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Diaphragmatic Breathing The Foundation of Core.5
Diaphragmatic Breathing The Foundation of Core.5
Diaphragmatic Breathing The Foundation of Core.5
Stability
Nicole Nelson, MS, LMT
Ponte Vedra Beach, Florida
SUMMARY are integral to the generation of core the grocery bags as they continue
stability. It is estimated that 10% of the to breathe.
MANY FITNESS AND REHABILITA-
population suffers from dysfunctional Maintaining neutral spine during
TION EXPERTS WOULD AGREE
breathing patterns; these percentages activity is believed to preserve the
THAT DIAPHRAGMATIC BREATH-
jump to 30% among asthma sufferers integrity of the spine and protect vary-
ING IS THE MOST FUNDAMENTAL
and 83% in those suffering from anxi- ing structures from injury (24,25,30,38).
DEMONSTRATION OF CORE
ety (7), creating a need for strength and According to Panjabi (30) 3 subsystems
FUNCTION. AS SUCH, ONCE
conditioning professionals to be able work together to maintain this integ-
PROPER BREATHING PATTERNS
to assess and help improve breathing rity, the central nervous subsystem
ARE ESTABLISHED, CLIENTS WILL
pattern function. This article will (control), the skeletal subsystem (pas-
HAVE A SOLID FOUNDATION TO
investigate the influence that upper- sive), and the muscular subsystem
FURTHER DEVELOP CORE FUNC-
chest and/or quick breathing patterns (active). The Panjabi model suggests
TION. IF WE CONSIDER THE
may have on core stability and will that dysfunction of any one subsystem
NOTION THAT BREATHING IS A
suggest basic breathing assessment will compromise stability and poten-
FUNDAMENTAL COMPETENCY OF
methods and breathing retraining tially cause back pain (30). Addition-
CORE STABILITY, WE MUST BE ally, a dysfunction in any component
ideas.
CERTAIN THAT BREATHING PAT- of any subsystem can lead to compen-
TERNS ARE HEALTHY BEFORE According to Kibler et al. (17), core
sation from other systems, long-term
PROGRESSING OUR CLIENTS TO stability is the ability to control the
adaptation by one or more subsystem
MORE ADVANCED CORE EXER- position and motion of the trunk over
or injury to one or more components of
CISES. THIS ARTICLE WILL REVIEW the pelvis to allow optimum produc-
any subsystem. In effect, stability of the
THE CONCEPT OF CORE STABIL- tion, transfer, and control of force and spine is not only reliant on muscular
ITY AND DISCUSS THE ROLE OF motion to the terminal segment in strength but proper sensory input to
PROPER RESPIRATORY MECHAN- integrated athletic activities. In other the central nervous system. Methods
ICS ON CORE FUNCTION. words, proximal stability sets the stage of training for core stability should
for distal mobility. As stated by Cook therefore consider protection of the
(6), “The best core training programs passive structures of the spine, optimi-
INTRODUCTION require the spine to be held in a natural zation of motor control, and improving
ore stability training has or neutral position while breathing and muscular strength and endurance. This
34 VOLUME 34 | NUMBER 5 | OCTOBER 2012 Copyright Ó National Strength and Conditioning Association
breathing patterns can be disruptive to a negative pressure in the thoracic O’Sullivan and Beale (28) studied sub-
the muscular and control subsystems. cavity that forces air into the lungs jects with LBP attributed to the sacro-
These influences suggest that breathing while increasing pressure in the iliac joints and compared them with
in a more diaphragmatic manner may abdominal cavity. control subjects without pain. By com-
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of the diaphragm when respiration varied causation of dysfunctional sensitization (3,38), the result of which
demand is increased. He hypothesized breathing, most patterns present in can alter motor control and ultimately
that during strenuous exercise when the same fashion. These patterns spinal stability (28,29). Dysfunctional
breathing is labored, spinal control will include increased breathing frequency breathing is also known to adversely
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be compromised, which could lead to and chest breathing. It is important to affect postural balance and propriocep-
increased potential for injury to spinal note that these patterns are not exclu- tive function of the lower limbs (16).
structures and reduced postural con- sive of each other, as an individual may Other complications resulting from
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trol. Much is still unknown regarding display more than one pattern at quick breathing include changes in
the cause/effect relationship of breath- a given time. These breathing patterns magnesium, calcium, and potassium
ing and postural stability, but it is pos- can be seen by simply observing tho- levels, which can also interfere with
sible that optimal breathing patterns racic and/or abdominal movement, the motor control mechanisms that
can improve the diaphragm’s postural upper-thoracic muscle activity, and govern the core.
stabilizing capacity, allowing individu- duration of inhalation and exhalation.
als to extend activity and intensify Increased and/or over breathing in
training while limiting the loss of core POSTURE AND BREATHING
extreme cases is referred to as hyper- Postural adaptation has been linked to
stability. ventilation and is closely associated breathing dysfunction (5,8,22,38).
PART II: DYSFUNCTIONAL with anxiety and apprehension (18). Breathing influences muscular function
BREATHING PATTERNS Stress tends to exacerbate quick and and posture because the habitual use of
Although breathing is regulated and upper-chest breathing patterns and breathing muscles during respiration
coordinated by the autonomic nervous can indicate a general dysfunction of affects how these muscles are used for
system, proper breathing is not auto- an individual’s ability to alternate nonbreathing movement and postural
matic. Physical, chemical, and emo- between heightened activity levels support (7). The reverse is also true
tional factors can alter the rate and and rest periods, limiting full recovery whereby everyday posture affects the
volume of the breath (4,7) and cause before resumption of activity. Recalling habitual use of the breathing muscles.
breathing pattern problems. Recalling that respiration is prioritized over spine As stated by Sahrmann (36), “repeated
Panjabi’s model, the body will compen- stabilization, stressed clients who are movements and sustained alignments
sate for these factors and create varying prone to poor breathing patterns can associated with everyday activities are
pathways to keep up with respiratory be at risk for losing the protective trunk the inducers of tissue adaptations.”
demands by either involving the upper- stabilization efforts of the diaphragm. Sahrmann posits that when everyday
chest accessory muscles or by quicken- Ironically enough, good breathing activities involve repeated movements
ing the rate of the breath. This is a com- patterns can be an effective tool indi- in a specific direction, the movement in
pletely normal adaptive response if an viduals can use to manage stress, there- that direction occurs more readily and
athlete is running; however, problems fore it should be encouraged during easily because of tissue changes. Fur-
may arise if the athlete cannot recover stressful times (4,7,34). thermore, once a joint develops a ten-
to a slower more diaphragmatic One of the major problems with a rapid dency to move easily and readily in
method of breathing during rest. Like- breathing pattern is the affect it has on a direction, that movement will occur
wise, if the athlete demonstrates a chest the body’s pH. Blood pH is tightly with all activities involving that joint
or quick breathing pattern at rest, it can regulated by a system of buffers that and not just the one that induced the
create further adaptive and dysfunc- continuously maintain it in a normal joint changes. If we apply this logic to
tional patterning when the respiratory range of 7.35–7.45 (slightly alkaline). chest dominant breathers, the sterno-
system is subsequently challenged. If Breathing at an increased rate increases cleidomastoid muscles, upper traps,
this is the case, the faulty breathing the amount of carbon dioxide exhaled, and pectoral muscles shorten creating
pattern may perpetuate on a subcorti- which can lead to alkalosis (elevated an overly kyphotic and forward head
cal level and lead to an ingrained motor pH). During respiratory alkalosis, red posture. This suboptimal posture has
program, even when the initial trigger blood cells bind more tightly to the a destabilizing effect on the trunk
no longer exists (7). In other words, oxygen they are carrying, which (21,22,24,30). It will probably never
breathing patterns, much like any other decreases the amount of blood getting be clear which came first, the breathing
motor pattern, can become a habit to the brain and muscles (the Bohr pattern problem or the posture prob-
whether it is healthy or not. effect). Additionally, less oxygen is lem. Regardless, both need to be ad-
Given the complex nature of breathing released by the blood. Lack of ade- dressed to optimize core stability and
problems, there is no gold standard quate blood supply creates a cascade overall performance (3,4).
definition of dysfunctional breathing, of events such as increased muscle ten- A study by Obayashi et al. (27) illus-
and it is often broadly described as dis- sion, reduced motor control (40) per- trates how posture and respiration
turbances in breathing functionality petuation of trigger points, increased influence one another. Subjects
that impact heath (7). Despite the muscle spasm, and increased pain breathed into a SpiroTiger (Autospiro
vatures, pulmonary function, and iso- muscles is believed to create muscle ment of the rib cage and pelvis nec-
metric trunk flexion as well as imbalance and suboptimal posture that essary for creation and sustainability
extension strength. Janda characterized as upper crossed of IAP. Mobilization efforts should be
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Thoracic kyphosis decreased by 5.5˚. syndrome (UCS) and lower crossed directed to improving extension and
Lumbar lordosis decreased by 3.1˚. syndrome (LCS). Individuals with rotation of the thoracic spine. Stretch-
Pulmonary function improved force UCS and/or LCS present with a for- ing should focus on the iliopsoas, rec-
vital capacity from 4.1 to 4.3 L and ward head posture, overly kyphotic tus femoris, tensor fascia lata muscles,
forced expiratory volume in 1.0 sec- thoracic spine, and an anteriorly erector spinae, adductors, and pirifor-
onds from 3.4 to 3.7 L. rotated pelvis. In order for optimal sta- mis muscles. Strength training should
Trunk flexion strength improved by bilization and respiration to occur, the focus on the gluteals and TrA.
10.6% (from 695 to 769 N), whereas underlying muscle imbalances must be Upper cross: Upper-chest breathers
trunk extension strength was addressed by creating a stretching/ will overuse accessory breathing
unchanged. strengthening plan to bring the pelvis muscles that can lead to UCS.
They discovered that exercising respi- and rib cage in a more neutral align- Likewise, those with a forward head
ratory muscles improved posture, most ment. Mobility work should be a rou- posture as seen in UCS will not have
likely because of the stimulation of the tine that is not only included in training the structural or functional opportu-
local core stabilizers (27). Although sessions but performed at regular inter- nity to breathe well. Stretching
participants were not engaging in dia- vals throughout the day. Specific should be directed to the levator
phragmatic breathing, it does suggest stretching and strengthening plans fall scapulae, scalenes, sternocleidomas-
that there can be positive postural outside the scope of this article; how- toid muscles, pectoralis muscles, and
effects from breathing training. ever, the following list includes a gener- the upper-trapezius muscles, whereas
alized plan for a client or athlete strengthening should be emphasized
JANDA’S BLUEPRINT TO presenting with UCS and LCS. It is among the inferior scapular fixators
ADDRESSING MUSCLE important to note that this is one (middle and lower trapezius, rhom-
IMBALANCE example of postural distortion that is boids, and serratus anterior muscles).
Janda and Richardson suggested that associated with breathing dysfunction.
certain muscles have a tendency to Each client should undergo a postural ASSESSMENTS
become short and tight and some have assessment at which time a mobility Despite the lack of a widely accepted
a propensity to lengthen and weaken, plan can be specifically designed for standard of normal breathing, there are
often as a result of postural or move- the individual’s needs. some widely accepted aspects to nor-
ment habits (15,33). Table 1 lists the Lower cross: Janda outlined muscles mal breathing that are described
global muscles of the core, which are that needed to be stretched as well as within the assessment descriptions.
believed to shorten and tighten, and muscles that needed to be Table 2 summarizes the more common
Table 1
Local and global muscles
Global muscles—prone to shortness/tightness Local muscles—prone to lengthen/weakness
Inhalation is initiated with lifting of the chest on the belly should rise before the
hand on the chest and additionally,
Limited lateral rib cage expansion the hand on the chest should move
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lie on their back. Place your hand on of the mid section and not simply the ventilation, followed immediately
the client’s upper chest, apply a slight rectus abdominus (evidenced by the by dismounting the bike and assum-
downward pressure to the sternum rectus “doming” up). This faulty ing the side-plank posture. McGill
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during their exhalation and hold it bracing pattern will negatively influ- believes that combining the efforts
there while they inhale and exhale. ence normal diaphragm function, of holding neutral spine in side plank
This tactile feedback will help guide encouraging an upper-chest pattern while breathing is elevated will
their breath into the lower ribs and (28). A tactile tip to help correct groove the motor patterns that coor-
belly. As you remove your hand, ask a rectus abdominus dominant firing dinate postural control and respira-
them to actively hold the chest in pattern is to have the client wrap tory function of the diaphragm (24).
this depressed exhalation position their hand around their waist line The diaphragm is the primary muscle
while they continue to breathe. Once (finger tips just above the waist line) of respiration and a postural stabilizer,
your client develops a sense of and ask them to try and push their as such, it is possible that optimizing
proper breathing, they should be hand away during bracing. breathing patterns will improve the
encouraged to practice on their own. Blowing up a balloon: Breathing capacity of the diaphragm to perform
Reducing shoulder movement (4): while bracing requires the ability to its role as a stabilizer of the trunk.
This exercise is intended to discour- control the nonrespiratory activity of Strength and conditioning specialists
age the elevation of the shoulder gir- the diaphragm, and maintain IAP should consider breathing pattern
dle while breathing. Instruct your while exhaling. This requires eccen- assessment and retraining for athletes
client to sit in a chair with forearms tric control of the diaphragm. The because better breathing habits may
and elbows comfortably supported by blowing up a balloon exercise is positively affect core stability and ulti-
the arms of a chair. During the inha- believed to help develop this pattern mately improve the overall condition-
lation (through the nose) have them of co-contraction of the diaphragm ing of the athlete.
gently push down onto the arms of and abdominal wall (2). Position the
the chair, as they exhale (through client supine with knees bent and
pursed lips) instruct them to ease feet flat on the ground. Have the cli-
the downward pressure of the arms. ent inhale through the nose and Nicole Nelson
Breathing and bracing: An important exhale through the mouth maintain- is a licensed
element of core training is learning ing neutral spine. Instruct your client massage thera-
how to brace and breathe concur- to then inhale through the nose and pist and owner of
rently (with the exception of per- slowly exhale into the balloon. Ide- her own massage
forming maximal lifts). There has ally, the client will be able to inhale business in Ponte
been much debate between those again without pinching off the bal- Vedra Beach,
who follow McGill’s core stabilizing loon with their teeth, lips, or finger- FL.
approach of bracing and Hodge’s tips. This requires maintenance of
strategy of hollowing. Hollowing intra-abdominal pressure to allow
involves drawing the navel toward inhalation through the nose without
the spine, which is believed to create the air coming back out of the bal-
TrA activation. Bracing is a voluntary loon and into the mouth. It is impor- REFERENCES
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