Why do we care about how we breathe?

When I first start seeing a patient one of the first things I assess is their breathing pattern. This sometimes leads to the patient wondering, "I came in for my shoulder/knee/foot <insert any reason for coming to PT> - why are you looking at how I breathe?"

Here's why: We take over 20,000 breaths per day. Imagine squatting the wrong way 20,000 times and what that could potentially do to your body. Breathing mechanics are just as important, if not more, than the mechanics of lifting, squatting, etc. and should be incorporated in everything we do.

The diaphragm is our main muscle for breathing. When it contracts, the diaphragm descends and allows air to fill our lungs. When the diaphragm relaxes, it helps push air out of our lungs during exhalation. Often times due to a weak diaphragm, compensations developed over time lead to use of accessory muscles (muscles around your neck, shoulders and upper chest such as the scalenes, sternocleidomastoid, upper trapezius, pectoralis, etc.) to assist in breathing. The use of these accessory muscles can result in muscle imbalances and tightness in various areas around the body that may lead to problems or pain over time.

If we aren't using our diaphragm to breathe when we are in a resting state, we definitely aren't using it when we exercise. So....what can we do?

Exercise your diaphragm!

Start by laying on your back with your knees bent and feet flat. Place one hand on your chest and the other on your belly, just below the rib cage. Inhale through your nose and focus on filling your abdomen with air (the hand on your belly should rise with minimal movement from the hand on your chest). As you inhale, think of your abdomen / core as a canister that is filling with air around the entirety of the canister - your stomach, sides and back. Exhale through your mouth, allowing air to leave your lungs and the diaphragm to relax.

I often tell my patients to use this exercise as a relaxation technique. You can close your eyes and really focus on your breathing. A lot times it actually helps to de-stress and ease pain!

Once you feel you have a good handle on the inhalation piece, you can shift your focus to exhalation and engagement of your core musculature to help push air out of your lungs and brace your abdominals. As you exhale, try to maintain the nice and full "canister" by bracing your core. In other words, you are using your internal obliques to pull the rib cage down toward your waist and push air out of your lungs. Meanwhile, you are slightly pushing out your lower abdominals.

The goal of these breathing and bracing exercises in a resting state is to transfer the mechanics to your daily activities. Try practicing in different positions such as seated, standing, squatting, etc. The more you practice, the more automatic using your diaphragm and bracing your core will become. This will give you a strong base to move better.

For questions on this blog and how breathing and core bracing can help, please email me at