Clapham Manual Therapy and Functional Movement


breathing retraining at Backs EtcProper breathing technique is something we focus on at Backs Etc in both our therapy and training appointments. Without addressing poor breathing mechanics, it can be hard to make lasting changes to your pain or dysfunction.  Often the problem stems from the inability to build intra-abdominal pressure ('IAP') using diaphragmatic breathing, causing an over-reliance on neck or back muscles that become painful.

True functional core stability is created when you can multi-task and breathe from your diaphragm into your abdomen whilst running, lifting, playing a sport or going about your daily life.  If you use breath-holding as a strategy to gain strength, or only breathe using your upper chest, you are 'robbing health to pay fitness'. Without core stability, your neck, shoulder or hip joints will likely tighten up so that your performance will be less than optimal and you will be more susceptible to injury and pain at any or all of this points.

We use a variety of drills to improve breathing, initially lying down, but working towards incorporating diaphragmatic breathing into all aspects of your life and exercise.  

Here is a video demonstrating the basic supine breathing technique that we teach at Backs Etc:


The Importance of Abdominal Breathing

We all come into the world with the ability to take full, unencumbered abdominal breaths.  Just look at a baby breathing freely using her diaphragm and abdominal muscles with very little movement in the chest and thorax.  But as we get older we forget how to breathe properly.   A host of challenges conspires to make us upper chest breathers.  This includes imitating our parents’ poor postural and movement habits, wearing restrictive clothing, and cultural cues that convince us to hold our stomachs in.  Not to mention our increasingly rapid and emotionally stressful lives, lack of exercise, excessive multitasking, and slouching in front of computers.  These are just a few of the things that literally take our breath away, creating a lifestyle that's incongruent with proper breathing.  Modern life causes the average person to use only about a third of their natural lung capacity.  Up until about 100 years ago, the natural breathing rate was 10 breaths a minute. Our daily activities – farm chores, hunting animals, hard manual labour – ensured that we use our diaphragms as our main breathing muscle.  In the past century, we've become sedentary and lost the ability to use our diaphragms well.  The average person now breathes at a rate of around 15 or more shallow breaths per minute. Rather than using our diaphragms to breathe down into the abdomen we are using our rib and neck muscles to breathe into our upper chest.  This has several knock-on consequences:

  • Our necks become tight and painful due to the overuse of muscles that are designed to be used occasionally to assist with breathing on exertion rather than the main muscles of respiration.  
  • Low and mid back pain and pelvic floor dysfunction.  A key function of the diaphragm is its ability to use the breathing to coordinate the deep abdominal, back muscles and pelvic floor to generate intra-abdominal pressure (IAP).  IAP is a pressure system created by the combined effect of all the muscles that surround the abdominal cavity that allows for a sustainable core stability that supports our backs and helps keep us pain-free.  The knock-on result here is that without good abdominal breathing the core muscles will become unbalanced and dysfunctional often leading to pain and injury.
  • Constipation. A healthy diaphragm will move up and down up to 10cm on each breath cycle which provides a fantastic massage to the internal organs stimulating peristalsis, the wavelike motion of the intestines that promotes digestion and elimination. In an upper chest breather with a ‘braced’ diaphragm, that range is reduced to 1 or 2cm, thus reducing gut motility.  The oesophagus passes through the diaphragm, and if this is braced and constricted, it is much more likely to allow for backflow of the stomach acid giving the symptoms of reflux.  
  • Circulation issues. Good diaphragm function from abdominal breathing is necessary to return the lymph and venous blood to the heart.  A well-functioning diaphragm is necessary to avoid venous congestion in the lower extremities and abdomen. Poor breathing can also lead to constriction of the blood vessels and higher blood pressure.
  • Anxiety and depression. Slow and deep breathing, particularly on the exhale, is very calming to our nervous system, allowing the parasympathetic ‘rest and digest’ part of the autonomic nervous system to take over and enhance the function of our repair mechanisms, digestive system etc.  Conversely, shallow and fast breathing will exacerbate feelings of stress and anxiety.
  • Insomnia and fatigue. Poor breathing is correlated with poor sleep patterns, sleep apnoea and snoring.  Poor breathing tells our brains that we are in ‘fight or flight’ mode, making it much harder to fall asleep.  
  • Without a complete exhale we can’t take the new air of the next inhale into our lungs. Thus the basic function of breathing to provide oxygen to our cells to allow for the release of energy from food becomes compromised
  • Since only one third of our lungs are in our upper chest, we need the deep diaphragmatic breathing to get the air into the bottom two thirds of our lungs.

Nasal Breathing

A related issue is whether someone breathes through their mouth or nose.  Normal relaxed breathing is done through the nose. Each nostril functions independently and synergistically to filter, warm, and moisturise the air before it reaches the lungs.  In mouth breathing none of this happens, leaving the lungs more vulnerable to infection. Also, mouth breathing can lead to hyperventilation, snoring, dry lips and an impaired sense of smell. With less oxygen being delivered to the brain, muscles, and all the cells of the body, the body functions less than optimally. Sleep is often disturbed and of poor quality, leaving the mouth breather tired in the morning and feeling fatigued mid-afternoon. If you wake in the morning with a dry mouth it is likely that you have been mouth breathing in the night.

Nasal breathing leads to a better position of the tongue on the roof of the mouth. In children, this is necessary for the proper development of jaws and teeth. Proper tongue and jaw positioning are also related to head posture with the nasal breather finding it easier to keep the head upright at the top of the spine.  A forward head posture, where your head is positioned so that your ears are in front of your shoulders, requires all the neck muscles to work much harder and when combined with upper chest breathing, it is a classic recipe for neck pain and headaches.

On exercise and exertion, exhaling through the mouth in a controlled fashion is preferable to maintain IAP. This is a technique you will learn to do in our functional training sessions.