The Importance of Breathing

Breathing Exercises Are Challenging!

This past week, the Seattle Children's Hospital Sports Physical Therapists held their quarterly in-service meeting which included a presentation by three of our PTs who recently attended a PRI - Postural Restoration Institute Seminar.  The presentation was led by Natalie Johnson, DPT, Paul Moraski, DPT, CMP, and Jeremy Kirschner, DPT, ATC, CSCS and was a great introduction to the basics of breathing.  I was really excited about the topic because I have had the PRI courses on my "to-do" continuing education list for a really long time and it was a great introduction to how breathing can impact movement.  The PRI courses are definitely going to move up on my priority list from this experience.

I have previously encountered breathing as a continuing education component when I went through my FMS (Functional Movement Screen) and SFMA (Selective Functional Movement Assessment) certifications through FMS - Functional Movement Systems.  I read Gray Cook's book "Movement" on my first orthopedic clinical affiliation during school and used the system to evaluate patients frequently back then.  While I don't use the SFMA or FMS in my evaluations very often now, I do like having them available to me as a fall back or as I'm progressing patients back to return to sports activities.  I really like using rolling techniques which comes from these systems and, when those aren't successful, breathing is the primary regression that remains.  Oh how I wish I had paid better attention during my motor control and developmental stages during PT School - but at that time, I just couldn't understand how these things were relevant.

Key concepts I took from the in-service:
1) Breathing is at the foundation of all activities.  If you're not breathing - you're not moving.  And if you're not breathing "properly" this can contribute to dysfunctions.  To work with patients that have a breathing dysfunction by training at a much higher level, you may be able to guide them to fully restored function.  However, focused training for proper breathing is sometimes necessary.
2)

photo (and additional information below) from: http://novusfitnesstraining.com/zone-of-apposition/

The Zone of Apposition (ZOA) describes the positioning of the rib cage and how it influences the function of the diaphragm which directly impacts breathing.  This also directly relates to posture, as the skeleton on the right side has a loss of ZOA due to the bottom of the rib cage flaring and influencing the available excursion of the diaphragm.  While I have joined the bandwagon of "there is no bad posture, only positions that are sustained for too long or that you can't get out of," I still feel that there are optimal postures for various activities.  For example, a basketball player who attempts to dunk but has increased thoracic kyphosis limiting shoulder elevation and anterior weight shift while squatting that limits the stretch-shortening cycle of the posterior chain while jumping will have difficulty getting the ball over the rim unless they're 8 feet tall.  The current trend of saying there is no perfect posture relates more to static positioning throughout the day than postures for activity.
3) There are commonly seen breathing fault patterns.  Three that were described at the in-service were:
- an anterior internal chain dysfunction which presents with quad dominance and decreased extension through the hip that is more often a unilateral pattern.
- a brachial chain dysfunction more related to the upper body presenting with accessory musculature facilitating breathing and rib flare with shoulder flexion.
- a posterior external chain dysfunction which often presents as a forward head with increased thoracic kyphosis and lumbar lordosis and anterior pelvic tilt and more often a bilateral pattern.
4) Basic breathing techniques to improve apical expansion generally require focused training of the left internal obliques and improved ability to breathe into the right upper lungs region.  In the picture at the top of this post, I'm siting in a position that allows for the right side of my rib cage to open up and increase my ability to breathe into the right side of my lunges while I'm using my left arm to reach forward and increase activation of my left interior obliques while simultaneously using left hip adduction that integrates the pelvis and the lower portion of the internal obliques.

Overall, an awesome learning opportunity and good reminder of the importance of breathing.  I know that I have far more to learn on this topic and hope to get to a PRI Course at some point.  Feel free to check out the link with the Zone of Apposition photo because that blog had really interesting information about breathing - among several other topics!