Breathing. Seemingly, the most innate skill set you have as a human being. So innate that it’s used as a benchmark for being a healthy newborn and your first time taking a breath happens within the first 10 seconds you enter this world. Fast forward to adulthood and you’re breathing an average of 12 to 20 times per minute without a single thought. With all that practice, we must be pretty good at it; right? Not exactly. Stress, lifestyle choices, and mechanics all play a huge role in how we breathe, and all breath is not created equal.
Want an example of just how easily influenced our breathing patterns are? Look no further than something called “Email Apnea.” Yeah, that’s a real term, and it’s used to describe the phenomenon of people holding their breath when they read their email. One study by Business Insider found that upwards of 80% of people actually do this and I bet if you pay attention you’ll catch yourself doing it as well.
But who cares? It's just reading emails, and if we don’t even notice it's happening it must not be that big of a deal; right? Wrong. When we interrupt our normal breathing patterns by either not breathing or taking short shallow breaths, we’re creating a stress response in our body, and when we do this over prolonged periods of time, it can have profound consequences on our health. That’s because our brain can’t decipher between the stress of being chased by a bear and the stress of being behind for an important work deadline. To the brain, stress is stress and breathing short, shallow breaths is one of the main ways our brain interprets stress. All this to say that shallow breathing is both a cause of increased stress and a symptom of increased stress responses, creating a vicious negative feedback loop leading people to live in a chronically stressed state of mind. Here are some examples of how detrimental this can be on your health.
Here’s the good news though: The negative health consequences associated with prolonged disturbances in our breath can be easily prevented with just a little awareness and some intention. Simply taking longer, deeper breaths using your diaphragm (vs your chest) has been demonstrated time and time again to prevent the effects of chronic stress. The key word here though is “longer.”
As we recently discussed on the Active Atlanta Podcast with therapist Megan Gillsespie, a big mistake commonly made when we tell people to “take a deep breath” is they do just that! We take this huge inhale and then quickly exhale all that air back out. All the focus is on the inhale, when it should be on the exhale.
When we focus on slow, long exhales instead of long inhales only, what we start to do is upregulate our parasympathetic nervous system, which puts our body into a relaxed state. By simply increasing the durations of our exhale, we can reduce anxiety, lower blood pressure, improve sleep, decrease pain, improve concentration, and so much more. It’s a true biohack that is free, easy, and incredibly powerful.
So, how do you do it? Do you just take long exhales and call it a day? While not wrong, there’s a more organized and effective way of doing so and it's called “parasympathetic breathing.” You can practice this technique by lying on your back with your feet up on the wall (as demonstrated in this video) and use a 4-7-8 breathing pattern, where you inhale for 4 seconds, hold your breath for 7 seconds, and exhale for 8 seconds. Set a timer for five minutes and repeat this pattern. Try not to fall asleep in the process! Be sure to use your diaphragm instead of your chest when doing this by simply putting one hand on your stomach and another hand on your chest. When you inhale and exhale the only hand that should be moving is the one on your stomach. Once you get the hang of it, feel free to make this less formal and start implementing throughout your day, at your desk, in your car, etc. It doesn't matter where, just make it a part of your daily habits.
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Thanks for reading,
Dr. Jake, PT, DPT, CSCS
Mindful Tolerance and The Parasympathetic Nervous System - How You Can Help Yourself Get More Out Of Your Manual Therapy
As a physical therapist, my job is to interact with pain and discomfort all day long. Most people don’t come to see me when they’re feeling great! They come to see me when they are injured, sad, and without a clear path forward. They come to see me when pain is not only slowing them down, but possibly taking away something that they love, such as running or sport! The pain they feel is a warning light that is flashing bright, and every patient I’ve ever seen has needed some guidance on how to interpret the signals that their pain is trying to convey.
Seeing as every experience of pain is unique to the individual, I won’t go into specifics on these subjective experiences, as they are so varied! What I do want to share is what we now know about pain science that we didn’t know even just ten years ago, and more importantly what can we do with this knowledge of pain science! As it turns out, there are reasonably well-performed studies that support the use of short bouts of mindfulness to manage pain tolerance.(1) A huge review came out in 2020 that may be worth looking through if you have the time (see citations). Now, within my treatment room, I’ve seen tons of evidence that mindfulness helps pain tolerance!
Any time I perform any type of manual therapy treatment -- dry needling, voodoo band application, Graston, or cupping -- I’m very aware of my patient’s pain tolerance. It is very important that my patients be able to relax while I’m performing these techniques. I’ve seen time and time again, if a patient is not breathing deeply in a relaxed state (or at least attempting to!), the technique is less effective.
This makes sense. In one of my favorite books on pain science, “Explain Pain,” by David Butler, the “fight or flight” system is the sympathetic nervous system. This system can be triggered by various stimuli, such as loud noises, fearful emotions, and other things that we determine as possible threats. Once this system is triggered, our muscles tense as we are getting ready to fight or run. This is the exact opposite system we want triggered when we are receiving physical therapy treatments! What we would like to trigger is the parasympathetic nervous system, as it is the system responsible for our “rest and digest” capacity.
As a side note, if you have any interest in pain science, I’d highly recommend you purchase the book, “Explain Pain.” It has been incredibly formative in my practice and is written in an approachable, well-explained manner that can give you a great understanding of our pain system. Ok, back to the systems!
If my patients are able to tap into this parasympathetic system, their muscles relax and absorb the treatments that I am providing. So, what is the best way to access this parasympathetic system? While I wish we could access this system with a light switch, we cannot. But, the most effective way to coax it into action is through deep breathing and mindfulness. Many times, I can simply hold onto a trigger point and ask my patients to breathe deeply, and with no motion and the proper application of pressure, we work as a team to access their parasympathetic system, thereby allowing the trigger point to release more rapidly than if I were to be fighting with their sympathetic system!
So, the next time you’re on that foam roller, lacrosse ball, or receiving dry needling, do your best to breathe deeply. You’ll be accessing your parasympathetic nervous system, getting more results more rapidly, and getting yourself to where you want to be with your muscle tissue. If you have any questions on this mechanism in our body or think you would like to experience the effect that breathing and “downregulation” has on physical therapy treatments, reach out and schedule a session with me today!
Thanks for reading,
Dr. Marcus Rein PT, DPT
1. Shires, Alice, et al. “The Efficacy of Mindfulness-Based Interventions in Acute Pain: A Systematic Review and Meta-Analysis.” Pain, vol. 161, no. 8, 2020, pp. 1698–1707., https://doi.org/10.1097/j.pain.0000000000001877.
2. Butler, David S., et al. Explain Pain. Noigroup Publications, 2019.
Breathing! During the stages of your day, breathing can change. Let's dive in. When you're breathing during a workout or run or sport, there are 3 main things affected: Neurological, Physiological and Biomechanical. The responses are very different than say at rest or meditating.
Watch Dr. Marcus walk you through the different types and how these will help you with your performance.
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