The Link Between Pain, Dysfunctional Breathing, and Lack of Exercise

It may sound strange that teaching people how to breathe can decrease your pain. However, observing the similarities among my patients with asthma and feeling the same problems in my own past has afforded me some personal experience.

As an asthma sufferer myself, I can draw upon my own pain patterns and muscles weaknesses to derive a few conclusions. My patients often display the "inhalation posture". The elevated shoulders, excessive straight and broad upper back are the primary signs. They are stuck in this inhaling stance, as they are constantly trying to take in more air. Their bodies don't realize that what they really need is to exhale more.

Weaknesses in the internal and external oblique muscles are a good place to start. These muscles are key for forced expiration, so it is good to fire these muscles up before doing aerobic exercise. Focusing on forced expiration and trying to prolong this phase will keep you going longer than the gasping for air on the inhale. In fact, whatever core/abdominal exercise you like can be made much more effective just by following this pattern: exhale fully and forcefully on the exertion part of the exercise. For example, during a "crunch" exercise, lifting your upper body up is the "exertion" phase. Prolonging this part of the exercise and fully exhaling will really activate these muscles.

This link shows another excellent core exercise that is also easy on your spine:

https://www.youtube.com/watch?v=2fwjGJ2MDsA

(I am not affiliated with Aaron Swanson, but this video saved me the trouble of doing one myself. Thanks Aaron!)

Lastly it is apparent to me that many people that have not done any cardiovascular exercise in a long time have the weakest core muscles. People who run regularly typically have fair core strength. Sprinters will typically have the strongest. High intensity training will make you forcefully inhale and exhale. This does not mean that couch potatoes should immediately take up sprinting for exercise. It is always best to ease into it.

Stress and Breathing

Psychological and emotional stress can have as much effect on breathing as physical stress. Recent studies suggest that merely paying attention to you breathing can have a positive effect in respiratory stability (Applied Psychophysiology and Biofeedback June 2007, Volume 32, Issue 2, pp 89–98.)

Without regulation, many of us would fall into a breath pattern that is a result of our daily stressors. This increases the production of cortisol in our bodies, which increases the heart rate and blood pressure. This system is designed to help us survive dire situations. Think of a caveman who suddenly see a predator and needs to run as fast as possible. The increased heart rate and blood pressure assist the body in getting moving more quickly. Rarely do we need this biological response in today's society. Yet, we are all too often stuck in this pattern.

Most patients have a posture that show a lack of exhalation. What I mean is the patients will usually display elevated and forward shoulders. This is the position we are in when we forcefully inhale. Along with this posture comes overactive levator scapulae, sternoclaidomastoid, and pectoralis minor muscles. In addition, they're often weak in certain core muscles involved with exhalation. Those are the rectus abdominus, external oblique, internal oblique, and transverse abdominus. This is how the breathing dysfunction can cause pain. It is through the over-activation of accessory muscles of inhalation, and under-activation of the muscles of exhalation.

Ideally, the shoulders do not elevate nor push forward. How can one avoid this? Simply by monitoring. Periodically check your posture. You can do this while we at the computer, or driving, or even while exercising. Make sure the shoulders are relaxed. Do not push the shoulders backwards in an attempt to get to perfect posture, as this still creates too much tension.

So, in summary: keep calm, and exhale.

Poor Posture and Breathing

From the first second a patient walks into my office, I am doing an assessment on their posture, movement patterns, and breathing patterns. If I stop to say "...and now I will do a posture assessment", it is guaranteed that the patient's posture changes. I will often do this anyway. This is because most people don't really know what good posture is. They couldn't show me good posture even if I offered them a million dollars.
Try this experiment. Slouch as much as possible in the seated position. Now try to take a full breath. It just doesn't happen. Now sit up straight and try again. Better, right?
Now try to find the best posture for your breathing. Experiment by tilting your pelvis forward and backward and deep breathe in any variation of upright posture that you can find. When assessing your full breath, judge by how much each position allows you to breathe sideways (think of breathing into your armpits). Avoid lifting the sternum or shoulders. Now try tilting your ribcage forward and backward. Lastly vary the position of the head. The best position is often the one where it feels like the base of the skull moves backwards, giving you a slight chin tuck. This is ironic because many people will reflexively poke their chins forward when their breathing increases. This has the opposite end result.

You will find the best posture is neutral where the ribcage is over the pelvis and the head is over the shoulders. The shoulders must be relaxed and not forced backwards, nor jutting forwards. Most of us will either slouch or be excessively upright. The forced upright position shown above will often be combined with a slight forward lean. This posture feels like "good posture" yet causes many painful syndromes. This is why we include posture coaching as part of the treatment plan at Schafer Chiropractic. A little knowledge can go a long way.

The Link Between Pain, Stress, and Breathing Muscles

Try this test:
Take a deep breath. Did your shoulders lift upwards? Did your chest lift upwards? Did your pelvis move? Did your chin tilt up? All of these indicate dysfunction breathing patterns, as they are artificially lifting the ribcage, rather than expanding the ribcage.
Now put your hands under your armpits and try to inhale by expansion (in circumference), without lifting upward. Don't worry, you are not the only one who has a hard time doing this.

Any clinician who is worth their salt will tell you there is a link between breathing and pain patterns. The first clue is that the most commonly tight and short muscles are the ones that are "accessory muscles" to inhalation. These are the scalenes, sternoclaidomastoid, pectorals, latissmuss dorsi, and serratus muscles.

The second clue is that the most commonly weak and atrophied muscles are the accessory muscles of exhalation. These are the external oblique, internal oblique, transverse abdominus, and rectus abdominus.

However, the real pain is in the dysfunctional accessory muscles, which include levator scapula, upper trapezius, and several subocciptal muscles. It is common for patients to use these muscles when I test their breathing in my office. These are usually the most painful, and indicate that the dysfunctional breathing has been present for a long time. This is why so many people have neck pain, headaches, and pain along the shoulder blades.

The next step is to find out why it is happening. The answer is usually stress, poor posture, or lack of exercise. Often it is a combination of all three. More information on these causes will be the topic of subsequent blog posts.

Finding a chiropractor who can re-align the spine is easy. Not many will give you home exercises to help correct the reasons for the misalignments. Even fewer will give you postural coaching. Rarely will any clinician look at your breathing. If your does not, give us a call at (616) 301-3000.

Back to school, not back in pain

Back to school should not mean a pain in the back. As the parent of an 8 year old, I am often amazed at how much stuff she can fit in her backpack. The weight of the pack seems to increase yearly. The big question is - How much is too much?
The weight of the pack should not be more than 15% of the child's body weight. So multiply your child's weight by .15. That means a 60 lb child should not carry more than 9 lbs. The incidence of low back pain in children is on the rise, and this looks to be one major factor. I know my daughter has considerably more homework than I had at her age. Her pack is filled with completed projects, notebooks, shoes, etc.
It is wise to consider a few more things than total weight, however:
-Foremost, make sure they wear both straps. Wearing only one strap will obviously create an unbalanced body.
-Keep the heaviest objects closest to the part of the bag touching the child's back. This ensures best weight distribution in carrying the load.
-The bottom of the bag should not pass the child's waist. If it does, the child will need to lean forward too much.
-A bag with a waist strap keeps the load closest to the body. Again this means the lightest effective load and less strain for your child.
Lastly, consider cleaning out the backpack weekly. Not only will your child have a lighter load, you may come across a few permission slips or upcoming projects that your child may have forgotten to mention to you. (If your child is anything like mine.)

Shoulder Rotator Cuff Injury Due to Poor Posture?

Yes. Posture has a profound affect on how you use, or overuse your body. And yes, posture is often the biggest reason why people develop shoulder rotator cuff injuries. The proof is simple. Let's look at the most commonly given exercise for the supraspinatus muscle. This muscle is one of the rotator cuff muscles, and helps hold the humerus head in the socket of the shoulder joint.

Note the angle that this person's shoulder is in. It is slightly forward, as if he is slouching.

Not surprisingly, the shoulder joint works best when you are in an upright position. In this position, the deltoid and the upper trapezius muscles do the heavy lifting.

With the body in a slightly forward slouched position, the heavy lifting is now done by the supraspinatus and infraspinatus muscles. Why is this bad? These muscles are much smaller than the heavy lifters. That is why they fatigue more quickly. It is a simple case of muscle strain due to poor body mechanics. Certainly not all cases of rotator cuff damage occurs this way. Repetitive stress can occur with or without poor posture, as can traumatic accident. Most cases in which I have observed rotator cuff injury, the patient does not have any accident or trauma to report, nor any reason why they shoulder be having shoulder pain. If this sounds like you, try standing up straight. If that doesn't help, call a good chiropractor. Posture coaching, shoulder, neck, and upper back adjustments, and rehabilitative exercises will get you on your way to being pain free.

Malicious Migraines

The term migraine is often mistakenly used to describe a severe headache. Although not all severe headaches are migraines, most migraines are severe. As the diagram shows, the typical pattern of pain is felt above, near, or behind one eye. Half of the face is usually affected. Most of those affected will also have abnormal visual disturbances without any other explanation. These "aura" can take many forms (see Table 2).

The aura is often preceded by light sensitivity, loss of appetite, dizziness, or depression. During the migraine, continued nausea and light and sound sensitivity is also common. The interesting part is that these symptoms occur in slightly more than half of migraine sufferers, but not all. Even the location of pain is not 100% consistent. There is no definitive diagnostic test to confirm or deny the presence of a migraine. This means we still know very little about why they happen, and what makes them different from other headaches.

What we do know, however, is what typically triggers a migraine. Allergies, stress and abnormal hormone levels are the most common triggers. Allergies can be food (chocolate, red wine and MSG are the most common), or seasonal (mold, pollen, grass). Just like with sinus headaches, an air purifier in the bedroom can be of great benefit. Steering clear of perfumes, scented laundry products, and and scented soap will help prevent chemical triggers.

Stress triggers may come in the form of biomechanical (excessive physical exertion, spinal misalignment and poor posture), emotional (loss of a loved one, life changes), or mental (work/other). Fluctuations in hormones during the menstrual cycle is a very common trigger for females, and is usually the most difficult to overcome. With all of these possible triggers, one can see the benefit of keeping a migraine journal. This often helps identify patterns and point the migraine sufferer to the source.

From the chiropractic perspective, spinal adjustments can help decrease biomechanical stress. Improving posture and relieving nerve pressure will decrease migraine severity by 50% on average. To a migraine sufferer this is an enormous improvement. For emotional and mental stress, meditation is most helpful.

In summary, if you really have a migraine, it may take a while to find your triggers, but it is well worth the effort.