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.
At Athletes' Potential, we have a profound understanding for how the body works and how your sleep, stress management, nutrition, and movement practices all coalesce to create a healthier life. If you’re dealing with low back pain, chronic pain, recurring injuries, or a nagging injury that’s preventing you from living life at your highest capacity, give us a call or click the button below and we’ll call you!
We help people just like you every single day. Whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience, we’re confident we can help you as well.
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.
About ⅔ of the population will suffer from neck pain and headaches at some point in their lifetime. Stress, posture, and muscle tension can all lead to headaches. Some common causes that can predispose you to headaches are: staring at a computer screen all day, lifting heavy weights overhead at the gym, or limited mobility of the neck, upper back or shoulders.
Tension headaches refer to headaches related to muscle or fascial tension, and the postural changes that accompany the muscle tension. This increase in tension might be from stress, a physically demanding job, or poor posture and muscle fatigue at the end of the day. Tension and stress can lead to trigger points and tightness in your postural muscles. This muscle tightness can directly refer pain into the head and face creating headaches on one or both sides of the head.
Muscle tension in the neck can result in compression and squeezing of the nerves going into the base of your head. Compression of these nerves can lead to pain behind the head, along the temples, as well as behind the eyes. Usually this compression is felt directly below the base of the head in the upper neck region, and is associated with a more forward head posture.
You can also get headaches from dysfunctional jaw mechanics (TMJ) associated with upper neck stiffness. The upper neck region can tilt the head and jaw creating abnormal muscle tension in the neck, jaw and face. If you have headaches associated with eating, notice your jaw clicking this may be an indication of neck and jaw dysfunction, also termed TMD.
Incomplete mechanics of the joints of the neck and upper back, as well as shoulder stiffness can create additional stress on the muscles of the head and neck. What steps can you take to relieve or reduce your chances of getting headaches caused by incomplete mechanics?
If you have tried these methods of headache relief, but continue to have symptoms contact us below to see if physical therapy is a good option for you.
Thanks for reading.
Dr. Sam Gillespie
As you wander through your bedroom in the early morning, reaching for shelves that seem to shift as you approach, you realize how helpless you are without your eyesight. Instead of walking, you carefully scootch your feet step by step, hands forward like a zombie, into the inky outline of a bathroom door.
Now it may come as a ‘duh’ kind of question, but why would we do this? Why would we modify our behavior to accomplish a goal that could easily have been accomplished much faster and efficiently if we just marched right through the dark towards what we thought was the bathroom?
I’ll allow these gifs to speak for me:
We modified our behavior based on those memories of SLAMMING our toe into that damn table one too many times, just as we modify our behavior when anything incredibly painful happens to us. Remember that time you sprained your ankle when trail running? I’m sure you learned to be more careful with your steps! Remember that time you played volleyball for four hours and woke up like a train rolled over you, backed up, then body slammed you? Sure you do.
You remember. Your body remembers. And, due to these memories, we do our best to make good decisions to avoid these painful problems in the future.
The reason I’m telling you these stories is to paint a picture that our body and mind remember injuries, and that these injuries that may have occurred decades ago are still affecting our bodies today. Don’t believe me about your body remembering injuries? Research shows a good ability to predict osteoarthritis in patients decades before it occurs… the main predictor is if they’ve had a knee surgery or injury.1,2 That osteoarthritis is your body’s ‘bad memory’ of your bad night you messed up that knee. And your mind remembers injuries just fine as well… just think of one of your many injuries and I’m sure it’s as vivid as a firework on the 4th.
Growing from these painful metaphorical and literal memories is a major challenge, and that challenge is met daily with the help of proper physical therapy treatment; to reset your body’s movement and your mind’s pathologically-based control of your body in order to imprint a new patterning system that accommodates your injury. In short: Unlearn old patterns. Build new ones. Grow.
Let’s go through a typical case of how I teach my patients to build these new patterns:
Bob Smithy Jones Fake Name Jr III comes into the clinic with back pain due to paratrooping since he was 5. He’s now 31 and his lumbar spine is comprised mostly of Legos and popcorn. He likes to deadlift small horses and fight yoga instructors to pass the time, but his lower back isn’t letting him do the things he loves. Bob is desperate. He knows he has to live with this spine for the rest of his life and is concerned with what the future holds. After going through a thorough physical movement and manual assessment, I see half a dozen regions that are contributing to Bob’s pain and dysfunction.
His mechanical memories are leaping out at me from each of my assessments, and his compensations are showing me exactly how he has been subconsciously “avoiding stubbing his toe” for decades. His mental memories are evident every time he guards, takes a sharp breath, or shows hesitation when trying a new exercise. The good news is, the more time I spend with him, the more I can help him!
Breaking these movement dysfunctions down, one by one, session by session, into compartmentalized pearls of digestible information for him to relearn movement is the treatment program. Some of these memories need to be processed with manual therapy, stretching, and motor control training. Some of these memories need to be processed with a good dose of strength training. Through time, grit, and trust, these memories no longer have their teeth around the throat of Bob’s aspirations. The “memories” such as osteoarthritis will always be there, but with the dozens and dozens of pearls in his toolbox, he is able to manage and grow into a new version of his old self. He is also better able to step back and contextualize the different types of pain he feels and is less fearful of his future. This is growth.
Our mind is a powerful thing. Our bodies are equally powerful. Each of them twist together into a complex story that many times involves loss, pain, fear, and sadness. As a working clinician, I see this day in and day out, which is why I am so motivated to help my patients’ minds and bodies learn new movement memories they need to better live the lives they deserve. With work, these old movement memories are reprogrammed into a new movement system that can give a fresh capacity to the function of the previously painful and weak movement patterns.
Thanks for reading,
Marcus Rein, PT, DPT, CF-L1
This month, we focused our blogs on the pillars of health that we cover with all patients—sleep, nutrition and stress. All of these play a major role in how you feel, how your body functions and the pain you may feel.
Our society is riddled with stress due to packed schedules, short attention spans and growing involvement of technology. It may seem simple, do less and stress less. But for many, there doesn’t seem to be TIME to do LESS.
When it comes to stress, it manifests in 2 major ways: MIND and BODY
Mind(n)- the element, part, substance,or process that reasons, thinks, feels, wills, perceives, judges, etc.
The mind is a powerful thing- particularly when it comes to how your body feels, reacts, copes, and heals. It is how we process the world around us. The environment in which our mind is processing will set us up for stress and anxiety or relaxation and control. When we are constantly in a stressed mindset, our nervous system ramps up the epinephrine. This is a hormone that elevates heart rate and blood pressure to enhance our awareness and prepare for an attack. You've probably heard of fight-or-flight. This is necessary for survival, but the problem is that every day we have this chronic increase in epinephrine due to stressful lives. Our bodies are staying in "fight or flight" mode for hours each day, even though we are simply sitting at desks or working a relatively low risk job. This leads to chronic fatigue, decrease immunity and various health issues.
What can you do to mitigate the effects?
For some, just deciding to put the time aside- in the morning, after work, etc- is enough for them to incorporate this in their day. Others might need a reminder or piece of accountability. Something that I suggest, at least to help you get started, is an app like Headspace. It gives you 10 minutes each day of guided meditation/relaxation. I learned that meditation & quiet time is not about just having a blank mind or taking a quick snooze, rather directing your mind to a different place, away from stress.
Try it for yourself. It might not sound like something you would enjoy or buy into, but you may be pleasantly surprised. I was!
Body (n)- the organized, physical substance of a human.
The body is what we, as physical therapists, are trained to treat and manage. However, the tissue- muscles, bones, ligaments, tendons- are all directed and supplied by the nerves. What makes this difficult, is that healing of the tissue can be slowed by a heightened neurological system. That is, chronic stress leading to poor immunity, heightened fight-or-flight hormones (epinephrine and cortisol), poor diet choices due to the stress, lack of sleep again due to stress... Do you see how this turns into a vicious cycle or sickness, weight gain and general un-wellness?
The easiest way to stop this in its tracks is to address stress immediately. We can mobilize, offer corrective exercises, dry needle, cup, manipulation, etc endlessly, but if we don't address the state of their neurological system, then we are doing this person a disservice. My two favorite drills for this will address tissues but also has an effect on relaxing the neurological system.
The diaphragm has a close relationship to the nervous system; breathing deeply can stimulate your vagus nerve. The vagus nerve functions to trigger the “rest and digest” hormones of the body- a.k.a the opposite of “fight or flight.” This will help keep the heart rate constant and controlled.
Don’t I breathe all day? What’s different?
We often take shallow breaths throughout the day, which also falls in line with “fight or flight.” It’s not often that folks stop and take a few deep breaths! Try these out and see how it feels:
All you need for this is a wall that you can put your feet on!
For this, we like to use a soft inflatable ball. The one Danny uses in the video is from The Roll Model, or go to Target and buy a $2 kids ball with Elsa or Spiderman on it!
Stress directly affects the results that you will see in the gym, sport, health, wellness, happiness, and so on. If you don’t have time every day for an hour workout, at least take about 10 minutes to breathe deeply and clear your mind. You will see a world of difference!
Thanks for reading,
Adrenal fatigue is the inability of the adrenal glands to carry out their normal function. The kidneys produce hormones to regulate blood sugar, blood pressure, burn fat and protein and react to stress. A disruption can cause changes in metabolism, fluid and electrolyte balance, the cardiovascular system and sex drive. The adrenal glands are the main stress control of the body and thus are affected with a stressful, overworked and under nourished lifestyle.
Some common triggers or causes of adrenal fatigue are: over-exercising, high stress levels, sleep deprivation, high sugar intake, chronic illness, depression, surgery. This is not an exhaustive list by any means but you can likely identify with a few of these.
The signs and symptoms of adrenal fatigue can be slightly different with each person. Keep in mind, one or two symptoms does not suggest adrenal fatigue. Rather, a cluster of the symptoms and lifestyle factors in an otherwise healthy adult could point towards adrenal fatigue. Unfortunately, adrenal fatigue is not on the forefront of “old school docs” minds or they were never taught this in med school. Holistic medical practices, dietitians or nutritionists are more likely to recognize the symptoms and prescribe a non-medicinal approach to working back to health.
Weight gain and inability to lose it- often abdominal area
High frequency of sicknesses that tend to last longer than normal
Reduced sex drive
Lack of energy, even with adequate sleep
Reliance on caffeine- coffee, soda, energy drinks
Chronic pain of unknown origin
Obviously, we at Athletes’ Potential are not dietitians or nutritionists but we have a strong belief that input = output. We tend to treat the output side, but you could see they are directly related! So if you train 6 days per week, crave and/or eat sugary foods, sleep 4-5 hours a night and have trouble sleeping once you lay down--- your body is TIRED. As a society wrapped up in the ‘go until you drop’ mindset, it is not often that we take time to slow down and let the mind and body recover.
Take a minute to answer these questions for yourself: How many minutes each day are quiet and calm? Meaning, no phone, no TV, no conversation, no working, no cooking. After a workout or long day at work, what do you do to ensure that your body is ready to do it all again tomorrow? How do you respond when your body sends stress signals?
Any “I don’t know” or “I don’t have time” responses? Keep reading!
Where to start?
Nutrition- Not my area of expertise, but definitely an area of interest! A friend of ours is a Nutritional Counselor at a Holistic and Integrative Medicine clinic here in Atlanta. She shared a short blog about supplements that she suggests if you are experiencing these symptoms, found HERE. There is also a delicious recipe--- you’re welcome! A dietician or nutritionist can work with you one-on-one to talk through symptoms and which food changes could impact your health.
Meditation- Meditation doesn’t have to be some mystic, religious experience unless you want it to be. By meditation, I mean taking a small chunk of time to relax the mind, breathe and calm the body. This is a new practice for me as well! The first time I tried it, I only lasted about 30 seconds before I was thinking about something else. Now, I almost always make about 10 minutes of relaxation! Check out the app Headspace. It’s free and is directed mindfulness for 10 min each day.
Journaling- Very similar to meditation, but some people prefer journaling. For those with busy minds, taking a few minutes to write down what you are thinking about can be freeing and lighten the load swirling in your mind.
Listen to your body- Although last, it is the most important and closing thought. Listening to your body while training is paramount to all practices. If you feel fatigued, foggy headed, have various aches and pains over the body, perhaps today isn’t the day to run your 10-mile loop or try to PR a lift. Take the time to slow down and be attentive to the signals your body sends!
Thanks for reading,
Dr. Jackie, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.