Welcome back to Gold Coast Physiotherapy's health blog. Today, we're delving into a topic that often goes unnoticed but holds profound implications for our well-being, that is the importance and impact of healthy breathing. Recent research has shed light on the alarming prevalence and implications of breathing pattern disorders in both adults and children. The upward trend in these numbers emphasises the importance of understanding the science of proper breathing and the implications it has on our health. At Gold Coast Physiotherapy, we take a holistic approach to health, whether you present with shoulder, neck or back pain, breathing patterns can often have a significant role to play in your condition, so be assured that our clinicians will address this if need be. So, lets jump in and check out what the evidence around breathing suggests.

Know Your Breath

Did you know that as human’s we can shift our bodies physiological and psychological state’s by simply altering the way that we breathe. Incredibly, we can go from a stressed state of fight or flight to a relaxed state of rest, digest and recover within a few minutes of specific and controlled breathing techniques.

Breathing practices are well documented to have been used by our ancient ancestors in practices such as yoga, meditation and in some culture’s, breathing has even been used as the primary form of medicine. Modern day research is now beginning to piece the puzzle together to allow us to understand exactly how we as humans benefit from conscious and focused breath training. In particular, the last 2 decades has seen a significant amount of research making its way into reputable journals to shed light on the astounding benefits of breath training. The way we breath is now known to play a major role in our immunity, digestion, pain, psychological health, and even our bodies response to stress. With studies showing that we can reduce cortisol (the bodies stress hormone) in our blood, reduce anxiety and depression, increase our bodies immune cells – Neutrophils, Platelets and Natural Killer Cells (cancer fighting cells), regulate our psychological state / mood as well as reduce pain just by the way we choose to breathe.

Additionally, we are starting to find the link between dysfunctional breathing and the associative and in some cases, causative relationships to certain health conditions.

·        Asthma (Barker et al. 2020)

·        Panic Disorder (Heck et al. 2022)

·        Anxiety Related Disorders (Preter & Klein, 2008)

·        Attention Deficit/Hyperactivity Disorder (Arias-Mera et al. 2023)

·        Autism Spectrum Disorder (Heck et al. 2022)

·        Chronic Pain (Li et al 2022)

An area of growing interest and which is gaining significant awareness at present is breathing retraining in sport and its effects on athletic performance. With significant research showing that breathing patterns affect the way we can move and perform physical tasks. (Allado et al. 2022)

Breathing pattern disorder (BPD) prevalence rates are suggested to be between 6-10% of the general population (Barker et al. 2022) and is estimated to be as high as 35% in children. Due to non-consensus in diagnosing BPD in the literature it is estimated to be a lot higher than these numbers with some experts suggesting that BPD’s could be as prevalent as 40-60% in the general population and increasing.

How Do You Know If You Aren’t Breathing Well?

As an evolving field of study, there is no single gold standard test to determine whether you have a breathing pattern disorder. Rather, from the research, there are 5 common tests used to detect breathing pattern disorders. We have listed them below, most of which you can do by yourself.

Hi-Lo Assessment:  

The Hi-Lo examination is performed by placing one hand on your belly and the other over your chest whilst breathing normally. Evaluating the balance between chest movement and belly movement gives you the relative effort of the diaphragm in comparison to the accessory breathing muscles (intercostals, sternocleidomastoid, scalene’s and upper trapezius). In normal breathing whilst lying: 90% of our breath should be done by the diaphragm (ratio of 90:10 belly movement to chest movement). In sitting the ratio changes to 70:30 diaphragm to accessory muscles.

Resting Respiratory Rate > 16 bpm:

A higher respiratory rate at rest most commonly indicates shallow breathing, pointing towards a breathing pattern disorder. This can be most easily assessed when someone in not conscious of your breathing. Getting your partner to check your breath rate in 1 minute is a great way to do this.

Breath-Hold Test <20 Seconds:

In a resting position with normal breathing, exhale to a normal point then start the timer. Stop the timer at the first point of any involuntary body movement. A score of below 20 seconds has been linked to breathing pattern disorders.

Carbon Dioxide Levels (etCO2 Score < 35mmHg):

Requiring a non-invasive machine, Capnography is used to the measure the carbon dioxide in a patient's exhaled breath. Carbon dioxide (etCO2) levels below 35mmHg indicates over breathing and thus the presence of a breathing pattern disorder.

Nijmegen Questionnaire:

This questionnaire assesses an individual’s experiences related to their breathing. It is a well researched and published questionnaire and a great indicator of the potential of a breathing pattern disorders. Click here to do one right now it takes 5 minutes. BW-Nijmegen-Questionnaire.pdf (bronchiectasis.com.au)

A score >23 is suggestive of the presence of a breathing pattern disorder.

Additional Signs that you may have a breathing pattern disorder are:

·        Frequently yawning and sighing

·        Frequently feeling the need to take deeper breaths “I can’t get enough air in”

·        Noisy breathing

·        Snoring or noisy breathing whilst sleeping

·        Upper chest moves outwards more than the tummy during a breath in

·        Cold hands or feet

·        Breath holding whilst working at the computer (Screen Apnea)

·        Fatigue and tiredness

·        Dizziness

·        Blurred vision

Why Does Good Breathing Matter? The Impact on Your Health

Understanding and addressing breathing pattern disorders are critical for overall health. As discussed, from research, breathing pattern disorders are now from research considered to be the cause of many common health conditions. See the list above: Anxiety, depression, panic attacks, asthma, ADHD, chronic pain and even fibromyalgia. Research has even shown that breathing pattern disorders compromise our physical/functional movement and athletic performance (Allado et al. 2022). By identifying and correcting these breathing patterns, individuals can experience easement of their symptoms and in some cases disease reversal and remedy.

Breathing well does not only benefit those with health conditions. In fact, research now shows us that good breathing can approve all individuals in the following areas of our lives:

·        Stress, mood, anxiety, depression (Jerath et al. 2015)

·        Quality of sleep (Bender & Lambing 2023)

·        Digestion (Gholamrezaei et al. 2023)

·        Pain (Wang et al. 2023)

The above research articles are reviews of the literature which further outlines the importance of healthy breathing and breathing pattern retraining as a form of medicine. Put simply, a healthy breathing pattern and regular focused breath training will significantly improve your quality of life. The great news is that individuals with dysfunctional breathing / breathing pattern disorders do significantly benefit from breathing retraining within 4 weeks of commencing a retraining program with a trained physiotherapist (Hagman et al. 2011). We also know that healthy breathing patterns significantly improved our ability to move well. Bradley & Esformes published a paper in 2014 that showed the importance of diaphragmatic breathing on functional movement. The study looked at breathing patterns of individuals and their functional capacity for strength, flexibility and functional movements like squats and core control. Individuals with poor breathing patterns scored significantly lower in the functional movement scale (FMSTM). The authors conclude that that inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations that detrimentally affect our movement.

When to Seek Professional Guidance

If you suspect you or your child may have a breathing pattern disorder, seeking professional guidance is highly recommended. The team at Gold Coast Physiotherapy are trained in breathing pattern disorders and breath retraining and are here to help provide personalise interventions to optimise your breathing for better health and well-being. Our breath trained physio’s will guide you through the process, from understanding your condition right through to strategies and techniques which will help you regain control of the power of your breath.

Remember, your breath is a powerful ally of your health. Take a moment to tune into your breath, relax, breath with ease and if you have concerns, give us a Call or Book an Appointment. Together, let's make your breathing amazing so you can live a healthier and more energetic life.

References

Allado E., Poussel M., Hily O., Chenuel B. (2021). The interest of rehabilitation of respiratory disorders in athletes: Myth or reality? Annals of Physical and Rehabilitation Medicine. Volume 65(4). The interest of rehabilitation of respiratory disorders in athletes: Myth or reality? - PubMed (nih.gov)

Arias-Mera C., Paillama-Raimán D., Lucero-González N., Leiva-Bianchi M., Avello-Sáez D. (2023). Relation between sleep disorders and attention deficit disorder with hyperactivity in children and adolescents: A systematic review. Research in Developmental Disabilities. 137(1). Relation between sleep disorders and attention deficit disorder with hyperactivity in children and adolescents: A systematic review - PubMed (nih.gov)

Barker N., Thevasagayam R., Ugonna K., & Kirkby J. (2020). Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management. Frontiers in Pediatrics. Volume 8(1). Frontiers | Pediatric Dysfunctional Breathing: Proposed Components, Mechanisms, Diagnosis, and Management (frontiersin.org)

Bender A., & Lambing KA. (2023). A practical guide to improve sleep and performance in athletes. International Journal of Sports Science and Coaching. 18(6). A practical guide to improve sleep and performance in athletes - Amy M Bender, Kari A Lambing, 2023 (sagepub.com)

Bradley H., & Esformes J. (2014). Breathing Pattern Disorders and Functional Movement. International Journal of Sports Physical Therapy. (1), 28–39. BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT - PMC (nih.gov)

Gholamrezaei A., Guadagnoli L., Teugels A., Peluso N., Fung A., Van Oudenhove L., Van Diest I., Vlaeyen J., Tack J., Vanuytsel T., Aziz Q., Talley NJ., Keefer L. (2023). Breathing exercises for the management of gastrointestinal conditions: protocol for a scoping review. MedRxiv. Breathing exercises for the management of gastrointestinal conditions: protocol for a scoping review | medRxiv

Hagman C., Janson C., Emtner M. (2011) Breathing retraining - A five-year follow-up of patients with dysfunctional breathing. Respiratory Medicine. Volume 105(8), 1153-1159. Breathing retraining - a five-year follow-up of patients with dysfunctional breathing - PubMed (nih.gov)

Heck DF., Correia B., Fox MB., Liu Y., Allen M., Varga S. (2022). Recent insights into respiratory modulation of brain activity offer new perspectives on cognition and emotion. Biological Psychology. 170(1). Recent insights into respiratory modulation of brain activity offer new perspectives on cognition and emotion (nih.gov)

Hopper SI. Murray SL., Ferrara, LR., & Singleton JK. (2019). Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database of Systematic Reviews and Implementation Reports. 17(9). 1855-1876. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review - PubMed (nih.gov)

Hopper SI. Murray SL., Ferrara, LR., & Singleton JK. (2019). Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database of Systematic Reviews and Implementation Reports. 17(9). 1855-1876. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review - PubMed (nih.gov)

Jerath R., Crawford MW., Barnes VA., & Harden K. (2015). Self-Regulation of Breathing as a Primary Treatment for Anxiety. Applied Psychophysiology and Biofeedback. 40(1). Self-Regulation of Breathing as a Primary Treatment for Anxiety | Applied Psychophysiology and Biofeedback (springer.com)

Li MT., Robinson CL., Ruan QZ., Surapaneni S., & Southerland W. (2022). The Influence of Sleep Disturbance on Chronic Pain. Current Pain and Headache Reports. Volume 26(1), 795–804. The Influence of Sleep Disturbance on Chronic Pain - PubMed (nih.gov)

Preter, M., & Klein, DF. (2008). Panic, suffocation false alarms, separation anxiety and endogenous opioids. Progress in NeuroPsychopharmacology & Biological Psychiatry, 32(3), 603–612. Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids - PMC (nih.gov)

Wang H., Liu X., Wang T., Tan JY., & Huang H. (2023). Breathing Exercises for Pain Management in Cancer Survivors: A Systematic Review. Pain Management Nursing. Volume 24(3), 299-310. Breathing Exercises for Pain Management in Cancer Survivors: A Systematic Review - PubMed (nih.gov)