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Basics of Breathing

February 28, 2020

Basics of Breathing by Lisa Burdick, PTA

Breathing is something that we must all do 24 hours a day and that can greatly impact how we move and feel in a positive (or negative) way. In physical therapy, we evaluate breathing to identify dysfunctional breathing patterns as well as muscle imbalances (e.g., tight or weak muscles) that may lead to pain and injury.

Normal breathing requires the use of the primary respiratory muscles, which consist of the diaphragm and intercostal muscles (muscles between the ribs). When we exert ourselves, we call on our secondary respiratory muscles within the neck and chest, which include the upper trapezius, scalenes, sternocleidomastoid, levator scapulae, and pectoralis minor. These secondary muscles help lift the ribcage to allow the lungs to expand further in order to bring in more air. When we develop dysfunctional breathing patterns, we begin to use our secondary respiratory muscles instead of our primary muscles, which leads to postural imbalances such as a forward head and rounded shoulders resulting in neck and shoulder pain, headaches or dizziness.

Dysfunctional breathing can also occur due to poor positioning of the ribcage. When our ribcage mobility is limited or the lower ribs are flared out, our diaphragm is at a disadvantage in its efficiency to pump air into our lungs. When we struggle to get air into lungs that are already full or into a tightly restricted ribcage, we again depend on our secondary muscles to breathe. By repositioning our ribs into an optimal neutral position, we facilitate our diaphragm muscle and improve the neuromuscular control of our intrinsic core stabilizers. This, in turn, helps us to move our bodies more efficiently with less stress on our joints and spine.

The diaphragm is connected to the central nervous system and engages the vagus nerve that produces a calm state in the brain. Dysfunctional breathing patterns can contribute to feeding the sympathetic nervous system, the system that is responsible for the “fight or flight” response to stress and that is characterized by increases in heart rate and muscle tone. When you take slow, steady breaths, your brain gets the message that all is well and activates the parasympathetic nervous system to help calm the mind and body. With as little as one minute of slow, mindful breathing, we can alter our stress levels, relax tense muscles, improve alertness, boost the immune system, and facilitate our inner core stability (abdominal and pelvic floor muscles) to optimize movement efficiency. The upward and downward movement of the diaphragm helps move toxins from the organs, promoting better blood flow and releasing endorphins, which are natural painkillers created by our own bodies. Focusing on your breathing during physical activities can help you become more mindful of your body, improving self-awareness.

Functional Breathing Exercise:

  1. If standing or sitting, distribute your weight equally through your heels or sit bones. If lying down, bend your knees up to flatten your lower back. Lengthen the back of the neck and move the tailbone down to promote neutral spine alignment.
  2. Consciously relax your neck and shoulders and avoid clenching your jaw.
  3. Begin with an exhalation, as you cannot properly inhale until the lungs are emptied. Slowly blow out through the mouth for 3-5 seconds focusing on closing/lowering the lower ribs and sternum down and engaging the abdominal wall to gently flatten your lower back. PAUSE FOR 3-5 SECONDS BEFORE INHALING.
  4. Slowly inhale through the nose for 3-5 seconds focusing on expanding the abdominals and ribcage smoothly in all directions but stopping at the collar bone to avoid using your neck muscles.
  5. Repeat 4-5 breaths, then rest by breathing naturally. Work up to 3-5 sets at a time.

If you are interested to see if your breathing patterns are contributing to your chronic aches and pains please reach out and fill out the injury screen form on our website ( to see if we are able to help! 

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