A Boost by Better Breathing
By Norah Wickerson
A good breathing process is synonymous with good health physically, mentally, emotionally and biochemically. Slow deep breathing can help us to relax, re-set and relieve mild anxiety. It can increase the release of carbon dioxide and toxins and increase the amount of oxygen available to our cells. Paradoxically it can make our brain feel calmer yet more alert and help us to feel less over-whelmed in stressful situations.
A good breathing pattern can help us to increase restorative sleep and recent studies show that good breathing can even reduce chronic pain as well as acute pain. It is thought to do this partly by distraction - the harder we concentrate on a particular breathing process, the less we are focusing on our pain. We also know that deep breathing can release endorphins which are our natural pain-relieving chemicals. This may help people to cope with acute and chronic pain with less analgesia if they have simple and natural ways of reducing their pain to a more manageable level. When we are feeling stressed, anxious, over-whelmed or in acute or chronic pain we often subconsciously take shallow, rapid breaths - the opposite of what we actually should and need to be doing.
In my personal and professional experience most sufferers of Fibromyalgia have a poor pattern of breathing. They will easily over-breathe and show a type of mild chronic hyperventilation syndrome. The common symptoms of over-breathing that you may recognise in yourself are:
· Feeling out of breath after even minimal exertion, making exercise unpleasant and may add to ‘pay-back’ suffered so often after exercise
· Struggle to walk and talk at the same time because of breathlessness
· Feel dizzy and ill during or after walking up inclines or lots of steps
· Excessive sighing and yawning even when not particularly tired
· Paraesthesia (pins & needles) in upper limbs and around mouth and nose
· Tightness in chest after sneezing, yawning or coughing
· Difficulty holding notes when singing and feeling breathless afterwards
· Awareness of frequently snatching breaths when talking even if seated
· Poor colour of skin, often marbling (‘corned beef effect’)
· Easily feel cold, especially hands and feet, outer thighs and buttocks
I believe that one major reason for poor breathing patterns in Fibromyalgia sufferers can be trigger points in their intercostal muscles. The intercostals are postural muscles that need to be able to stretch enough to allow our lower ribs to move out and upwards in the characteristic 'bucket handle' action. Trigger points act like ‘knots’ in a piece of elastic. They limit the extent that these thin strip-like muscles can stretch. The lower ribs cannot then move as far as they should. Therefore, the lateral bases, of what are probably perfectly healthy lungs, cannot be utilised as fully as they should be. As a result, if a person needs more oxygen to supply increased needs during exertion, e.g when climbing stairs and walking up inclines, then because they cannot breathe deeper, they have to breathe faster.
A normal range of expansion of the lower rib cage, depending on age, gender, fitness, height and weight, should be 7 - 15 cms (three to six inches). I have found that most sufferers of Fibromyalgia have less than two inches difference between inhalation and exhalation. It is not unusual for this to be less than one inch. A handful of my patients have even shown paradoxical breathing movements where their inhalation measurement was less than their exhalation measurement. This is incredible since they had no evidence of actual lung disease such pulmonary fibrosis, COPD or Asthma. Remember, if we cannot breathe deeper, then we have to breathe faster to meet the extra demands of oxygen needed whenever we exert ourselves. These sufferers can be extra limited exercise-wise by their chronic poor breathing pattern.
On palpation of the intercostal muscles in my Fibromyalgia patients I very often find obvious areas of very painful nodules. These are the 'knots' that restrict the intercostals and inhibit the normal 'bucket handle' action of the lower rib cage. Unfortunately, dietary ‘burdens’, chronic stress, anxiety and lack of effective exercising can all add to these painful ‘knots’ building up in and around the intercostal muscles. Add in, rounded shoulders, anterior head syndrome (poking chin) and hunched-over posture that many Fibromyalgia sufferers present with and it is easy to see why a poor breathing pattern is so common in Fibromyalgia. Some sufferers are also incorrectly diagnosed with costochondritis as a way of explaining their severe anterior chest pain especially on taking deep breaths. True costochondritis is a severe inflammatory condition and patients would present with high inflammatory markers and be acutely unwell often with a fever. What I repeatedly find is that by using ‘trigger point’ and myo-fascial release techniques their ‘costochondritis’ symptoms quickly resolve and they are able to take much deeper breaths without discomfort. They are also able to stop taking the NSAIDs they may have been taking long-term with all the potential side-effects for their digestive system and kidneys and still not addressing the true root cause of their anterior chest pain.
We know from medical archives going back to the 1850’s that in Victorian times the average rate of respiration for a healthy adult at rest was 11 or 12 breaths per minute. The Victorians were obsessed with breathing measurements because of TB. Now in the 2020’s the respiratory rate for a healthy adult at rest is 12 - 16 breaths per minute. Why is this? One possible explanation is more air pollution nowadays. But the Victorians had to deal with unrestricted pollution from factories, industries and smog from constantly burning fossil fuels. Another explanation is obesity which can restrict our lower level and diaphragmatic breathing whereas with poverty, food shortages and a higher level of daily physical activity for most working-class adults in Victorian times obesity was not prevalent in healthy adults. We also have to consider poor posture, lack of regular physical activities and not addressing chronic stress as other factors nowadays.
Types of Breathing Exercises
· 4-7-8 Breathing - 4-7-8 breathing exercise is very popular with my Fibromyalgia patients and is excellent for both relaxation and ‘livening up’. It consists of a gentle slow breath of just 4 seconds which is then held for 7 seconds to allow the oxygen to pass across the air sacs (alveoli) in the lungs. Then a controlled breath out for a full 8 seconds is followed by a relaxed and gentle breath in again for 4 seconds. The cycle of 4-7-8 breathing should be repeated 5 times in each session. The 4-7-8 breathing exercise can be performed several times a day and has a great advantage over standard ‘deep breathing’ exercises as it does not cause dizziness which often happens when a higher than ideal level of oxygen reaches our brain which is a common complaint of too much deep breathing. With the 4-7-8 technique the optimum amount of oxygen is generally achieved by allowing it to gradually pass through the air sacs in the 7 second ‘held’ stage.
· Modified Buteyko Breathing - can be especially helpful to patients with mild exercise induced ‘asthma’ type symptoms. Over-breathing can be an irritant to our bronchus (wind pipe) and so actually induce mild bronchospasm. By learning how to breathe less and use the ‘control pause’ of Buteyko Breathing before the next breath in can really help. This breathing technique needs to be taught by a Buteyko practitioner.
· Diaphragmatic Breathing - also known as ‘belly breathing’. Breathing deeply, making use of our diaphragm and basal (lower) parts of our lungs will help us to relax and if practised regularly can help to lower blood pressure and heart rate. Upper chest breathing increases our resting respiratory rate whereas diaphragmatic breathing, when the diaphragm pushes downwards, allows our lungs to fully inflate. Carrying excessive weight around our midline will hinder diaphragmatic breathing so aiming to reach optimum weight and BMI will also improve your breathing pattern.
· Box Breathing - is a very simple breathing technique consisting of a breath in for 5 seconds followed by holding that breath in for 5 seconds and then exhaling the breath over the next 5 seconds and repeating the process 5 times. Deep breathing in this mindful way will help to focus our attention only on our breathing and can be used as an easy distraction for mild pain, stress and general anxiety whilst benefitting our whole body.
· Pursed Lipped Breathing - is another simple breathing technique that slows down the rate of our breathing because of the extra effort of breathing in and out with pursed lips. It is another distraction technique that can be used for chronic and acute pain and to re-set your breathing when you feel stressed or anxious.
· Humming Bee Breathing - this is an easy technique to use as a pain distraction or to induce calmness when you are feeling stressed, anxious or frustrated. It is achieved by putting your index finger on the tragus of your ears (the bit protruding from the opening of our ears) and gently pressing to simultaneously partially close your ear openings with the tragus. By gently make a humming sound, gradually getting a bit louder for up to 20 seconds at a time can have the effect of almost instant calmness.
In conclusion, breathing exercises are easy to learn and need no equipment. There is a selection of different techniques, try them and see which suits you best. Ideally have the choice of several effective breathing techniques that you can practise and then use in different situations. You can combine most types of breathing exercises with mindfulness, meditation, visualisation and mind-body interventions such as yoga, tai chi and qigong. Learn how you can achieve a boost by better breathing.
Norah Wickerson is a Chartered Physiotherapist and qualified Nutritional Advisor in Derby who has specialized in treating patients with Fibromyalgia and CFS for 20+ years using her ‘Combination Approach’.
norah.wickerson@gmail.com