The Postural Restoration Institute (PRI) is a holistic approach that respects the need to establish appropriate breathing patterns in order for the rest of your body to be able to achieve balanced alignment, movement capability, lymphatic circulation, restorative sleep, optimal gas exchange, nervous system regulation, and so much more.
One 2 One Physical Therapy is a certified Postural Restoration Center with Doctors of Physical Therapy who are experts in Breathing Re-training.
One 2 One Physical Therapy recognizes the fact that the human body functions in neuromuscular patterns which are asymmetrical in nature primarily due to the differences in size between your left and right respiratory diaphragm leaflets, lateralization of your brain hemispheres, and your environment. This asymmetry creates a natural twist in your body that is present with every breath, step, and movement you make as you go about your day.
Stress of any kind can result in your body tightening up and coiling even more into this asymmetrical dysfunctional breathing pattern.
This further locks up your postural system negatively impacting movement, energy, balance, and breathing. In these situations, some lung regions can become underinflated while others overinflated leading to inefficient respiratory function.
Furthermore, when your rib cage is not optimally pumping and ventilating your lymphatic system can become stagnant impairing your ability to flush out toxins and cellular debris. This puts undo burden on not only your immune system but essentially every cell, tissue, organ, and other system in your body.
Locked-up postural and breathing patterns have a direct impact on your ability to breathe at all times of the day and night.
This is particularly problematic for sleep as your airway and airflow can be negatively impacted setting the stage for sleep apnea and disturbances. Asymmetrical postural and breathing function can promote a coiled and narrowed airway as well as sub-optimal airflow pressure relationships contributing to sleep apnea behavior.
Furthermore, your airway is regulated not only by the alignment of your skull bones, occlusion, and neck but also what serves as their foundation below-your rib cage, pelvis, arms, and legs. At One 2 One, we are specialists is training your entire body to optimize your breathing so that you can have restorative and restful sleep.
Dysfunctional breathing patterns have a marked effect on the biochemistry of your body and significantly alter your blood gas levels of (but not limited to) oxygen, carbon dioxide, nitric oxide and pH levels.
This significantly reduces the ability of your body to delivery oxygen to tissues! Poor breathing habits also influence your emotions, mental processing and functioning, circulation, digestive function, musculoskeletal function, and regulation of the autonomic nervous system (the ability to properly shift between a parasympathetic (rest and digest) state and a sympathetic (fight-or-flight) state at the appropriate times).
One 2 One Physical Therapy utilizes a wide variety of breathing techniques to re-train your body to learn proper breathing patterns. By addressing breathing first we reduce a primary dysfunctional pattern that can lead to a myriad of other health problems.
This process involves specific manual and non-manual techniques as well as neuro-sensory integration of your entire postural system including your visual, vestibular, somatosensory, and auditory systems. We utilize a diaphragmatic breathing approach, promote nostril breathing and even incorporate fun re-training exercises like humming, vowel toning, kazooing, and blowing up balloons.
There is plenty of research and evidence supporting breathing re-training and the health benefits. Many of us don’t realize we even have a breathing dysfunction at the core of our health issues! One 2 One Physical Therapy teaches you to breathe right so you can live right!
Further Reading & Videos
Here are some videos and articles we have created about breathing restoration:
At One 2 One Physical Therapy our Doctors of Physical Therapy are specialists in posture and breathing through the Postural Restoration Institute. We created this video and accompanying blog article to teach you what we consider to be one the most important exercises you can do right now to improve lung health and potentially help prevent and manage the breathing and respiratory issues related to COVID-19.
As many of you know, COVID-19 primarily infects the lungs and if it progresses far enough can result in pneumonia where there is increased fluid and scar tissue. This reduces our ability to obtain oxygen and ultimately breathe.
According to this source, it appears that this pattern of edema and fibrosis can be present in the lungs even before symptoms appear. (https://www.genengnews.com/news/coronavirus-early-pathology-examined-in-lung-tissue-of-symptomless-patients/.
The increased fluid and scar tissue are a result of the body’s immune system trying to fight off the virus. However, problems arise when the debris created from the immune response is not being cleared out effectively and efficiently. This is what causes the congestion and fibrosis in the lung tissue.
When dealing with an infection in the lungs we need to not only have a strong enough immune system to kill the virus but we also need to be able to clear away the debris. This occurs primarily through our lymphatic system.
Our Lung Lymphatic System
We have lymphatic channels and nodes throughout our lungs to filter and clear away the waste created by an immune response. Just like our heart powers our circulatory system, our lymphatic system also requires a power generator. This power generator is our breathing and movement.
Therefore, in order to power your lymphatic system pump to keep your lungs clear it is imperative that you optimize your breathing and movement.
Did you know that most likely your baseline breathing is not sufficient to accomplish this?
This is especially true if you are under stress, have asthma, allergies, or any other baseline respiratory condition. We find that the majority of our patients are shallow breathers, when in fact our diaphragm needs to fully contract and relax in order to be an efficient pump. When we breathe too shallow, our diaphragm becomes too tight.
In order to relax the diaphragm, you must first learn how to exhale completely. After a complete exhale, you can then take a large inhale. These excursions of inhales and exhales create the pressure differentials needed in the lungs for efficient lymphatic drainage and clearance of respiratory debris.
However, we can't forget the other driver of lymphatic flow which is the 3-dimensional movement that should normally occur through our pelvis and rib cage during breathing and walking. This also serves to pump our lymphatic system. It is ultimately the combination of our breathing coupled with the alternating rotation of our bodies during walking that drives this mechanism.
Body Rotation During Walking
Used with permission. Copyright © 2020 Postural Restoration Institute®, www.posturalrestoration.com
We have adapted a Postural Restoration Institute based breathing and movement technique that accomplishes these goals. We believe if everyone could perform this exercise a couple times per day it could significantly help prevent and minimize the respiratory complications related to covid-19.
Seated Alternating Reach, Breathe, and Tone Technique
- Depending on your physical ability, sit on either a low step stool/stack of books in a squat position or a regular chair facing sideways. The lower the chair the better. If in a regular chair you can try placing a footrest/books under your feet.
- Round out your low back and roll your pelvis back so you can feel your sit bones.
- Reach forward with your right arm (thumb up) and backwards with your left arm (thumb down) while keeping your back rounded and weight through your sit bones.
- Inhale through your nose as you reach backwards with your left arm. You should feel your front left chest opening. Do NOT inhale too aggressively so that your neck muscles engage. Inhale enough so that your neck muscles stay relaxed.
- As you exhale create a low toned vowel sound such as "uh", "oh," or "ah." Try to maintain the tone as long as you can get ALL of the air out of your lungs. You will feel your abdominals engage during this and maybe some vibration in your body.
- You may notice that your next inhalation feels deeper and more opening in your chest.
- Repeat this for 4 toning/breath cycles on one side and then switch to the other side (L arm forward/R arm backwards) for 4 cycles.
- Perform 3-4 cycles each side, ideally 2x day to optimize your lung lymphatic flow.
We also suggest incorporating this breathing technique at times when you are walking. You can substitute the exhale toning with a prolonged pursed lip exhale if you think you might intimidate nearby passerby.
If you experience any discomfort during this exercise we do not recommend you continue.
THIS WEBSITE IS NOT INTENDED FOR THE PURPOSE OF PROVIDING MEDICAL ADVICE
All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. If you think you are experiencing symptoms consistent with COVID-19 contact your doctor or hospital.
Check out this 8 minute video to find out!
This article is going to discuss the physiological aspects of breathing, specifically related to our primary blood gases, oxygen (O2) and carbon dioxide (CO2). “The Oxygen Advantage” by Patrick Mckweon and “Advanced Buteyko Breathing Exercises” by Artour Rakhimov serve as the primary resources for this article and where you may obtain more information on this topic.
The primary purpose of breathing is to take in oxygen, one of our most vital nutrients. About 90% of our energy production requires O2 and thus impacts virtually every cellular, tissue, and systemic process in our body. A by-product of these cellular energy reactions is CO2 and thus is generally considered a waste product.
Typically, we assume that we need to take big breaths to maximize O2 and minimize CO2 levels in our body. In reality, we don’t need to take bigger breaths or breathe more frequently to increase our O2 blood saturation as it takes very little breath volume and rate to do so. The key element is getting O2 to disassociate from our red blood cells (hemoglobin) and get into our tissues.
The trigger to facilitate O2 to leave hemoglobin and get into our cells is actually CO2!
Yes, we need adequate levels of CO2 in our blood to serve as a stimulus for O2 to transfer into our cells, tissues, and organs. CO2 is not just a “waste product” for us to excrete via exhalation but a potent driver of our ability to fully oxygenate our body!
What determines our level of CO2 in our blood? How much we breathe! If one is over-breathing they are likely getting rid of too much CO2 for adequate oxygenation. Over-breathing can be characterized by taking too big of a breath and/or breathing too rapidly. For example, fast breathing is very commonly seen in asthmatics. In fact, Buteyko breathing techniques (as will be described here) have been heavily used in asthmatics with amazing success. However, the problem of over-breathing is not limited to asthmatics but has become a modernized society health issue as most of us are not breathing correctly. This even includes elite level athletes!
We generally aim for our patients to achieve about 8-10 breaths/minute but we typically find that many of our patients are averaging significantly more than this. On the flipside, some individuals will have a slower breath rate but are taking too big of a breath coupled with excessive belly breathing. Please refer to this video to learn more about belly breathing: http://www.one2onephysicaltherapy.com/blog/the-truth-about-belly-breathing/
Regardless of whether you are breathing too rapidly or with too much volume per breath, either scenario is considered chronic hyperventilation and is taking away too much CO2 out of the lungs and blood.
One breathing pattern that lends itself to chronic hyperventilation is habitual mouth breathing which results in a higher volume breathing averaging 12-15 L/min compared to nasal breathing which is ~ 6 L/min. Therefore, if you mouth breathe you are nearly doubling your air volume with excessive CO2 loss!
Once these blood gas “habits” are established the nervous system adjusts and establishes a baseline point where it aims keep the same CO2 level. The nervous system perceives this to be a “safe” level and is constantly modifying your breath rate and volume to stay within this range. Therefore, if one starts to increase one’s CO2 levels by either reducing their breathing rate and/or volume they may feel like they aren’t getting enough air. We refer to this as “air hunger” as it makes one feel a bit panicky. This is the nervous system’s way of trying to protect you and thus what keeps one ultimately in an over-breathing pattern.
We can determine the extent of our CO2 tolerance/set-point with the following test, which we refer to as the “control pause” or the “BOLT” (Body Oxygen Level Test) based off of the Buteyko Breathing method. To perform the test:
- After a regular exhale, pinch your nose to hold your breath and start a stopwatch.
- Note-do not take a bigger breath in or out prior to starting the test.
- Hold your breath until you feel a moderate urge to breathe.
- Note-this is not testing how long you can maximally hold your breath, just until the first urge.
- At this point stop the clock. The time recorded is your score.
- A time of 40 sec or more is considered excellent, 30-40 good, 20-30 fair, and below 20 poor. It has been found that there is a correlation between these scores and overall health with decreasing health the lower the score, particularly below 10 sec.
Now for the most important part: How do we improve our breathing so we can get enough oxygen delivery to our body?
First, if you are habitually mouth breathing you need to switch to nasal breathing. In addition to facilitating an appropriate breathing volume, nasal breathing has a number of other important physiological effects on the body. Nasal breathing warms and humidifies air for improved gas exchange vs mouth breathing which can be very dehydrating. It is via airflow through the nasal cavity which promotes nitric oxide (NO) production. NO is a powerful anti-microbial agent and serves to sanitize the air we breathe. This can also impact the type of microbiome colonies in the oral cavity and gut which is extremely important for our health. NO is a vasodilator which has implications for improving gas exchange in the lungs as well as influencing circulation and blood pressure.
In addition to learning how to breathe through your nose during the day it is imperative that you only nasal breathe when you sleep. If you continue to mouth breathe during sleep you will essentially reverse all the good training you did during the day as well as reduce your body’s ability to oxygenate. This is crucial for the cellular repair that should be occurring during sleep. A simple, inexpensive solution to ensure consistent nasal breathing during sleep is to tape the lips. I recommend using the hypoallergenic tape, Hypafix, (can easily be bought on Amazon) that can be cut into strips to be placed over the lips as displayed below. Myself, husband, father, and many of my patients are proud mouth tapers!
If you are unable to consistently breathe through your nose then that must be addressed first. There can be a myriad of reasons why this is a problem as well as solutions which is not within the scope of this article. However, if you are limited with nasal airflow one thing you may try is a nasal clearing technique described by Patrick McKweon here:
“Reduced Breathing Training,” which is a version of Butekyo breathing has been shown to significantly improve one’s CO2 tolerance. It must be done for a minimum of 5 min, 2x day to have a significant carry-over effect but we have many patients practice up to 30-60 min a day broken up into segments no less than 4-5 minutes at a time. The first step is to take notice of your habitual breathing pattern. How many breaths do you take a minute? Is there is any pause between the exhale and inhale? Do you take big or small breaths?
To begin the training, using a soft and gentle breath size (which is what your habitual breath quality should be) pause an extra 1-3 seconds after each EXHALE. You are essentially trying to slow down and soften your breathing rate and overall air volume which will gently increase the levels of CO2 in your lungs and blood. This will create a level of “air hunger” and discomfort. It is very important that you keep the intensity of this “air hunger” to no more than minimal. You will likely need to adjust the amount of time you are pausing after each exhale to maintain this mild intensity of air hunger while training. If you push beyond the minimal limit your nervous system will perceive you are in a stressful state and try to protect you by not allowing it to learn a new set point. This amount of time will vary from person to person as well as for a person depending on the time of day, recent food/beverage consumption, room temperature, activity level, etc. After you have practiced this for 5 min go back to your normal breathing pattern for 60 sec and then retest your control pause. It should have increased. If it didn’t or went down then you most likely pushed yourself too hard during the training and need to adjust.
Progress will vary from person to person but generally one should aim for their control pause to improve a few seconds each week. To get a more accurate and consistent control pause, it is recommended to take it every morning when one first awakes. When one’s control pause gets into the 20s there are also walking and exercise breathing techniques that can be incorporated to further progress. Overall, when one is performing exercise the goal is to only breathe through the nose. A great way to work up to this is to aim to maintain nasal breathing during walking and regular day to day activity in addition to at rest.
It is important to point out that certain individuals may need to proceed very cautiously or seek training from an experienced practitioner. Examples are individuals with heart or lung disease, migraines, post-concussion syndrome, any acute trauma, chronic infections, dysautonomia conditions such as POTs, or if you feel worse after trying the technique. If you are not making progress despite keeping yourself within the mild training parameters, there may be other factors that need to be addressed such as environmental problems. Examples are living or working in an environment with toxins such as dust, mold, poor ventilation, too high of a temperature (particularly during sleep), and/or consuming too may processed foods.
Finally, this article describes the physiology related to breathing. However, as mentioned in a prior post (http://www.one2onephysicaltherapy.com/blog/the-truth-about-belly-breathing/), it is also just as important to breathe properly from a biomechanical and postural perspective. In fact, these two aspects are inter-connected with one another. It will be very difficult to maintain appropriate breathing physiology if you are not properly breathing with your diaphragm and vice versa.
Founder of One 2 One Physical Therapy
Take 6 minutes to learn about how to properly belly breathe and how the respiratory diaphragm, abdominals, and pelvic diaphragm work together!
By Noelle Ekonomou, PT, DPT
The diaphragm is often one of the most underestimated muscles in the body. It has a systemic impact on our health, including our pain perception, autonomic nervous system, lymphatic drainage, digestion, mood, and sleep. I often argue that it is the most important muscle in the body- it is the core of the core. Breathing is a coordinated movement of muscle and visceral contractions. It is a synchronous activity between the upper chest and rib cage, lower rib cage, and abdominal musculature. Our diaphragm not only attaches to the thorax, but it is strongly anchored to our spine and has connections to our deep hip flexor muscles (psoas), obliques, and transversus abdominus. Countless number of research studies have confirmed the relationship between faulty breathing mechanics and poor posture, abnormal scapular movements, low back pain, neck pain, temporomandibular joint pain, and pelvic floor disorders.
Faulty breathing patterns are correlated with hyperventilation. When our normal respiratory rate goes above 12-16 breaths per minute, we are actually “over-breathing” (or rather “over-inhaling”). This mechanism of over-inhalation can eventually alter our posture, leading to a hyperinflated postural pattern. This means we are holding too much air in our lungs, called “air trapping”. A cascade of hemodynamic and neurologic changes can then occur. The CO2 levels in our blood lower, which in turn increases the sympathetic or “fight and flight” response system. Your body is then constantly on high alert and in a stressful state. This is a very common breathing pattern for adults with sleep apnea, asthma, COPD, and anxiety- but we also often find this posture in many of our patients. This is because stress is often a large culprit of this breathing pattern.
This hyperinflated breathing pattern is also associated with over dominance of the “accessory” or secondary muscles of respiration in our neck and chest. These muscles include the sternocleidomastoid, upper trapezius, scalenes, and pectoralis. When these muscles are over-worked to help us breathe, it alters abdominal pressure gradients, and can lead to painful trigger points which cause neck discomfort and headaches. Additionally, several studies including one published in the Journal of Biomechanics have discovered a relationship between the diaphragm and low back pain. Professor Paul Hodges of the University of Queensland (a chief researcher of the diaphragm), found that poor coordination of the diaphragm can result in compromised stability of the lumbar spine, altered motor control, and dysfunctional movement patterns (Hodges et al. 2005).
At One to One Physical Therapy, we use manual techniques and therapeutic exercises to restore breathing patterns, functional movement, and eliminate pain. Because our breathing dysfunction often involves holding our breath and hyperventilating, we place more focus on exhaling in our breathing exercises. Exhalation promotes relaxation- imagine taking a sigh of relief. We couple exhalation with core activation and postural exercises, which aim to restore rib cage positioning, reduce accessory muscle use, and improve diaphragm coordination. One way we do this is a specific breathing training technique utilizing a balloon.
We also believe in pairing breathing with mindfulness practices and “visualization” exercises for many of our patients. One major breathing technique we use is called Buteyko breathing. Buteyko breathing teaches you to slow down your breathing which promotes relaxation.
For more information about breathing we suggest you refer to our other blog videos and articles here.
Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidisciplinary Healthcare. 2013; 6: 281-291. Doi: 10.2147/JMDH.S45443
Hodges PW, Eriksson AE, Shirley D, et al. Intra‐abdominal pressure increases stiffness of the lumbar spine. J Biomech. 2005; 38(9): 1873–1880[PubMed]
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