There have been several major events in my life causing me to stop and appreciate the miracle of life and the breath that sustains us. On top of that, being amongst colleagues who are expectant mothers in the clinic right now, one such event that I’ve been reflecting on lately, is the birth of my daughter. On memories of her taking her first breath, or rather gasp of air upon entering the world, the delivery that felt like it required every ounce of breath I had to offer, never mind trying to focus on all the prenatal breathing techniques I’d learned prior, and my husband beside to support us, breathing words of encouragement, while at times I’m sure holding his breath in anticipation of what was to come. If it weren’t for occasions such as these in life, that heighten our awareness of breath’s true value, we probably wouldn’t give it much thought otherwise. After all, for most of us this process happens automatically.
“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” – Albert Einstein
The Science - basics of breathing and respiration:
Simply stated, we breathe in and oxygen enters our lungs with the aid of respiratory muscles through a signal from the brain. Oxygen diffuses into our blood, hemoglobin takes it to our working muscles and energy is produced to sustain healthy function, at the same time carbon dioxide (as waste) is carried back to the lungs for removal as we exhale. Though a complex process in theory, this reaction is seamless and automatic for most of us who don’t have significant pulmonary complications. However, as eluded to in my example above, not every breath is created equal.
The Diaphragm – lead role and anatomy:
By far, one of the largest contributors to this automatic process of breathing, is our diaphragm,, “mainly recognized as the primary respiratory muscle of the body responsible for about 80% of all of the respiratory work in normal… (restful) breathing.” (1) As a dome shaped muscle within the chest cavity, your diaphragm extends below at the 1st to 3nd vertebrae in your low back along the inner surface of your lower six ribs and lower surface of your breast bone, through to its’ peak central tendon at the 3rd vertebrae in the low back. These extensive attachments surrounding the base of the lungs make it our most effective respiratory muscle. However, “like many structures in the body, the diaphragm has more than one function, and has links throughout the body…” (2) And it is through two of these links that the diaphragm has another important lead role as a coordinator for stabilizing our postural core.
The Diaphragm – it’s other lead role:
As stated by Julie Weibe, PT, MPT, BSc in her course The Diaphragm/Pelvic Floor Piston for Adult Populations: Part One, “(The diaphragm) is the gateway to the rest of the core” (2)
The diaphragm, along with the deep stabilizing transversus abdominal muscle, the pelvic floor muscles and the lumbar multifidus muscles, together make up what she refers to in her course as “the anticipatory core”. Within this group, the diaphragm can be considered a key player in how these muscles work together as a team, to efficiently stabilize the core in a way that can be managed by how we breath. In other words, you might consider the diaphragm as the conductor, in charge of directing the orchestra (transverse abdominal and pelvic floor muscles) in preparation or anticipation of the performer (peripheral limbs) taking the stage to execute movement. It is by working within this natural sequence of events in the body, that we are able to tap into increased efficiency when performing our daily tasks or exercises.
The research/proof - activation sequence of the anticipatory core
“On exhale, the diaphragm ascends, relieving the pressure from above on the abdominal contents. The TA and pelvic floor engage concentrically (in response) recoiling to resting length (pelvic floor rises 1-3 cm on exhale) and more actively contribute to spine and pelvic stabilizer functions.” (2) It is by working within the basic mechanics of the breath cycle in this process that we are able to utilize its’ normal pattern of recruitment, taking advantage of the diaphragm’s multifunctional role as a way to access balanced control of our inner core muscles. We are then able to apply this principle to exercise prescription to be utilized according to the demands of the task at hand, with increased control and efficiency.
Application to exercise prescription - timing the breath with the task:
In her course, Julie Weibe presented us with a tangible way to tap into our body’s normal breath mechanics, and use them as a “gateway” to accessing “…central stability and postural control,” factors that are considered to be key ingredients in developing safe and effective exercise programs for our clients. In using this principle to prepare for performing a functional task, whether it be rolling over in bed, transitioning from lie to sit or from sit to stand or dead lifting 200 kg, we can use the timing of our breath to make sure we have the most optimal access to our core muscles for support. By simply exhaling prior to initiating your task, or as Julie Weibe would say “BLOW BEFORE YOU GO,” we are reminded by a simple key phrase how to safely, effectively and efficiently complete our task which allows us at the same time to increase our focus on form and technique. Though this may seem like a small thing, it can have significant impact on effort, efficiency and safety among all patient populations but especially among our more senior population, of which I now include myself. Holding your breath when learning new things or when an increase in physical effort is required is often a natural reaction for people, particularly as the complexity of the task increases. However, “don’t forget to breath!” Considering your entire body relies on a steady supply of oxygen to function at its’ best, decreasing the risk of breath holding or other adaptive breathing strategies on a regular basis should be considered of high importance.
Adaptive breathing strategies - potential consequences:
Without the diaphragm fulfilling its’ role as a primary respiratory muscle, and balancing the proper activation of the anticipatory core muscles through its’ lead, “…adaptive breathing strategies can develop, such as relaxation of the abdominal muscles more than necessary on inspiration… or increased use of accessory muscles of respiration,” (1) These strategies “can in turn lead to several negative consequences, among which can include:
- shortness of breath
- decreased respiratory efficiency
- decreased exercise tolerance
- increased lumbo-pelvic instability
- increased activity of paraspinals
- low back pain
- thoracic outlet syndrome
- sacroiliac joint pain
- headaches and
- asthma” (1)
Well, even knowing all this information I still find it challenging at times to sustain an efficient breathing pattern when I’m learning something new, when I find myself in a situation where I feel less that comfortable and when I get into my zone of concentration on a specific task. Can anyone else relate to catching themselves bracing their abdominal or other core muscles and relying on shallow breathing from time to time? So I continue to rely on cues throughout the day to remind me to STOP for a moment and check in to where I’m at. A tool that I’ve found very useful to incorporate into a busy day, is the “One-Minute Breathing Space” https://palousemindfulness.com/docs/STOP.pdf
On slowly expanding through the lower rib cage during each “in” breath, and allowing my diaphragm to do what it does best, I am usually able to achieve a calming and energized effect to carry on with my day with much less effort. This increased awareness and practice can then be carried over into all my activities of increased physical effort.
Though this post scratches only the surface as to the wealth of knowledge contained within Julie Wiebe’s neuromuscular-based clinical model, which also includes postural, pelvic floor and abdominal cueing strategies that are important in accessing the power that is contained within our core, I felt that the breathing component can make a significant difference in the prescription of regional and functionally specific exercises, and was an important springboard from which to start.
For more information on achieving a balanced core strategy and transferring it to functional tasks and sport specific exercises, keep an eye out for future blog posts or contact our office directly. You can also visit Julie Weibe’s website at https://www.juliewiebept.com
~ Elizabeth, PT
(1) Network of breathing. Multifunctional role of the diaphragm: a review. Janusz Kocjan, Mariusz Adamek, Bozena Gzik-Zroska, Damian Czyzewski, Mateusz Rydel. Adv. Respir. Med. 2017; 85: 224-232
(2) The Diaphragm/Pelvic Floor Piston for Adult Populations: Part One Julie Wiebe, PT, MPT,
(3) Anatomic connections of the diaphragm: influence of respiration on the body system. Bruno Bordoni, Emiliano Zanier. Journal of Multidisciplinary Healthcare 2013: 6 281-291