Perfect Breathing

Physical Therapy & Three-Dimensional Breathing

Here's an inside look at how breath and breathing can vastly improve the benefits you seek from physical therapy.

Joni Fischer-Jones is a physical therapist at Laurelhurst Physical Therapy Clinic in Portland Oregon. She uses breathwork and breathing techniques extensively in her work and personal life. We sat down with her and asked her to share her knowledge and experience:

How were you originally drawn to the physical therapy profession?

I had originally planned on being nurse, but I didn’t want to work nights, long shifts or weekends. I had also considered being a doctor, but didn’t want to take on the schooling, so I looked through the Allied Medical professions and saw Physical Therapy, and thought, “This looks interesting.” I applied to the physical therapy clinic and spent a week there and knew immediately that it was for me. I loved it! That was 30 years ago and I never looked back

 
While training to become a physical therapist, was breathwork part of the curriculum?

They did talk about it, but only from an oxygen (O2) perspective. I don’t know what they are teaching now, but if you are involved with yoga, Pilates, or tai chi, breathing is everything. I’ve learned that eye movement, breathing, and core stabilization are all integrated, so if you learn to integrate breathing with proper movement and posture, it helps to increase your awareness.

How does eye movement relate to all of this?

Eye movement is very important because the eyes are very connected to the neck as in terms of the neck position. If you don’t use your eyes correctly from a upper cervical standpoint (where the neck meets the head), you start recruiting muscles in your neck and that can cause a cascading effect into your shoulders and upper back. This can contribute to or encourage the abnormal upper respiratory breathing pattern which most of us have developed instead of the proper lower lateral ribcage breathing.

That bad breathing pattern can cause a host of muscle and joint related problems such as headaches, dizziness, nausea, joint instabilities, as well as shoulder and neck problems. Prolonged upper respiratory breathing, which de-emphasizes the diaphragm, can also result in the diaphragm, becoming weak, and “stuck” like any other unused muscle.
 
What can people do as far as eye movement to encourage proper breathing?

I don’t look so much at breathing and eye movement as a unit, but I look at them from an individual perspective. If I’m having them work in their upper cervical, for example, I’ll have them move their eyes up for extension (of the spine), and eyes down for inflection. Then you look to see what is happening with the neck. Are the spine segments staying stable? Are they moving 1-2-3 as they should? And if they are not, you go down and start looking at what could be pulling on these segments. Once you start moving below the neck, you start looking at the scapula (shoulder blade) position and how they are breathing relative to the scapula. The muscle problems in the neck and shoulders that we spoke about in the previous question can cause the scapula to move vertically, rising and falling with the breath instead of expanding with the ribs.

The first thing I look at a in a person is how they are breathing and what muscle groups they are using or not using with the breathing. Once you get a person to understand what they need to do, and you get them to do it with the breath, they have learned it. It becomes automatic.
 
What are the roles that breathing plays in your work, other that what you’ve just mentioned?

I combine breathing with movement patterns. You’ll have them inhale and exhale with certain movement patterns. We know that when you inhale, when you take a deep breath in, it makes the thoracic spine (the 12 vertebrae of the back, between the neck and lumbar) extend and the ribs roll to the back or posterior. So if you have someone who is very flexed (hunched forward), you will want to have them work on inhaling to bring the rib cage back and get their thoracic spine in extension and if you have some one who is stuck up their upper chest, you will do the opposite – have them exhale to encourage forward flexion of the spine. When you evaluate a person you analyze what spine position or rib movement you want to facilitate.

If you talk to the Pilates people, this is what they are also teaching. It is the lateral rib cage breathing - expanding it three dimensionally. You get al lot more oxygen if you get your lower rib cage expanding. They say after the age of 40 if a person has not done a lot of breathing - heavy, aerobic breathing - the rib cage becomes fixed. It doesn’t have the flexibility, and if your rib cage can’t flex, you can’t get as much oxygen in or carbon dioxide (CO2) out. The body really wants movement.
 
Are there exercises you can do at that point to improve the flexibility of the rib cage?

You can make sure that you are exercising regularly to keep your breathing in shape, which is of course related to a host of other health issues as well. Make sure your breathing stays in shape. If you are breathing deep, the bones move and flex with the breath.

 
It’s clear that the breath plays a role in all of the different dimensions of life. In your work do you use it to deal with other aspects of your patient’s health, such as emotions for example?
 
A lot of my patients are very stressed, for whatever reasons. They have personal issues going on, they’ve been in a car wreck and are in a lot of pain, their employer is driving them crazy, they own their own business, or the market is crashing. Who knows? I look at how they are holding themselves. If you take an inhalation and exhalation it relaxes your muscles. So we do a lot of cleansing breaths. I have them take a deep breath in and hold it a little bit and then exhale it all the way out and hold it a little bit. That gets the muscles to relax and gets the O2 in because they are generally not breathing well and not getting the fuel they need and not getting the CO2 out as well.
 
I had a patient today who does a lot of upper respiratory breathing. She’s got a lot of issues with a child that is sick and we did a lot of breathing and she said “Oh my gosh! I’m so dizzy!” I get that a lot. They’ll get dizzy when they start getting more O2 and you’ll also see that they start getting giddy. It’s like having two glasses of wine.
 
What is the cause of the dizziness?

It is an imbalance of the O2 and CO2 and sometimes people are not used to having that much O2. That can worry them or make them scared.

You can also get someone who is getting too much O2 by hyperventilating and they can actually faint. When they start hyperventilating it gives them a panicked feeling which makes them hyperventilate more which can result in fainting. Breathing into a bag recycles the exhaled CO2 which lowers the O2 levels and calms them down.
 
We’ve seen that athletes can improve their performance by strengthening their breathing. What the best way to approach that?

Oftentimes marathon runners say it’s not their legs that are getting tired, it is their lungs.

Look at the posture muscles, you want to make sure that dynamically all the joints, the ribcage, the thoracic spine, the lumbar bones are in proper position. For example if you have pectoral muscles that are really tight, they are going to put you into a collapsed, or hunched-over position. Same if you work over a computer, you are probably going to be in a flexed position. So to build up your breathing, it is like treating any other patient from a posture perspective – you want to strengthen the posture muscles. In between each rib segment are the intercostal muscles. Breathing in and out uses your intercostals and any muscles that attach to your rib cage would be muscles you would want to strengthen. I would think that aerobic conditioning and training, getting a lot of O2 in would be helpful as well.
 
What is the purpose of the hold in the breathing cycle?

There are two purposes. You can use it to increase the O2 absorption on the inhale and also to get the spine to extend. When you inhale, the ribs are going to rotate backwards, and the spine is going to extend. Holding it for a moment creates muscle memory and allows for more O2/CO2 exchange.

 
What are the ways that you use breathing techniques in your own life?

I think about it a lot. If I’m driving down the road and I’m late for work and there are all these cars in they way, I realize there is nothing I can do to change the situation, so I deep breathe and generally use it for relaxation purposes. Also, if some part of my body is hurting, I’ll use the deep breathing techniques to take away some of the hurt.

I also find that the techniques give me a lot of energy. The other night I participated in a sleep study and it was at the end of my work shift and I was very tired. The technician had me try on a CPAP (breathing assistance) machine just to get used to it. I had the machine on for 5 minutes and got so much O2 that I couldn’t sleep. It is fuel for your system.
 
What would you suggest for people who are new to these techniques?

Deep diaphragmatic breathing is the most important. Using a Thera-band (elastic band) wrapped around the lower ribcage gives a little proprioceptive resistive feedback, so as you inhale you are going to feel that Thera-band and be more aware of your body movement and position .You can also use your hands instead of the Thera-band, but it is not quite as effective.

I don’t teach patients to make the belly rise, but like to have them think about it as a three dimensional opening up of the rib cage cavity and making sure that they inhale through nose and exhale through the mouth. Inhaling through the nose filters allergens, and conditions and moisturizes the air and exhaling through the mouth uses 50% less energy.

They other thing I would have you think about is where you hold your ribcage in space with regards to your posture. Many people hold their ribcage up as they straighten their posture. They lift their ribcage up and they can’t get good breath because now the ribcage is up really high. So pay attention to where you are holding your ribcage. Imagine that your ribcage is stacked on top of your pelvis, which is shaped like a bowl. Ideally, you don’t want either of them tipping.

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Don Campbell and Al Lee are the authors of Perfect Breathing: Transform Your Life One Breath At A Time (Sterling Publishng/2008) and write, speak, train, and blog tirelessly on the subject. Discover more ways you can improve your health, performance, and wellbeing at www.perfectbreathing.com. Reach them at info [at] perfectbreathing [dot] com or call 1-888-317-6718 (toll free).