The breath – movement connection
Breathing and moving are two constant components of life. People seek help when there’s an interruption to their movement and physical therapists are experts in human movement. As a PT, I teach people how to move so they can reduce pain, improve function, and excel at their activity of choice. In order to teach someone to move well, I create an approach based on the whole person. This extends far beyond muscles and joints to include beliefs and mindset, nutrition, sleep, movement patterns, coordination and control, function, resiliency, stress response, and most importantly breathing.
Dr Karel Lewit has said, “If breathing is not normalized, no other movement pattern can be.”
Breathing is the link to all movement. Respiration supplies the necessary oxygen to enable movement but perhaps more importantly, it is linked with brain activity. Focused breathing is the foundation for the brain-body connection which can aid in both stress reduction and improving human movement. Whether recovering from injury or trying to stay strong to ward off injury, breathing is the integrated connection to moving better.
The diaphragm muscle contributes to more than just breathing. This one muscle influences swallowing, the bowel and bladder, posture, core strength, pelvic floor function, pain response, mental focus, the nervous system, and digestive health. Breathing regulates our heart rate and blood pressure and balances O2 and CO2. Due to the diaphragm’s vast fascial connections, breathing positively affects our blood vessels, lymphatic flow, muscles, bones, and nerves from the head to the feet.
The diaphragm’s location, connections, and activity make it arguably the most important voluntary muscle in the body as it is necessary to sustain life.
How does breathing better make you move better? Learning to breathe better will improve performance, enhance posture, reduce pain, and balance pressure. In short, better breathing improves both movement efficiency and energy efficiency.
Breathing enhances high level performance. In sports, breathing goes beyond cardiovascular endurance. It can be used for enhancing acceleration, deceleration, power, speed, and, precision. One can breathe to improve mental focus and clarity and it connects to sleep patterns, and the digestive system both of which play a vital role in the athlete’s abilities to perform well.
Shelley has been a high level athlete all her life and is currently a personal trainer. She came to my clinic for help with urinary incontinence. When working with female athletes, I look at their specific movement complaints and assess their recruitment strategy, pressure management, impact, control, and movement patterns. The first thing I noticed was her strategy for breath holding. This can be common in athletes, they have been pushed to go stronger and harder in their sport and sometimes their grit and focus keeps their body tense during activity. The breath holding contributed to tension and pressure on the pelvic floor which contributed to leaking. This imbalance of pressure, limited her performance. The focus for her was not on bio-mechanical factors but on integrating the nervous system into her dynamic movement to give the body ability to let go and try something different. We incorporated breathing into movements, both slow and quick. She is an example of using the breath to regulate the pressure system, tap into the nervous system, and improve performance; this is better movement.
Besides movement efficiency, breathing can also improve energy efficiency. Elite athletic performance is a combination of strength, endurance, explosiveness, flexibility, aerobic capacity, load, and recovery. An athlete can excel in his/her sport if their body can perform at a high level of intensity while using less energy to do it, then recover quicker afterward. One measurement of energy efficiency is heart rate variability (HRV). This study describes HRV as “the beat-to-beat alteration of the heart and it is becoming one of the most used training and recovery monitoring tools in sport sciences.” HRV measures the activity of the autonomic nervous system. Simply put, it measures the pause between heart beats and it is regulated by breathing.
Higher levels of HRV indicate a healthy heart and better physical health. “Low HRV, or less responsiveness to physiological needs, predicts mortality and morbidity and also occurs in depression, anxiety, and chronic stress.” Since breathing is the volitional way to influence parasympathetic action, you can use breathing to improve HRV values. Along with influencing HRV, breathing (specifically nasal breathing) creates better lung volume and oxygen saturation. Training the breath to improve energy efficiency during performance is about slowing the breath rate which will slow the heart rate. In this way, breathing can promote exercise intensity and reduce physical fatigue because the heart doesn’t have to work as hard or require as much oxygen for the work load.
One way to slow the breathing rate is through nasal breathing. Author James Nestor writes, “Breathing slow, less, and through the nose balances the levels of respiratory gases in the body and sends the maximum amount of oxygen to the maximum amount of tissues so that our cells have the maximum amount of electron reactivity.”
To connect for performance, set a timer for one minute and inhale/exhale through the nose only. Each part of the breath cycle should be between 5 and 6 seconds which brings the breathing rate to about 6 breaths/min. The average person breaths 12-20 breaths/min so 6 is substantially slower. The goal is not to force the slowed breath until it becomes erratic, but to notice your normal breath pattern and work toward slowing it down bit by bit.
Pay attention to how the body moves with breathing, vertical or horizontal. The lungs are housed inside the rib cage, so which parts of the rib cage are moving with breathing? Ideally expansion includes all the way around the rib cage which brings us to the next area of focus, posture.
Good posture means your ability to hold and/or move through positions with resiliency. Diaphragmatic breathing moves the rib cage allowing for better mobility in the whole spine, pelvic girdle, shoulders, and hips. Diaphragmatic breathing also engages your core allowing for better control through movement.
The diaphragm is a flat muscle that sits as a dome shape and lies in between our thoracic cavity and our abdominal cavity. On inhale it lowers to make room for the oxygen entering our lungs. The lung expansion means our rib cage expands 360 degrees then on exhale the rib cage narrows and the diaphragm returns to its resting position. Diaphragmatic breathing works on both the mobility of the thoracic cage through rib movement and the strength of the core due to its position as the roof of the core canister. Its activity on the core works in conjunction with the transverse abdominus, internal and external obliques, quadratus lumborum, hip flexors, and the pelvic floor muscles to provide a fully functioning torso that holds you upright, enables movement, accepts load, and provides control.
One interesting fact about this core connection, the iliopsoas muscles (hip flexors) balance respiration and influence the functional relationship of both the diaphragm and pelvic floor. The ilipsoas muscles connect from T12 (near the diaphragm) to L5 (lower lumbar spine) and have fascial connections running from the diaphragm all the way down to the pelvic floor. Here is a video that dives into more of this connection with tips to improve postural and hip flexor tension. The diaphragm-pelvic floor connection is discussed more in depth in the pressure section at the end of this article.
To connect for posture, practice diaphragmatic breathing by lying down in a relaxed position. Place one hand on each side of the lower rib cage just above the abdomen. Let all the air out then inhale and notice what moves. On inhale the lower rib cage should expand into your hands. The belly should not tense, but relax and expand. The upper chest should rise last, not first.
Many people have a hard time with learning to inhale from the lower rib cage, practicing a full exhale first allows for a greater inhale as the body will want more oxygen. Full deep breathing helps you connect to your breath, but is not necessary for continuous breathing. Once you connect to which area of your rib cage should move, then practice shallower breaths while still using the diaphragm.
Breathe this way when your still and when you move. One reason people with desk jobs complain about postural tension, may be from a condition called screen apnea. It’s the condition where constantly scanning the screen/email makes breathing cease. Sound familiar? 80% of people studied have this condition where breathing becomes shallow and erratic or sometimes no breath at all for up to a minute. Linda Stone, a Microsoft researcher who coined the term says,”Screen time feeds into a vicious cycle of chronic stress in a way that most of us don’t realize.” Perhaps the body’s tension isn’t from poor sitting posture after all but from the nervous system triggering fight or flight mode while not breathing.
Connect to your breath while sitting at the computer by rhythmically holding your breathing between inhale and exhale. Sit with your feet on the floor, for better neural input. Inhale for a count of 4, hold for a count of 7, exhale for a count of 8. Strategic breath holding allows the body to become better adapted to carbon dioxide levels which is how the body determines breathing rate and amount. Breath holding in this way is done by closing your mouth and pinching your nose. It does not involve bearing down with increased intra-abdominal pressure.
Postural tension is also derived from a lack of mobility in the thoracic spine, which is commonly overlooked but extremely important. Diaphragmatic breathing improves thoracic mobility by expanding the rip cage thus influencing healthy movement in the neck, low back, abdomen, pelvic girdle, and upper/lower extremities.
My favorite type of exercises for the thoracic spine involve rotation. Think about sitting in the car and reaching into the back seat; besides shoulder motion, one needs rotation to turn around and reach. Athletes in about every sport need rotation to kick, bat, throw, run etc. Even the act of walking requires rotation in the thoracic spine enabling the reciprocal motion that happens between the scapula and pelvis in order to propel one forward. Combining breath work with rotational exercises is the sweet spot for postural mobility. This video provides a series of dynamic movements with breathing to unlock posture.
Breathing is a tool for calming the nervous system. A heightened nervous system can manifest in many ways: anxiety, stress, pain, pelvic health issues, heart palpitations, constipation, feeling “wound up”, and muscle tension anywhere in the body. Breathing is the connection to the vagus nerve – the rest and digest part of the Autonomic Nervous System. Activity of the vagus nerve is measured by tracking heart rate, breathing rate, and HRV. This direct access to calming the nervous system is how one can control the pain response.
Treating persistent pain is first and foremost about calming the nervous system. Certain contributors to a sensitive nervous system are stress, sleep, food, fear, trauma, hormones, infection, and inactivity. Pain is not one of these inputs, but an output of the central nervous system. Pain is best understood as a signal of sensitivity, not danger. Oftentimes, it is a sign to do something different. Both breathing and movement improve brain health and reduce nervous system sensitivity. They are the gateway to do something different. Another important tool to help with persistent pain is to take a log of your sleep, stress, and eating patterns as these also play a role in brain health.
Take a look at the list of contributors above and notice how intricately linked breathing is with each one. Diaphragmatic breathing is shown to decrease stress and anxiety, and PTSD. It improves sleep quality, digestive health and stress hormones. Nasal breathing is shown to ward off infection. As far as inactivity… breathe better, move better.
Breathing is the simplest way to activate the vagus nerve.
To connect for pain and calming, first give yourself time and space. Next, relax your abdomen fully – this can be harder than it sounds. Let all the air out first and inhale from a place of depth not shallowness. This means inhaling from the lower rib cage as opposed to the upper chest. The nerves connecting to the parasympathetic system (vagus nerve) are located in the lower lobes of the lungs which is why deeper breathing with long slow exhales is more relaxing. Let the rib cage expand from the front, sides, and back and on the next exhale make it long and slow. Try inhaling for 5 seconds and exhaling twice as long.
Focus on the exhale to stimulate the vagus nerve. When combining breath with movement – choose movement that is also calming like rocking or rotating the upper trunk as opposed to jumping or bouncing. You can also add low tone speech to hum, create guttural sounds, or use the voice in a lower tone to speak truth over your life all of which stimulate the vagus nerve. Breathing won’t magically make all your symptoms disappear, but it will empower you to control the pain response.
I once overheard a personal trainer tell his client to make sure she keeps breathing. She responded, “I can’t do both, it’s either breathe or exercise.” There is a disconnect between breathing and movement. It’s almost never taught through movement, but rather in a passive lying down pose. Even more, the core is taught to stay tight and stable all the time, but when that happens we miss out on the length required for efficient core strength and pelvic floor function.
Don’t believe the lie that tight, ripped abs are the ideal. Core workouts are held in the highest esteem so people push to work the core harder and harder and keep the abdomen sucked in at all times.
However, the core isn’t just a group of muscles in the front that help you do a crunch.
The core is like a canister with a top, bottom, and sides that wrap around. It’s a pressure system and breathing is how you regulate it. When working with athletes, postpartum women, or de-conditioned adults utilizing the breath can be the key connection to a more functional core. Having a core that functions well under load because the entire pressure system is integrated and efficient is the ultimate goal.
We’ve established the notion that most humans are poor breathers. This can apply to athletes as well. In the clinic breath holding is seen as a common strategy with squatting, jumping, lifting, overhead reaching, running and core exercises. This strategy of breath holding can be the body’s compensation as a means to gain more abdominal control and pressure to handle the extra load, but it can negatively affect intra-abdominal pressure, pelvic floor action, and core strength. The pelvic floor is a crucial part of the core. “The pelvic floor muscles are a dome-shaped muscle complex with contraction occurring in 3 planes. Its complex actions include tightening, lifting, squeezing, and relaxing.”
Increased intra-abdominal pressure on the pelvic floor looks like grunting while bearing down; breathing stops, the throat closes, the abdominal muscles tense, and pressure is placed in an inferior direction. Studies show when the respiratory demand is increased, the pelvic floor and deep core muscles show decreased activity. Postural activity is also reduced when respiratory demand increases. Therefore holding your breath combined with increased pressure on the pelvic floor can lead to a cascade of symptoms.
Incontinence is a common pressure symptom -think leaks in the canister. Leakage is something females deal with (in fact 1 in 3 women), but don’t have to continually live with. Kegels aren’t the answer, but are a component in a bigger strategy. Improving leakage with sports is about balancing the pressure by restoring the breath. Studies even show that breathing increases control of the lumbar spine through positive intra-abdominal pressure. The body is brilliantly designed. The majority of my female patients (no matter the diagnosis) are educated on how to connect the breath with the pelvic floor and deep abdominal muscles because it’s that vital.
Did you know pelvic floor muscle activity increases before heel strike during a run or walk? That means it is preparing the core for greater impact. It’s anticipating the load. This is good news because running and jumping don’t always have to result in leaking.
To connect your breath and engage the pelvic floor, lie on your side in a fetal position. First inhale and relax/open the pelvic floor muscles. Next exhale and contract gently as if squeezing a blueberry.
Think of breathing as your preemptive strike. Exhaling brings the pelvic floor on board prior to the exercise. This prepares the core for the demand and improves central hip stability. Physical therapist, Julie Wiebe uses the term, “Blow before you go” as a way to facilitate pelvic floor engagement prior to the task or load. For example, when performing a hop exhale right before you hop and keep exhaling as you land. This strategy enables better central hip stability and balance.
Sometimes leaking is caused from increased tone in the pelvic floor muscles. In this case, inhaling should be the focus to relax the pelvic floor muscles for when the diaphragm lowers, the pelvic floor opens and then draws up and in on exhale.
Each person is unique there is no one size fits all approach, so consult your physical therapist for any issues involving the abdomen and pelvic floor.
To connect breathing for pressure regulation, I have several videos explaining how to connect the breath to pelvic floor here.
My role as a physical therapist is to rule out red flags and serious pathology, find the driver/stressor, teach resilience to movement, educate on the body and pain, instill hope, and provide an avenue to meet the requested goals. This approach requires looking at the whole person and every aspect of physical health. It is my aim with this article to give you a comprehensive look at the power of breathing while educating on how to integrate the breath to improve performance, enhance posture, reduce pain, and balance pressure. To continue this learning join a large and growing group of people who are part of my connected breath group. Contact me here for in person or online support with your physical health. Breathe better, move better.