The Best Breathing for Reducing Pain and Stress

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When working with our clients one of the first things we check is their breathing pattern. This is because the way a person breathes can have a big impact on their health, including the health and function of the musculo-skeletal system. Much of the impact of breathing on our health has to do with the role of our diaphragm.

The Diaphragm during Respiration

There are many ways to breathe but the most effective, efficient and relaxing way to breathe involves using our diaphragm. The diaphragm is a dome-shaped muscle that spans the lower border of our rib cage. On inhalation, as the diaphragm contracts, it flattens and moves downward. This downward motion creates a vacum in the chest, helping to pull air into the lungs. When the diaphragm relaxes it moves upward, back into its dome shape, and this upward motion helps us to exhale.

Intra-abdominal Pressure and the Stabilizing Role of the Diaphragm

The downward motion of the diaphragm also creates pressure in the abdomen. This pressure is called “intra-abdominal pressure” and is important for facilitating a stabilizing response in the muscles of our abdomen, low back and pelvis. This highlights the dual role of the diaphragm. Under optimal circumstances it acts as a facilitator of both respiration and muscle-skeletal stabilization.

Often people are taught diaphragmatic breathing by lying down and breathing into the belly, inflating it toward the ceiling. Although this may be a good way to get started, it is an approach which focuses only on the respiratory role of the diaphragm and fails to address its crucial role in stabilizing the trunk and pelvis.

Experiencing Diaphragmatic Breathing and Intra-abdominal Pressure

For the diaphragm to perform optimally in both of it’s roles it is essential that its downward motion be symetrical and that the pressure it creates in the abdomen be distributed evenly. To experience this even distribution of intra-abdominal pressure for yourself, place your hands around the abdomen just below the lower ribs, making contact with the front, sides and back of your body. Your diaphragm sits just above where your hands are touching. Now inhale and feel how the pressure created in your abdomen is pushing gently into your hands.

True diaphragmatic breathing creates intra-abdominal pressure that expands outward into the full circumference of the abdomen. When you breathe in with your hands wrapped around your abdomen, check and see if you feel the pressure moving in all directions. If you feel most or all of the pressure pushing into your belly, then on subsequent breaths try to gently, but consciously, redistribute the pressure into every place your hands are touching, especially into the sides of your waist and into the back.

Another technique for improving diaphragmatic breathing and intra-abdominal pressure involves tying a theraband or a stretchy cloth around your lower ribs and feeling your inhale touch the whole circumference of the lower ribcage.  Here you can feel the intercostal muscles between your ribs move. The intercostals assist the diaphragm in playing both its roles and are an important source of load and mobilization of the rib cage, helping to keep these bones healthy and mobile.

Intra-abdominal Pressure and the Pelvic Floor

As I mentioned earlier, when we are truly breathing diaphragmatically the downward motion of the diaphragm will be symetrical and create an even distribution of pressure in the abdominal cavity. But it doesn’t stop there! In fact one important benefit of diaphragmatic breathing is its affect on the pelvic floor. This is because true diaphragmatic breathing and optimal intra-abdominal pressure will move directly downward toward the pelvic floor, loading the pelvic floor muscles and soliciting a response from those muscles that maintains their strength and responsiveness.

To sense the intra-abdominal pressure in your pelvis,  place your hands on the front of your belly below your umbilicus (belly button) and above your pubic bone and take a breath. You should feel a gentle pressure increase here. You may also begin to sense a gentle pressure in the floor of your pelvis.

Other Benefits of Diaphragmatic Breathing

Another reason the direction our diaphragm moves is so important is that it helps pull air into the lowest lobes of your lungs. Since the lungs are narrow at the top and wider at the bottom, blood flow into the lower lobes is greater than into the upper lobes and therefore breathing diaphragmatically will allow for more oxygen transfer into the blood. With a big chest breath we are actually taking in less oxygen than if we simply take a small but healthy diaphragmatic breath!

Diaphragmatic breathing also has benefits to our nervous system. The para-sympathic nervous system (rest and digest) is activated by relaxed, diaphragmatic breathing while the sympathetic (fight or flight) is activated by chest breathing. Again, for healthy breathing that big chest breath is not always what we want. It is actually preparing our body to ramp up, promoting a stress response rather than alleviating it.

Diaphragmatic breathing can also help alleviate back pain and reduce back tension. When breathing diaphragmatically, the intra-abdominal pressure solicits a response in the abdominal and lower trunk muscles that gently unloads the spinal joints and strengthens the abodminal muscles. These muscles get a gentle massage and workout just by breathing correctly!

Breathing through Your Nose is Essential

Finally, to get the most out of diaphragmatic breathing it is essential to breathe in and out of your nose. Mouth breathing is shallow and will promote lifting the chest up in lieu of the diaphragm moving down. Since ALL of the benefits of diaphragmatic breathing hinge on the symetrical downward movement of the diaphragm and the even distribution of intra-abdominal pressure then breathing through the nose is key in reaping these benefits.

For guided instruction on the basics of diaphragmatic breathing, check out this video.

The Importance of Alignment

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I was first introduced to alignment in the context of yoga.  The Iyengar Yoga system in particular is often characterized as emphasizing “alignment” in postures.  It’s only recently, however, with the study of biomechanics, that I have begun to understand better what alignment really means and why it’s so important.

Katy Bowman, M.S., whose work I’ve been studying describes our alignment as being distinct from our posture.  She points out that posture is cultural while alignment is based on objectivity.  For example, some women I have talked to about posture and alignment have told me that their parents encouraged them not “to stick their butts out.”  This view of posture is purely subjective as it is based a particular point of view.  Alignment must be objective and must therefore be based solely on identifiable objective markers.

One such marker is the alignment of the hips relative to that of the knees and ankles.  When standing in a bio-mechanically functional alignment the hip joints must sit directly over the center of the knees and the center of the outer ankle bones.  Most of us tend to stand with the hips pushed forward of the knees and ankles.  This tends to rotate the pelvis back (posteriorly) such that the pelvis sits a little “tucked”.  To correct this misalignment we must back our hips up until our hip joints align over the outer ankle bones.  When the hips are backed up this way it not only brings the pelvis and hips into a more functional alignment with the legs, it also tends to correct the “tuck” of the pelvis and rotate the pelvis back to neutral.

Figure 2

Figure 2

When I ask students to back their hips up this way, they usually say they feel like they are “sticking their butt out,”  something some have been deliberately trying NOT to do!  This is partly because they’ve gotten so accustomed to having their hips forward and their pelvis tucked that this misaligned position feels normal and the new position feels “strange” or “wrong” relative to what they are used to.

This example is a strong argument for using objective markers when aligning our bodies.  We cannot rely on what “feels right” to us.  When it comes to our own bodies we are not all that objective.

Besides the fact that it just feels right to push the hips forward, there’s another reason we tend to stand with our hips pushed forward – it’s easier!  Standing with the hips forward is essentially us sitting loosely into the front of our hip joints.  We often do the same thing to one side, swaying the hip out to act as a fulcrum to support our weight.  This puts a great deal of stress on our hip joints and will eventually lead to pain.  It takes a lot less effort to stand this way because the bones are in a position that doesn’t require (or to some extent even allow) important stabilizing muscles in our hips to work.  When we back the hips up and align the hip joints with the outer ankles bones, it suddenly takes a lot more effort to stand!

This alignment of the hip joints helps a great deal in yoga with many of the standing postures.  In the posture “samasthithahi,” for instance, where I am standing with my feet “hips width” apart (as opposed to “tadasana” where the feet are kept together), judging the position of the hips relative to the knees and ankles can be done by using a belt with a buckle as a plum bob to tell if my hips are lined vertically up over the outer ankle bones (see the diagram above).   When I get the hips aligned I can feel that I’m anchored through the heels and the legs and hips are active and alive while I have a distinct sense of depth and space in the groin.  Re-establishing neutral pelvis also does wonders for the function of the pelvic floor and is an essential step in the practice of the mula bandha.

Most importantly, aligning the hips properly in a yoga posture brings life into the posture.  And this is not just true for samasthitahi but can be applied in many of the standing postures including trikonasana, parsvakonasana and ardhachandrasana to name just a few.  In fact, this bringing of life into the postures can be manifested in just about any yoga posture when I can establish a better anchored and neutral pelvis.

Bio-mechanically sound alignment in yoga postures not only makes them better postures, it also helps us avoid injury and derive more benefit from our postures. So it’s worth the time and energy in a yoga practice to improve our alignment.

But ultimately, it’s our day to day activities that have the biggest impact on our health and function.  Therefore alignment should not be limited to the domain of yoga but be a feature of how I stand, sit, walk and move throughout the day.  In fact, the better my alignment in these every day activities the better my yoga postures will also become.