Sue Falsone: The Breath

Let’s take some time today to think about breathing.

When you breathe, do you feel like the whole region is expanding during breathing?

Ideally, it should be. Breath should occur in 3-D. But for some people it won’t.

As you watch your clients breathe, are they moving top-to-bottom with the breath, or are they moving in-and-out?

Ideally, it should be in-and-out. We should not have to go to superior-inferior breathing . . . a little bit, but not all.

In order to breathe well, we need mobile ribs and a mobile t-spine. If we don’t have that mobility, we have to breathe from somewhere else. A body is going to breathe no matter what. When the ribs and t-spine gets locked down, what happens? We start to breathe from the top of the ribs or into the neck. How many of your clients’ shoulders are moving to just breathe? When sitting, if you put your hands on their shoulder blades as they breathe and your hands are going up and down, this is not good.

Ideally, we see a little lateral movement. If all you’re seeing is elevation, which you will in a certain number of your clients, there is something wrong.

Breathing is influenced by our actions and emotions, and it also influences our actions and emotions. Breath changes with feelings, whereas respiration is a natural act. The act of respiration—a gas exchange—is happening without us thinking about it. If we’re in pain, it changes our breath. Things like poor posture can cause an alteration in breath, or vice versa, where breathing issues can cause poor posture.

Respiration is the exchange of gas. A body cannot store oxygen, so we have to constantly exchange it. Luckily, that’s not something we have to think about. It happens automatically. It’s the simple exchange of gas that we’re not focused on. Respiration depends on the oxygen needs of a body—when exercising, we’re going to have different needs for different levels of oxygen depending on the activity.


Breathing can also be affected by what we’re doingif we’re exercising or if we’re sitting or resting. It can be affected when we’re angry or upset or happy. The mind affects the breath and vice versa.

There are different breathing patterns to consider. If you’re just sitting and have to use the neck muscles to breathe, that’s probably a problem.

When you get your heart rate up into 75-90% of max, your breathing will change. When your heart rate is up that high, you are going to have apical breathing. As we talk about breathing patterns, it’s not that apical breathing is wrong; it’s just wrong to see it when a person is sitting relaxed. When working out at a high intensity, it’s a beautiful strategy to respirate.

We have costal breathing and diaphragmatic breathing; neither one is right or wrong. Both have variations and which is best depends on what we’re doing at that moment.

Think about breathing as a therapeutic exercise. When I talk about breathing, it’s no different than talking about an RDL or a single-leg squat. Breath is used, in my practice, as a therapeutic exercise to either facilitate or inhibit a movement pattern I either am seeing . . . or not seeing.

Breath facilitates movement.
Movement facilitates breath.
Breath facilitates stability.
Stability facilitates movement.
It’s just one big circle.

As we breathe in, we get shoulder flexion and scapular elevation. As we breathe out, we get scapular depression and relative arm extension. Obviously, we don’t go into extension, but we get less flexion.

Sometimes in training, we get into the old “exhale on exertion” idea from the past, but it doesn’t have to be that way. We can use breath to facilitate mobility or movement and can use movement to facilitate breath. You can use breath to inhibit or facilitate a movement, depending on what’s going on.

Breath facilitates stability. As you look at the diaphragm, you’ll see it attaches onto the ribs. It attaches all the way up to T-6, all the way down to L-3; there’s a central tendon and it’s attached all along the periphery.

The diaphragm has to function as a respirator and as a stabilizer. But, remember, it’s not that we don’t want the spine to move. If the spine wasn’t meant to move, it would be one long bone. But it’s not; it’s 24 moveable parts.

The spine is meant to move. The point is, it’s not meant to move as a compensatory pattern for something the hip or shoulder can’t do. When I want to go into hip extension or shoulder flexion, I should be able to do those without using my back to get there.

The direct anatomical connection between rib position and the lumbar spine, the psoas and hip position are all connected. You cannot isolate these. As you’re breathing, think about the diaphragm as being double-sided tape. As you take a breath in, the diaphragm pulls down and the lungs expand with oxygen. As you breathe out, the diaphragm comes up, forcing the lungs to expel the carbon dioxide. The diaphragm not only affects the thorax, but it is also affects the abdomen. It can obviously affect the thoracic spine and lumbar spine.

Clearly, the diaphragm is a very important part of what we’re doing in our breath training.

Now we have to again look at these anatomical connections. The scalenes attach to the first and second ribs, and if someone is using the scalenes as a primary breathing tool, you are going to see an elevation of the first two ribs.

We have an entire neurovascular bundle coming out of the brachial plexus along with arteries. If these two vertebrae get elevated, this decreases the space between the vertebrae and the collarbonethe clavicle, which can produce thoracic outlet symptoms.

We can decrease the space and encroach on that neurovascular bundle, giving circulation issues as well as paresthesias under the arm. Often, these scalenes get a little bit overactive with breathing. Again, we need them when we increase heart rate, but we don’t need them while we’re sitting around doing nothing. When a person is using these as a primary mover for breathing, this can potentially be causing other trouble.

The diaphragm attaches onto the ribs and across the back. When we see a poor breathing pattern, the body is choosing breath over other needs. Now the person has lost stability. Every time this person takes a breath, the back is moving a little. That’s paradoxical breathing.

The diaphragm has to move up and down from the central tendon. If that doesn’t happen, the central tendon gets fixed and the back and ribs flare. Now we can use that exhalation movement to connect the abdominals with the back muscles and with the diaphragm. We can use that expiratory reserve volume. We can use that uncomfortable exhale to really facilitate stability around the abs and get the diaphragm to act as a stabilizer.

That exhalation movement is helping the diaphragm function as a stabilizer and as a respirator. But if you lock down the abs, you can’t breathe well. If you fire your abs, your diaphragm doesn’t have anywhere to go. It can’t distend.

You have to figure out how to get some tension at the diaphragm, at the distal end, so the central tendon can function normally, to be the thing to descend and ascend during respiration. Stability with respiration—we have to get that stability with breath.

We must differentiate between the spontaneous act of oxygenation and the act of breathing for purposes outside of respiration. Respiration depends on the oxygen needs of the body.

Breathing influences our actions and emotions and is influenced by our actions and emotions.

Respiration is automatic; breathing in conscious.

Breath facilitates movement.
Movement facilitates breath.
Breath facilitates stability.


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