Later this year I will be teaching a course for Pilates instructors about breathing. It’s not uncommon to develop less than optimal breathing habits that become obstacles to alignment and wellbeing. To supplement my materials, I thought I’d ask the expert advise of Physical Therapist Elizabeth Shah from Thrive PT to answer a few questions about the benefits of breathing. I also thought it would be of interest to our studio clients!
Halle: Hi! When we decided to have a conversation, we talked about many areas of professional overlap. There’s lots of crossover between what you and I do!
Elizabeth: That’s right. Ultimately, both PTs and Pilates instructors spend a fair amount of time doing movement analysis. We’re both trying to enable multi-dimensional, pain free movement.
Halle: In the spirit of that crossover, I have some questions for you that I thought might relate to both of our client populations. Specifically, let’s talk about breathing. How do you think about breathing as it relates to your patients? It’s a natural and automatic process, so is it something that you have to instruct?
Elizabeth: Good question! The short answer is “YES,” I do talk to my patients about how they breathe. There are two lenses from which I frame the discussion. The first is straight up mechanical. Breathing effects the how we engage the abdominal and pelvic muscles, and understanding the relationship between the muscles and breath is helpful in the initial stages of core training.
Halle: Can you expand on that?
Elizabeth: Absolutely. When we inhale, the diaphragm shortens and moves down into the abdominal cavity. The pelvic floor and the abdominal muscles would tend to relax and descend at this time too. Exhalation is opposite. As we blow out, the diaphragm ascends and the pelvic floor muscles lift and shorten. So, from a practical perspective, it’s easier teach someone how to lift and contract their pelvic floor on an exhalation. I use this mechanical paradigm all the time with my post-partum moms, persons with diastasis recti, persons with back pain, etc. Basically, people who I’m teaching to re-engage their “core.” I’d imagine you have clients that fit that bill, too.
Halle: Of course. Do you always coordinate your client’s abdominal or pelvic floor contraction with the exhalation?
Elizabeth: Not necessarily. I find it to be a great learning tool and I often start there, and then as therapy progresses we move and breathe in all different patterns.
Halle: That’s true for Pilates as well. I also find that once the client has mastered the engagement on the exhalation they can then use the breath in a variety of ways throughout the session. You mentioned that you look at breathing from two lenses. What’s the other one?
Elizabeth: I use breathing as a tool to help my patient’s quiet their nervous system down. It is common, at least in the PT world, to see patients who are in chronic pain. With that often comes anxiety and fear around making the pain worse. How do we breathe when we’re afraid?
Halle: We take short, shallow breaths.
Elizabeth: Right. We don’t breathe fully into our lungs, our respiratory rate gets faster, and we sometimes even use our neck muscles as we breathe. This type of breathing pattern signals to the body that we’re under threat, and our musculature responds to that signal. It’s flight or fight! This heightened state of arousal, sometimes called upregulation, makes sense when we are trying to score a goal or run from a bear but is not so helpful when trying to relax and rehabilitate sore and overworked musculature. This is, in part, how fear or anxiety can actually make pain worse.
Halle: Are there certain patient groups where you see this systemic upregulation?
Elizabeth: Yes…my mind starts churning in this direction any time a patient has had chronic pain (especially in the neck, pelvis, or jaw) or a lot a fear associated with movement. I cue in to people who describe their pain as worse when they’re stressed, who grind their teeth, and who use language like “clenching” to describe their muscles. In the pelvic floor world we also see this with patients with urinary urgency.
Halle: Those are great tips! I’ll keep an eye out for those symptoms. Sometimes stress isn’t on the surface and it’s good to know some signs when my clients might be internalizing their emotions.
Elizabeth: And as for Pilates clients, this is New York City! I’d imagine a lot of your clients are generally high functioning, striving, and stressed out people.
Halle: That’s true! Are you saying we should all move to the beach?
Elizabeth: (Laughs) No, but I do think there’s incredible therapeutic value to working towards nervous system downregulation. In other words, the act of quieting our bodies, slowing our exhalations, and breathing into the whole of the ribcage (instead of just into the upper ribs) dampens the flight or fight response and is a tool for muscle and mind relaxation! From a pain perspective, this is really helpful. From a movement and exercise perspective, muscles that move (as opposed to muscles held in shortened or “tensed” position) tend to be stronger and more efficient. It allows people to move with more freedom.
Halle: Mindful breathing as a mechanism to enable quality movement.