs. During exercise, the abdominal activity increases even more so to assist exhalation.

Why the Diaphragm Is So Important to Musculoskeletal Health

The diaphragm has multiple attachment sites throughout the rib cage and into the lumbar spine (spine of the lower back). Because of its attachment to the lumbar spine, one major benefit of the diaphragm is that it allows for another level of spinal stability. During inhalation, the diaphragm has an upward pull that naturally decompresses the spine. With poor diaphragmatic control, the lumbar spine can go into a compressed state over time. No one wants a compressed lumbar spine! 

Normal ribcage and thus pelvic alignment posture also allows for the lower abdominals to work in their optimal length. Very commonly, I have patients with chronic low back pain, neck, hip, etc. presenting with the lower rib cage flaring outwards. This posture positions both the diaphragm, transverse abdominis, and internal obliques in an inefficient position to contract. Compensatory patterns can occur when the diaphragm is in a chronic flattened state.

Some negative consequences of inefficient breathing mechanics include:

  • Instability of the pelvis and lumbar spine
  • Excessive anterior pelvic tilt (tipping forward) because of muscle imbalance
  • Cause for chronic scoliotic curve formation
  • Compensation of neck muscles (scalenes, pec minor, upper traps, sternocleidomastoid) during inhalation, resulting in chronic neck stiffness
  • Poor digestion from lack of counterpressure of the diaphragm/rib cage during respiration
  • Trouble breathing with exercise
  • Snoring and possibly sleep apnea
  • Decreased airflow in and out of the lungs
  • Increased risk of lung infections
  • Decreased venous return
  • Impaired homeostasis of blood pH levels (inability to fully exhale CO2)
  • Increased anxiety, stress, and chronic “flight or fight” state (driven by sympathetic nervous state)

How to Tell If the Rib Cage Is in Bad Position

If you place the palms on your hands on the left and right sides of your lower rib cage and feel that your lower ribs pop outwards significantly, chances are your diaphragm, and lower abdominals are not activating as well as they could be. Also, look at yourself in the mirror while breathing normally. If you notice your neck muscles popping out of your skin, you are likely over utilizing these muscles to breathe.

Fixing Improper Breathing Mechanics

An easy way to begin training correct breathing mechanics is to lie on your back with your knees bent up. Place one hand on your chest under your collarbone and the other hand on your lower rib cage. Take a breath in through your nose, allowing your lower rib cage AND your sternum (breastbone) to expand outwards towards the ceiling. Incorrect mechanics would occur if you feel your neck muscles working too much to bring air in. It is normal to feel some tension or pressure in your chest wall as the ribs should move outwards. During exhalation, think about your abdominals anchoring your ribcage downwards towards your belly button.

If you can master this critical movement pattern and carry it over throughout all activities, chances are you will prevent a lot of musculoskeletal and other health concerns. 

Are you having trouble reaching full rehabilitation or suspect you may not have proper breathing mechanics down? Set up an appointment with SetPT today!