Clapham Manual Therapy and Functional Movement

Follow Your Nose

Breath book coverIf you’ve visited us for treatment or training or even just followed our newsletter/blog with any regularity, you’ll know that proper breathing is a huge focus for us here at Backs Etc. Quite simply, breathing retraining is a game-changer. So we were very excited when we heard about James Nestor’s new book, Breath: The New Science of a Lost Art. Being fans of his previous book Deep which centred around freediving, a book by Nestor focusing directly on the art of the breath sounded right up our alley. And, with one exception, it didn’t disappoint. Frustratingly, there was no mention of the role of breath in creating Intra-Abdominal Pressure, the foundation of core stability. But even with this omission, there is a wealth of great information, so definitely worth a read.

But this post isn’t just a book recommendation. Today we’d like to focus on one aspect of proper breathing technique that is discussed at great length in the book: nasal breathing.

If you’ve ever watched a baby breathing, you may have noticed that, barring any developmental issues or a cold, they will always be breathing in and out through their nose. This is instinctive and it is the way we are designed to breathe. Yet, so many of us seem to have lost this over the years, and the effects can actually be quite serious. Perhaps this is why the term “mouth breather” can be used as a pejorative, just as Mike does in Stranger Things.

Breath starts out with a bang. The first chapter is entitled The Worst Breathers in the Animal Kingdom, and you can probably guess who is being referred to. Spoiler alert: It’s us! If a vet or farmer come across an animal that is mouth breathing (except for a few that pant to reduce heat), that is a pretty good indication that the animal is sick, but humans mouth-breathe for years with no idea that something is wrong.

After learning about humanity’s poor breathing epidemic, Nestor and fellow pulmonaut (as those who have stumbled on the power of breathing are referred to) Anders Olsson embark on an experiment casting themselves as guinea pigs. For 10 days, the two men were forced to breathe solely through their mouths, even whilst eating, exercising and sleeping with earplugs wedged firmly in their noses. Phase 2 of the experiment had them repeat the exact same activities, but with nasal breathing as well as some specific breathing exercises. At the beginning, middle and end of the experiment, their blood gasses, inflammatory markers, hormone levels, sleep, pulmonary function, and more were thoroughly tested, and of course, they also documented how they felt throughout.

The results were pretty spectacular. With his nostrils blocked, Nestor’s snoring and sleep apnea events increased dramatically, his blood pressure spiked at an average of 13 points higher than usual, and indeed all of the markers tested indicated increased dysfunction, some quite seriously so, and these effects started almost immediately on around day 2 of the experiment. Anecdotally, though no less significant, he and Olsson felt simply awful, with Nestor describing the experience as being “trapped in some sad sitcom in which nobody laughs, a Groundhog Day of perpetual and unending misery”. Conversely, the 2nd phase of the experiment where the two men breathed exclusively through their noses, produced dramatic improvements in every marker tested, and consequently, they slept far better and felt energetic and mentally sharp.

So, why is nasal breathing so much better than mouth breathing, you may ask. The answers to this are so powerful and numerous that they could probably have their own book, but since you’ve stuck with us this long, we’ll give you a taste:

Nasal breathing produces nitric oxide. This is hugely important as this molecule plays an essential role in increasing circulation and delivering oxygen into cells. Immune function, weight, circulation, mood, and sexual function can all be heavily influenced by the amount of nitric oxide in the body. In fact, Viagra works by releasing nitric oxide into the bloodstream which opens the capillaries in the genitals and elsewhere. The effect of nitric oxide on the immune system is especially crucial during the pandemic we are currently experiencing, and some people theorise that proper breathing can make the difference between being mildly symptomatic and getting very sick if you are exposed to SARS COV-2. If you mouth-breathe you are completely missing out on the benefits of nitric oxide.

Nasal breathing filters the air. The nose is lined with cilia, tiny hairs that can trap potentially harmful particles which would otherwise enter the body. These cilia also help regulate the temperature of the air before so protecting the lungs, helping improve proper lung function. They also moisturise the air, which helps to reduce the risk of respiratory conditions. If you wake in the morning with a dry mouth that indicates that you have probably been mouth breathing during the night and so would benefit from taping your mouth at night as described in the book.

Nasal breathing can calm the mind. By stimulating parasympathetic (“rest and digest”) nerve receptors, nasal breathing can reduce anxiety and improve our mood. It’s interesting to note that each nostril works independently. The right nostril stimulates the sympathetic nervous system and the left activates the parasympathetic nervous system. If there is an imbalance, alternate nostril breathing, such as that practised in certain yoga techniques, can be helpful.

Nasal breathing can improve facial structure. Nasal breathing allows for your tongue to rest on the roof of your mouth resulting in the proper development of the jaw, sinuses and teeth.  This is particularly critical in children for proper facial development. The tongue-up position also acts as an anterior support for the head, without which there is an increased likelihood of neck pain, headaches and a forward head posture.

Mouth breathing is dysfunctional. Amongst other issues, mouth breathing can increase blood pressure, create sleep disorders (including snoring and sleep apnea), and cause dental health issues and facial deformities. It also allows unfiltered, dry air to be delivered to our lungs increasing the risk and severity of respiratory infections.

Mouth breathing can make us dumber. A Japanese study showed that rats who were forced to mouth-breathe developed fewer brain cells and took twice as long to make their way through a maze than those who nose-breathed. Studies on humans also showed mouth breathing to potentially increase the risk of ADHD.

The scientific evidence is overwhelmingly clear that breathing through the nose can greatly affect our health and wellbeing. We should be able to nose-breathe during the day and night and even during exercise, yet so many of us seem to have lost the ability to do so. The good news is that pretty much everybody can relearn to breathe the way we were born to. Even if your nose often feels blocked, you can still learn to breathe correctly.  Breathing retraining plays a big role in the treatment and training we provide at Backs Etc. and can be done in-person or remotely. For a brief primer, check out our video here, and If you are interested in working with us directly to learn to breathe properly, please follow your nose and get in touch.

Coronavirus and your immune system

coronavirus and masked womanFour weeks into lockdown and we are well into our new routine here in Clapham: daily meditation and exercise followed by video calls with patients, a daily walk, and more time for study, reading etc.  We are also preparing for the possibility that we will contract COVID-19 at some time over the next year. We are approaching this as though we were training for a race or other athletic endeavour. We are not hoping to get it. However, with the reality of a vaccine being at least 18 months away, it seems unlikely and undesirable, considering the effects on the population’s mental, financial health that we can all stay on strict lockdown until then.  We, therefore, want to spend this time preparing our immune systems to be in the best possible shape to mount an effective response to the virus.

Although the knowledge of this pathogen is evolving from day to day, we know that there is a vast difference in the effect it has, with most people getting mild symptoms easily treated at home, but a few suffering very badly and needing intensive medical support. Why is there this difference? The answer is multifactorial and may relate to the amount of the pathogen they were exposed to i.e. viral load, which may explain the number of medical staff treating COVID-19 patients without adequate PPE that have succumbed. But the other factor is the response of the infected person’s immune system, which has a genetic component but is also related to a person’s current state of health and metabolic function.  Almost everyone who is getting seriously ill is suffering from an underlying condition or conditions such as heart disease, diabetes or obesity. It is known that all of these have a lifestyle component and are hitting people at increasingly early ages.  Therefore, there is much we can do whilst in lockdown to improve our health and immune systems.

In short, the things that you can do to improve your immune system response are also things that will improve your metabolic health and resilience. So here are some ideas split into three groups: nutrition, exercise, and psychological. Now, none of us is perfect, and doing all these things all the time may be too much, so we believe in the 80:20 rule, especially in lockdown: try and do as much as you can (80%), but don’t beat yourself up too much when you trip up (20%).

Nutrition – immune health starts in the gut!

  1. If you are overweight or obese, this is the time to try and tackle this problem as it really does increase your risk of a poor outcome with COVID-19. This is often related to insulin resistance.  If you want help with diet or exercise, Jack has a wealth of experience.

  2. Even if you are of normal weight you need to think about your diet and try to eat as healthily as possible.  Much of the immune system is in the gut lining, so if you are constantly bombarding this with too much sugar, alcohol and processed food, this puts the system on alert, starting the chronic inflammation which is the underlying factor in most lifestyle diseases.  So do try to eat real and nutrient-dense food to get sufficient micronutrients for the normal physiological function of your body.  We focus on unprocessed meat (including organ meats) and fish, with plenty of vegetables and a moderate amount of fruit and fermented dairy.

  3. There is also some evidence that industrial vegetable oils drive inflammation, so another reason to avoid processed foods which are full of these. Cook with butter, olive oil, coconut oil or animal fat.

  4. Many of us now have more time under lockdown to get into the habit of cooking meals from scratch. If you do want a comforting sugary treat, make it yourself from real ingredients.

  5. It is also important to support your microbiome, so we make sure to eat fermented foods such as kombucha, kefir, and sauerkraut every day

  6. We have increased our use of supplements as an insurance policy, but supplementation is not a substitute for a nutrient-rich diet. We are currently using:

    1. Vitamin D

    2. Vitamin C

    3. Fermented cod liver oil

    4. Astragalus

    5. Turmeric

    6. Magnesium

    7. Zinc

  7. We also use intermittent fasting as this can boost immunity and enhance longevity via autophagy. We generally skip breakfast, resulting in a 12-16 hour intermittent fast, and since lockdown have added a weekly dinnertime to dinnertime (24 hour) fast.

  8. Don’t drink too much. Alcohol is not great for the immune system. Sometimes the reduction in stress from a glass of wine is more important, but don’t overdo it.

  9. Stop smoking – this shouldn’t need any explanation


Exercise has an effect on the immune system but it is a Goldilocks situation. Rather than HIIT or long runs, both of which can contribute to an inflammatory state that can suppress the immune system, focus on lower-intensity activities such as walking, mobility, breathwork, and bodyweight training.

Check out our new video where Jack puts Sue through a bodyweight training session, offering some ideas on how to improve your fitness without much space or proper gym equipment. Also don’t forget that Jack can help design you your own workout by video, or if pain is stopping you from exercising, both Sue and Joel are offering video calls to help you.


Our mental state literally affects our physiology, and increased stress levels suppress our immune system, so we do need to try and keep fear under control at this difficult time:

  1. Breathing and or mindfulness. Check out the breathing video we featured in the last newsletter.  Diaphragmatic breathing can stimulate the spleen, the home of your immune cells.  It sits under the lower ribs on your left side so encouraging the movement here may improve its function.

  2. Limit consumption of news and social media. We do need to stay abreast of world developments, but ration it to maybe once a day, and try not to focus on the things that you can’t do anything about.  That fear and stress amp up your cortisol levels and suppress your immune system.

  3. Watch some comedy or put on some music and dance instead.

  4. If you are not in a vulnerable group, try not to obsess about contracting COVID-19, but do be concerned about not passing it on.

  5. Try some gratitude, even though the world is in a difficult situation, trying to focus on a few small good things can be really helpful for our state of mind, as without effort we do tend to focus on the negative.

  6. The Greek philosophy of stoicism, which advocates facing challenges with grace, humour and perspective may be of help.

  7. Maintain virtual contact with friends and family. We’ve been arranging a few ‘quarantini’ dates (remember the 80:20 rule for drinks) with friends near and far.

  8. Cold showers can give your immune system a boost, as well as wake you up!

  9. Sufficient sleep is a huge factor in immune function.  Some people find that lockdown is giving them the chance to sleep more as they are no longer ruled by the tyranny of the alarm and the commute, but for others, anxiety levels may be increased and make sleep harder.  It’s important to follow good sleep hygiene rules, and try to avoid caffeine and alcohol close to bedtime, and if you still need a little assistance try herbal remedies such as valerian, reishi mushrooms, magnesium or 5-HTP rather than sleeping pills, which don’t provide true restorative sleep and may leave you feeling knocked out the next day.

mona lisa with a mask

Kathy Dooley: Restoring Authentic Breathing and Core Control

This article was originally published By On Target Publications, and can be found here.

I am very proud to call myself a chiropractic rehabilitative specialist. Rehabilitation requires rebuilding patients from the ground up, starting at the reflexive stability with which we were genetically gifted.

However, my patients are shocked on the first visit, when I point out their suboptimal breathing patterns and lack of core control.

I always get the same retorts: “but I breathe all day. How can I not be good at it?”kathy-dooley-breathing-crunch

“I do tons of crunches and ab work how can my core not be strong?”

It’s hard to admit that we exist in a sub-optimal state of movement. But many of us do.

It’s important to understand that we did not start off that way.

We are the best movers we’ve ever been within the first 4-13 months of our lives. This is when our nervous system didn’t mimic, nor try to derive compensations, for movement. The reflexive stability to earn movement was passed down through our DNA, and at this early stage, our bodies knew better than to interrupt perfection. So, the baby struggles and fails, on repeat, until he figures out the stable way to move.

The longer we live, the stronger our cognition develops. We mimic the behaviors of those in our environment, as more opportunities arise for our innate perfection to be interrupted. And since we amazing humans don’t prefer failure, we derive compensations around our failures.

Make no mistake. Aches and pains are not failures. They are attempts to succeed in the face of failure. This is why aches and pains must be approached as simple compensations, veering away from our innately perfect stability.

In order to tap back into that inborn perfection, one has to regress to achieve the dynamic stability earned at 3-4 months of age. This includes the baby’s boring days of learning how to build trunk stability in positions on the belly, prone, and on the back, supine.


I have the honor and pleasure of co-owning a mid-town Manhattan clinic and gym, Catalyst SPORT, where our utmost principle is: never rob trunk stability to gain fitness. In the eyes of our clinicians and trainers, nothing is more crucial than the maintenance of trunk stability. Trunk stability is the stable platform for all human movement around its center of mass: the lumbosacral spine.

But, trunk stability is not reborn through traditional, widely used core exercises crunches or sit ups. Watch a baby. You’ll never see her do a crunch, especially on repeat for 100 reps.

Babies build trunk stability through breathing.

At 3-4 months, the baby does the boring and endless task of earning trunk stability through the proper building of intra-abdominal pressure. All day, every day, they spend months coordinating the abdominal muscles to build trunk stability around the lumbar spine, in order to support the center of mass relative to the ground.

Think for a second about that. Unless the nervous system is interrupted, the baby refuses to move on an unstable platform. So, he works on trunk stability for thousands of repetitions per day. He knows that ambulation on an unstable platform will only get him hurt.

He doesn’t think about it. He doesn’t walk around his road blocks. He earns every ounce of his strength. When was the last time you did tens of thousands of reps per day, for months straight . . . of anything?

Most likely it was in your first year of development.

At Catalyst SPORT, we start all workouts with breathing correctives, either in supine or prone positions. We know that our clients initially used breathing for core stability at the strongest time in their development. Thus, we use proper breathing to build a stable foundation upon which to build fitness and rehabilitation.

Clients may not be compliant with breathing drills. In that case, it is necessary to remind them that they are amazing humans, who create compensations around potential failures. The auto-pilot breathing patterns they’ve developed may not be the optimal ones they utilized as babies.

But, in infancy, they develop the fastest and with the maximum amount of stability. Thus, regressing to the way the baby breathes can tap us into the trunk stability we earned when we were at our peak of development.

Prone breathing, often deemed “crocodile breathing,” is utilized to tap into posterior abdominal expansion. A stretch sensation is often felt and seen around the lumbar spine, which clients report a feeling of relaxation and stability.

This can be progressed into a prone-propped breathing, as seen in the baby at 3 months. Often deemed “tummy time,” this breathing and resting position is crucial for developing proper spinal extension patterning on breathing. This transfers into proper extensibility and load-sharing with spinal extension in movement.

Also at 3 months, the baby breathes in the supine position, developing proper coordination of crucial inhalation muscles like the thoracic diaphragm and exhalation muscles like the transversus abdominis and abdominal obliques. The four sagittal plane spinal curves are maintained, while one expands the abdomen into a 360-degree push-out on inhalation. Exhalation in performed in a controlled release of air, much like a tire releases air from its valve. This creates core stability around the lumbar spine to permit limb ambulation on a stable platform.

This position is often called “supine 90/90,” with the knees and hips flexed at 90 degrees. The heels can rest on a ball or chair, but ideally, they would suspend in the air, as seen below.

Prone and supine breathing are simple. But, they are not easy positions for most people, particularly those suffering from pain in the spine or limbs.

Typical rehabilitative and personal training strategies may be tempted to focus more on what hurts or what is missing. But without trunk stability, the entire platform wobbles around the center of mass. If breathing is what we used as a baby to stabilize the platform than it must be our primary focus of all corrective and performances exercises.