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Breathing: The Forgotten Art

The Simplicity of breathing. Nothing Fancy.
The Simple Cycle of Breathing

Breathing correctly promotes optimal sleep, digestion, organ function, mental health, core and postural control. It’s cardinal to stay alive!

Breathing is the basis of life, function and expression. A newborn baby is the purest example of basic physical functions such as breathing. When you observe a newborn baby you will see breathing at its best. The chest and abdomen visibly rise and lower together. This is called Diaphragmatic Breathing because you use your diaphragm to breathe. However, if you were to observe an adult breathing you will observe only their chests move with breathing. Shockingly, as much as 80% of the general Western adult population breathes in this manner.

Correct vs. Incorrect Breathing Patterns

Oxygen and Carbon dioxide Exchange in the Alveoli of the lung

Your breathing pattern refers to the work or biomechanics of breathing. The manner how you breathe determines how much air you take in and where it goes in the lungs. Ideally, the air you breathe in should reach all of the lung’s alveoli. The alveoli are minute sacs of lung tissue where oxygen and carbon dioxide are exchanged in the bloodstream. For optimal air exchange, as much oxygen-rich air must be drawn into as many alveoli as possible. Similarly, as much carbon dioxide-rich air as possible must be expelled to make space for the next breath of air. Proving that deep breathing is extremely important.

Diaphragmatic or Belly Breathing

The diaphragm is a large dome-shaped muscle below the lungs and ribcage. It divides the body cavity into thoracic and abdominal cavities. The diaphragm is also structurally a point of attachment for multiple organs such as the lungs, heart, liver, stomach and kidneys. However, it’s most important function is regulating pressures in the thoracic and abdominal cavities. When inhaling, the diaphragm pushes down into the abdomen. This creates a negative pressure and air rushes into the lungs. It also increases pressure in the abdomen, pushing the belly out. This is why its often called belly breathing. When exhaling, the diaphragm relaxes and pushes the lungs up to expel the air and the belly relaxes inwards as well. 

The Diaphragm in Action

Recent studies show that by controlling pressures in the body cavity, Diaphragmatic Breathing has the power to:

  • Increase blood oxygen levels
  • Reduce unused space in the lungs
  • Decrease blood pressure by enhancing blood flow back to the heart
  • Regulate Stress via the Vagus nerve
  • Regulate Pain by relaxing muscles and stimulating the vagus nerve
  • Improves Digestion 
  • Promote optimal Organ Function by maintaining cavity pressure and organ motion
  • Provide the correct Intra-Abdominal pressure for Posture and Core Control

Along with the diaphragm, the external intercostals and levatores costarum assist in elevating the ribs to allow space for the lungs to expand. To expel air from the lungs the abdominals and internal intercostals help to depress the ribcage and force air out of the lungs.  These are the primary muscles of breathing. The secondary or accessory muscles are the sternocleidomastoid, scalenes, pectoralis minor and upper fibres of the trapezius. They help to increase chest expansion in a stress response or exercise when more oxygen is needed.

The Muscles of Breathing

Diaphragmatic Breathing and the Vagus Nerve

An important relationship that needs to be mentioned is that of the diaphragm and your vagus nerve. The vagus nerves are the 10th cranial nerves that exit from the brain and travel directly to the rest of the body bypassing the spinal cord. The word Vagus means ‘wandering’ in Latin. Quite appropriate considering that it is the longest cranial nerve, and travels from the brain to the colon.

The Vagus Nerve Pathway

The vagus nerves provide the brain with sensory information from the throat, heart, lungs and abdomen. It controls muscles in the neck for swallowing and speech. The vagus nerve also controls the digestive system, heart, breathing and heart function through the parasympathetic nervous system.

The parasympathetic or “rest and digest” nervous system is controlled by a neurotransmitter called acetylcholine. Acetylcholine is released by the vagus nerve. This helps you to calm down, decrease blood pressure and lowers your heart rate.

The sympathetic nervous system controls your “fight and flight” nervous system. This is a very important function. If this system is not regulated; your body will not move out of a stressed state, even if the threat has passed. We are no longer chased by lions, but mental and emotional stresses are daily occurrences for many people. This means that we are constantly on the alert and not able to relax even in no stressful situations. This leads to chronic stress syndrome, anxiety and depression.

Other functions of the vagus nerve are:

  • To decrease inflammation
  • Lowering heart rate and blood pressure
  • Taking information from the gut to the brain, including that of fear.

It is therefore important to consider that the Vagus nerve can influence your breathing and vice versa. By controlling your breathing you can affect your whole nervous system.

Apical or Chest Breathing

In the chest breathing pattern, the diaphragm and other primary muscles of breathing do not do the main work of breathing. The secondary muscles of breathing take over and lift the top of the chest and shoulders to try and expand the lungs. It is important to remember that the largest part of the lungs are at the bottom. Chest breathing does not allow the bottom of the lungs to expand. While there is still some diaphragmatic movement, it does not drive the action, therefore not allowing the lungs to sufficiently expel carbon dioxide-rich air fully out of the lungs. This leads to a backlog of carbon dioxide-rich air in the lungs which prevents the lungs from taking in more oxygen-rich air. Oxygen is an essential nutrient for all body functions. Chest breathing does not allow you to take in enough, so your body automatically breathes faster to compensate.

Apical or Chest Breathing

Chest breathing is bad for you because it:

  • Leads to insufficient oxygen in your bloodstream
  • Causes chronic muscle stiffness and tension
  • Leads to poor posture
  • Leads to chronic pain and headaches
  • Increases stress and anxiety
  • Causes poor sleep patterns
  • Causes chronic fatigue

Nose Breathing vs. Mouth Breathing

Another important part of the biomechanics of breathing is how we take the air in. Breathing through the nose causes resistance to the airflow. This slows inhaling and exhaling which in turn allows full lung expansion and expulsion of air from the lungs. Nose breathing warms and moistens the air before it gets to lungs which keep the lung muscles relaxed and airways open. The hair and mucosal lining in the nose filter out bacteria and particles that would cause disease or irritation to the lungs. 

Conversely, mouth breathing does not supply resistance to airflow or have filters to protect against particles and bacteria. Mouth breathing is normal when the nose is blocked. However, if it continues long term it will cause problems. Common problems caused by mouth breathing are: increased asthma symptoms, sinusitis or nasal congestion, dental problems, bad breath, jaw pain and poor sleep quality. Common causes of mouth breathing are: allergies, asthma, chest breathing, chronic colds or flu, deviated septum in the nose or enlarged tonsils and adenoids.

Why Do We Breathe Incorrectly

Many factors can influence how we breathe. Poor posture, biomechanics, shoulder girdle control, low back pain, neck pain, mental or emotional stress, smoking or lung disease can cause chest breathing. All these factors affect breathing by reducing the air the lungs can take in. This happens either from increased breathing rate or activating long term use of the accessory muscles leading to a carbon dioxide backlog. Smoking and lung disease damage the tissue of the lung leading to decreased oxygen uptake. This in turn, puts the body in a stressed state and perpetuates a cycle of chest breathing. 

Assessing your own breathing pattern

You can check if you are chest breathing by placing one hand on your sternum and one just below you ribcage on your stomach. As you breathe normally notice which hand moves more. If your top hand moves more you are chest breathing. If your hands move equally or the bottom hand moves more you are breathing diaphragmatically.

Stop and Breathe

How to Breathe Correctly

  1. Lie on the ground with your knees bent up and feet on the floor. Place a small cushion or rolled-up towel on your stomach, just below your rib cage. Spread your arms slightly away from your body.
  2. Focus on relaxing your head, neck, shoulders and back into the floor.
  3. Take a long breath in while focusing on pushing the cushion/towel upwards towards the ceiling with your stomach. Continue inhaling until you feel your lungs are full.
  4. Then exhale and focus on sinking the cushion/towel towards the floor and drawing your lower ribs in. Continue exhaling until you feel all the air has been expelled from your lungs. 

Timing of your breaths are very important: Measure the inhaling to a count of 2 seconds and exhaling to a count of 3 seconds. If you feel you have more capacity to take in air, try inhaling to 3 seconds and exhaling to 4 seconds. Your inhale will always be shorter than an exhale. The cushion/towel on your stomach must move more than the top of your chest.

Visualize Your Inhale and Exhale.

Do this routine 3 to 4 times a day. Start with 5 to 10 deep breaths then reduce to a more relaxed effort. Spend between 5 and 10 minutes in this manner.


Once you feel you are comfortable doing it lying down you can change your position to sit. 

  1. Sit on a chair with the correct posture. Make sure your shoulders and upper chest remain relaxed. Place 1 or both hands on your stomach just below your ribcage. 
  2. Take a long breath in while focusing on pushing your hands away with your stomach. Continue inhaling as you did in lying.
  3. Then exhale and focus on sinking your hands in towards your spine and drawing your lower ribs down. Continue exhaling as you did in lying. 

To help integrate diaphragmatic breathing into your daily life you can create reminders to check your breathing. Examples of this are to when you wake up, have your coffee, get in the car, meal times, at the start or end of work. Make a conscious effort to stop and see if you are breathing from your stomach.

Exercise and Diaphragmatic Breathing

Example of Pilates type exercise

Exercise is another important time to check your breathing, especially for asthmatics. Yoga and pilates are good forms of exercise to do to learn how to breathe as you train. In types of exercise like yoga, pilates or weight lifting where each movement is defined – you can match your breathing to your movements. For example, you will inhale on your preparation and exhale on the effort. An example in pilates would a leg raise. Inhale as you lower your legs towards the ground and exhale as you lift them back up. For weight lifting an example would be a squat or deadlift. Inhale as you bend and lower the weight down and exhale when you move back into an upright position. You will notice that the exhale happens on the movement that requires extra effort from the abdominal canister to support the spine and trunk.

For more complex exercise that doesn’t have a clear effort and preparation phase such as dancing, running or cycling you would not breathe with specific movements. For these activities rather focus on beginning and maintaining a pattern of relaxed diaphragmatic breathing throughout your session. It is however important that your breathing effort remains relaxed. Do not breathe deeply for the whole session, rather only when needed. If you feel that you can’t maintain your breathing, rather reduce your effort and even stop for a bit to regain the correct pattern.


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Breathing In and Out

While diaphragmatic breathing is a basic physical function it has unfortunately not remained a common one. This is due to a societal tendency toward a sedentary but mentally fast-paced lifestyle and bad habits of eating and smoking. If you suffer from chest breathing, chronic stress, anxiety, high blood pressure, fatigue, digestive problems or have trouble sleeping you should pay your physiotherapist a visit. Your physiotherapist can help you assess your breathing and what is causing the problem. They will then be able to give advice on how to correct this multifaceted problem and overall improve your lifestyle.