The Compelling Links Between Pain and Dysfunctional Breathing

September 5, 2023

Dysfunctional breathing" is breathing in a way that is inefficient, or at its worst, makes it almost impossible for the diaphragm to work correctly. Most of us give  little thought to breath unless our situation forces us to be more conscious of this semi-automatic activity. However, many people learn strategies for breathing that can have quite negative consequences for the body.

There are many valid strategies for breathing, but unless the diaphragm plays a central role during inspiration, other muscles will be forced to substitute for it from a position of far less mechanical advantage. They then may cause pain and other symptoms in a confusing array of seemingly unrelated effects.

The diaphragm cannot effectively do its job without displacing the viscera, causing movement and expansion in the abdomen, and to a lesser extent being able to expand the costal margin around the bottom of the ribcage where it attaches. To the extent that we harden and lock the muscles of the abdomen and the costal margin of the ribcage during inspiration, we essentially block the action of the diaphragm.

Allowing these areas to move has other benefits as well. The viscera benefit from alternate compression and release, a form of self-massage if you will. The body in general is made for dynamic movement, not being hardened and static. When we allow the muscles of the abdomen to expand and contract, they are being moved through their range of motion rather than being kept in a permanently contracted state.

Over time, if the abdominal muscles are not allowed to move, they will stay short, develop taut fibers and tenderness, and will actually cause discouraging pain if the person suddenly then tries to cultivate a habit of diaphragmatic breathing. The rectus abdominis and obliques can refer back pain, intrapelvic, groin, visceral and abdominal pain, symptoms that are very often misdiagnosed as serious internal pathology. Abdominal bodywork can be key in retraining this area to be supple and mobile, and dealing with these confusing pain issues.

Healthy, efficient breathing is a concert of coordinated movement between multiple diaphragms in the body: pelvic, respiratory, vocal and cranial. This wonderful video by Belgian osteopath Roger Fiammetti is a brilliant rendering of this dance (it's in French but a picture is worth a thousand words):

In addition to the abdominal wall muscles, some of the muscles that are likely to become troubled if we breathe inefficiently include:

Scalenes: the scalenes are involved in normal low-volume breathing, such as when we are asleep. If the diaphragm isn't working properly, the scalenes must initiate very strongly and attempt to lift the ribcage by the first and second ribs. Not being made for this heavy lifting, they will develop trigger points and refer a confusing array of pain in the hands, shoulders, between the shoulder blades and in the chest.

Pectoralis minor: Also assisting in lifting the upper ribs during strong inspiration, the pect minor if it becomes troubled may refer pain down the arm (very frightening if the left side is involved), and also acts a strap across the thoracic outlet. If it is shortened, the thoracic outlet may become compromised and cause pain, numbness, blood pooling and other disturbing symptoms in the hands and arms.

Sternocleidomastoids: The SCMs will also contribute to high chest breathing, and if they are overused, may cause frontal migraines, vertigo, disturbed hearing and vision. Very few practitioners will associate these symptoms with breathing dysfunction.

While the abdomen may seem to be a relatively quiet area in terms of common pain complaints that practitioners see, this is far from true. Our Clinical Thai Bodywork for Mid Back and Abdominal Pain class is extremely important. While clients may not directly approach therapists for help with abdominal pain, this area is key to a host of other problems. Cross-referral between the front and back of the body is very common, and the convergence of serious, seemingly unrelated complaints makes it a key area to understand as a practitioner.

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Most pain is referred by trigger points in muscles, although most medical professionals don’t understand this, and are misled by the “illusion of injury”.

The truth is, most pain can be eliminated fully and efficiently by understanding its true origins using the Coaching The Body principles and techniques.

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