Diaphragmatic Breathing

A patient presented the other day with a long history of back pain as well as numbness and tingling in the arms and legs while swimming.

After extensive workup by a number of providers: orthopedist, pediatrician, neurologist, rheumatologist, physical therapist (me); it was decided that she had "Hyperventilation Syndrome".  Basically she was breathing very rapidly with exertion but not getting enough oxygen to her working muscles when exercising.  The lack of oxygen was causing the feelings of numbness and tingling in her arms and legs.

Hyperventilation and improper breathing are issues we see with patients in a lot of different scenarios.  These scenarios can range from an athlete that is overusing accessory muscles of inspiration to the COPD patient that is trying to cope with reduced lung capacity and reduced lung tissue elasticity, to the desk jockey who is under considerable stress.  Let's face it, we NEED oxygen and will do whatever we can to get it.  No matter the cause, oftentimes it is failure to breathe using the diaphragm ("belly breathing") that leads to hyperventilation and shallow breathing and reduction in the amount of air that is inspired.

When we "mouth breathe" or bring air in without allowing the diaphragm to be the primary mover in inspiration, or breathing in,  we use other muscles located in the neck and thorax to do the job.  We tend to use these accessory muscles when under stress; be it from exercise, life, lung disease, heart disease, asthma, allergies, etc.

One particular set of muscles, the scalenes, which reside in the neck, are a very good contender for causing symptoms in the upper extremities like those mentioned above as the anterior and middle scalene muscles "straddle" the nerves and artery that will ultimately end in the fingers.  Below is a picture of the location of these muscles and the nerves (yellow) and artery (red) that can be affected.

The reason these muscles are typically overused in strenuous exercise or when struggling to breathe is that they are positioned to assist in elevating the rib cage which occurs when breathing air in.  Raising the rib cage helps increase the diameter of the thorax and reduce pressure within the thoracic cage to allow for the influx of air.  This air which ultimately enters the lungs is transferred to the bloodstream where it is taken to the organs and working muscles to supply them with oxygen.

If the scalenes are overused they can become tight and squeeze the artery and nerves that lie between them causing numbness and tingling in the upper extremities.  Hyperventilation can limit the amount of air that we take in with each breath as when we hyperventilate we typically take shallower breaths.  Or, as mentioned earlier, in the case of obstructive pulmonary disease, the lack of compliance of lung tissue makes it nearly impossible to bring in more than a "sip" of air with each breath.  In these scenarios we either breathe more frequently or use muscles like those described above to help force more air in.

So how can we combat these very different, yet related scenarios?  The answer typically comes down to breathing predominantly with the diaphragm, thus minimizing the use of these accessory muscles of inspiration and controlling the breathing rate.  These breathing techniques have been employed to help reduce stress, help athletes perform better, help heart and lung patients conserve energy and maximize oxygen saturation.

How do you do it?

Learning how to breathe in this way seems as though it should be easy, but actually takes quite a bit of practice.  We have to basically retrain ourselves to breathe in a different way as we have probably been breathing incorrectly from birth.  As my 6th grade band instructor said, "The only correct breath we took was our first".

So how do we do it?  Below you will find a link to a website that explains the proper way to breathe diaphragmatically.  It demonstrates breathing in this manner in a number of different positions.  Starting with the supine position or laying on your back may be the easiest way to start and then progress to sitting and standing as you gain mastery.

Go to the link listed below and enter access code:  T2LPPLH3

Diaphragmatic Breathing