Breathing is commonly overlooked as a contributor to pain as well as stress. Conventional wisdom advises us all that when we are stressed, we should take deep breaths for long holds upon inhalation to help relax. While this may be true, it is important to know WHY this is working to relax the body. Knowing the different OPTIONS available to perform the function of breathing can also be important to understand because this will determine the way our breathing interacts with the nervous system.
There are two general categories of breathing systems in the body referred to as diaphragmatic breathing (more colloquially referred to as belly breathing) and apical breathing (commonly referred to as chest breathing). Belly breathing is performed when our diaphragm contracts to expand downwards into the abdominal cavity to pull air downwards into the lungs when we inhale. When we exhale, the diaphragm relaxes and retracts upwards towards the lung creating less space in the lung cavity pushing air out of the lungs. As a result, the visual appearance is that in which the abdominal area will rise upon inhalation and fall upon exhalation.
Chest breathing is performed when expanding the top part of the rib cage during inhalation by using muscles in between the ribs, muscles that attach to the neck, and the pectoral muscles. When we exhale, the rib cage muscles contract to reduce the space in the rib cage and force air out of the lungs via compression. Chest breathing presents with a raising of the chest and tightening of the front of the neck upon inhalation and collapsing inwards of the shoulder and sternal region upon exhalation.
Belly breathing is theorized to be the default system of breathing mechanics in the body and in most circumstances, should be producing the majority of breathing demands at rest. Chest breathing is theorized to be reserved for times of extreme oxygen demands (like after performing an all out sprint) or when the environment creates a sympathetic response. The diaphragm receives nerve supply from the parasympathetic nervous system and the apical breathing muscles receive nerve supply from the sympathetic nervous system. The ability to access BOTH types of breathing is important to be able to meet different oxygen demands for different circumstances.
The sympathetic nervous system is the division of the nervous system that is generally referred to as “Fight or Flight” due to increased heart rate, raising blood pressure, increasing apical respiration, and increasing blood flow to skeletal muscle to prepare for an external threat. The parasympathetic nervous system is referred to as “Rest and Digest” due to the facilitation of decreasing heart rate, lowering blood pressure, increasing diaphragmatic respiration, and increasing blood flow to the brain as well as the digestive organs to allow the body to relax.
Very frequently at Move Better, we assess patient’s breathing mechanics to determine if their breathing pattern is diaphragmatic, mixed, or apical. We do this by asking them to take a deep breath with minimal instruction to evaluate what their intuitive subconscious breathing preference is. The correlation that we commonly see is that patients who experience neck pain very frequently have a biased preference towards using an apical breathing system and have difficulty breathing into their diaphragm. Spending time working on diaphragmatic breathing very frequently leads to an immediate and direct decrease in neck pain.
This leads us to ask the question of how does diaphragmatic breathing decrease neck pain? The answer to this question we believe may be that when the diaphragm is activated, this may lead to activation of the parasympathetic nervous system. Activation of the parasympathetic nervous system may lead to deactivation of the sympathetic nervous system. Deactivation of the sympathetic nervous system may lead to inhibition of the apical breathing muscles. If the muscles in the neck were tight or tender due to maintaining respiration, then teaching the cervical musculature how to relax will lead to a reduction in pain because the irritant is being consciously controlled.
Diaphragmatic breathing also leads to mental relaxation. At the clinic, we frequently observe a correlation between patients who are chronically stressed or anxious tend to have a bias towards subconsciously preferring an apical breathing pattern and struggle more on average to obtain control over the diaphragmatic breathing system. While the daily stresses of life such as caring for children, fulfilling work responsibilities, finishing daily errands, or being stuck in traffic aren’t the same as a 600lbs sabertooth tiger sprinting at you with the paleolithic munchies, our bodies unfortunately react with the same level of intensity. Our once advantageous highly reactive sympathetic response is now obsolete in a society where having our bodies engage the neurological turbo thrusters in most instances is unwarranted.
This can create a subconscious preference towards apical breathing because the body is stuck in a loop of sympathetic drive. Learning how to diaphragmatically breathe can help us control our subconscious nervous system by consciously learning to engage muscular action that directly involves the parasympathetic nervous system. It is important to emphasize that the problem is not apical breathing or the sympathetic nervous system but rather the inability to engage or disengage a musculoskeletal or neurological function which creates a predilection to a singular bodily function and limits our ability to have options. At Move Better we do not believe in “Right vs Wrong” or “Good and Bad” but rather “Options and Contexts”. We focus on giving our patients the awareness to observe the options they have for a particular circumstance and then choose the one that agrees most with their body regarding their experience of pain or dysfunction.
