Diaphragmatic Breathing: Assessment & Corrective Ideas

The average individual takes about 12,000 breaths in a day. This presents a huge problem for those with dysfunctional breathing patterns.

 

Dysfunctional breathing patterns are known to limit performance, challenge core stability, decrease motor control, increase sympathetic nervous system activity and increase pain sensitivity.^2,5,7 Breathing can become dysfunctional for many reasons including “sucking in your gut”, stress, poor postural habits, overtraining, etc. The good news is that it is relatively easy to assess and, with consistent practice, fairly simple to improve.

Assessment

Lateral rib cage expansion test: Ideal diaphragm breathing involves an expansion of the lower ribs predominantly in a lateral direction. With the client facing away from you, gently place your hands on the sides of the lower ribs with your thumbs close to the spine. Instruct the client to inhale deeply and note if there is any lateral widening of the trunk. Take note if your hands rise first upon the client’s inhalation, this is a sign of an upper chest pattern. Ideally, your hands should move apart from each other about 1.5-2 inches and the belly should rise 6.

Deep breathe challenge: Normal resting respiration involves approximately 10-12 breaths per minute.³ When asked to breathe deeply, clients should be able to slow this rate and take 10 seconds for a full inhalation/exhalation (about 6 breaths per minute). Individuals that are upper chest breathers or quick breathers are challenged when instructed to take a deep breath. Other signs of dysfunctional breathing include frequent sighs or yawns, repeated throat clearing or air gulping and/or continual mouth breathing.

Corrective Ideas

Guiding the breath: The goal in retraining clients breathing patterns is to reduce their upper thoracic efforts during early phases of inhalation, to increase exhalation time and increase abdominal displacement. Instruct your client to lie on their back, have them place one hand on their upper chest and apply a slight downward pressure to the sternum during their exhalation, have them hold it there while they inhale and exhale. This tactile feedback will help guide their breath into the lower ribs and belly.

Upon completing several breathing cycles ask them to remove their hand from their chest, while continuing to keep the chest in the depressed exhalation position while they continue to breathe. Once your client develops of sense of proper breathing, they should be encouraged to practice on their own.

Blowing up a balloon: The blowing up a balloon exercise is believed to help develop co-contraction of the diaphragm and abdominal wall.¹ Position the client supine with knees bent and feet flat on the ground. Have the client inhale through the nose and exhale through the mouth, maintaining neutral spine. Instruct your client to then inhale through the nose and slowly exhale into the balloon. Ideally the client will be able to inhale again without pinching off the balloon with their teeth, lips or fingertips. This requires maintenance of intra-abdominal pressure to allow inhalation through the nose without the air coming back out of the balloon and into the mouth.

It is important to tell the client not to strain the neck or cheeks during this process. After the fourth breath in, have the client take a break, and then repeat four more times. As the client demonstrates the ability to inflate the balloon while holding a neutral spine and not stressing the muscles of the neck or cheeks, have him or her progress to performing the exercise seated, and ultimately performing the exercise while standing.

Mobilize the T-spine: Upper chest breathing involves an over reliance of the anterior cervicals, pectorals and upper traps.^2,4 Over time, these muscles are believed to adaptively shorten and alter posture. Mobilization of the thoracic spine in addition to stretching the pecs and upper traps will likely help your client’s in their effort to retrain their breathing habits.

Have your client seated with the feet flat on the floor, hips/knees flexed at 90 degrees. Place a foam roller between the knees, have him or her hold it in place. With a tall spine, have the client place the hands behind the head, depress and retract the scapulae. Have your client rotate to the right side, without changing lower body position, now have them laterally flex. Hold for three to five seconds. Instruct your client to come out of lateral bend, but hold the rotation. At this point have your client attempt to rotate a few more degrees to the right, and once again laterally flex to the right. Repeat this one more time, for a total of 3 rounds of rotation and lateral flexion.

After three rounds to the right, have him or her perform 3 rounds to the left. [Note: Emphasize pure thoracic movement only, when this is the case, the movements will be very small, perhaps only a few degrees.]

To sum up, proper breathing patterns are essential in order to improve performance and overall health. Learning to assess and improve dysfunctional breathing habits will prove to be a valuable skill in every trainer’s toolbox.

References

1. Boyle K, Olinick J, Lewis C. The value of blowing up a balloon. North American Journal of Sports Physical Therapy. 5(3): 179-188, 2010.

2. Chaitow L, Bradley D, & Gilbert C. Multidisciplinary Approaches to Breathing Pattern Disorders. Edinburgh: Churchill Livingstone, 2002

3. Courtney R. The function of breathing and its dysfunctions and their relationship to breathing therapy. International Journal of Osteopathic Medicine. 12:78-85, 2009.

4. Cuccia A, Lotti M, Carradona D. Oral breathing and head posture. Angle Orthod. 78(1):77-82, 2008.

5. Gandevia S, Butler J, Hodges P, Taylor J. Balancing acts: respiratory sensations, motor control and human posture. Clinical and Experimental Pharmacology and Physiology. 29(1-2):118-121, 2002.

6. Pryor J, Prasad S. Physiotherapy for respiration and cardiac problems. 3rd ed. Edinburgh: Churchill Livingstone, 2002.

7. Van Dieen J, Selen L, Cholewick J. Trunk muscle activation in low back pain patients: an analysis of the literature. Journal of Electromyography and Kinesiology. 13:333-351, 2003.

About the Author

Nicole Nelson holds a Master’s Degree in Heath Science from the University of North Florida. She is a licensed massage therapist as well as an advanced Heath and Fitness Specialist through the American Council on Exercise. She currently has her own massage and personal training business at the Ponte Vedra inn and club in Ponte Vedra Beach, Fl. She has been published in the NSCA’s Strength and Conditioning Journal, IDEA fitness Journal, Massage Magazine and Massage Today.