The Breathing Process

Enhance Your Therapeutic Exercise

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Understanding the mechanics of your breathing is not as geeky as it sounds, and it may enhance your efforts at pain relief:  Here are a few of the therapies people with pain do every day that may benefit from some breathing wizardry:

  • Back exercises
  • Movements to release tension out of your back
  • Posture exercise
  • Pain management
  • Holistic therapies in which you are an active participant in your healing.

For example,'s Alternative Medicine Expert, Cathy Wong has a great tutorial in her Breathing from the Belly article.

Slide on to learn the basics of breathing.

At it's "geeky-most," breathing is defined as "the exchange of gases between the cells of an organism and the external environment" by Kendall and Kendall in their classic physical therapy text, Muscles - Testing and Function.  According to Kendall and Kendall, two body processes make this happen:

  • Ventilation, or movement of  oxygen into, and carbon dioxide, out of your lungs.
  • Circulation, or transporting the oxygen to where it is needed throughout the body.

    Most of our discussion on breathing and back pain centers on ventilation, i.e., taking oxygen in and releasing carbon dioxide out.  This happens in the lungs, but without the mechanical processes of inhalation and exhalation, it cannot occur.  Inhaling inflates your lungs with life-giving oxygen, and exhaling deflates them, which lets the CO2 out.  

    Both inhalation and exhalation occur (mostly) automatically, when the lungs respond to changes in volume of the rib cage and trunk.  When the rib cage gets smaller (after you've exhaled, for example,) the lungs respond automatically by expanding with air.  And the reverse is true, too:  When you're all filled up with air, your ribs are expanded and the lungs automatically respond to this by exhaling.  Exhaling reduces the volume of your rib cage again.

    Certain trunk and core muscles participate in the breathing process, as well.  You might say they do double-duty as both posture and breathing support.  These most important of these muscles are:

    • Diaphragm muscle, which is the principal muscle of breathing.  The diaphragm contracts when you take air in and relaxes when you exhale.  When the diaphragm contracts, it moves down from the bottom of your ribs towards your pelvic region.  This makes more space (and creates a vacuum) inside the rib cage, expanding and stretching the lungs, and as we talked about earlier, drawing air into the lungs (inhalation.)
    • When you exhale, the diaphragm is actually relaxing;  it is pulled back up to its starting place at the bottom of your ribs as the natural  "elastic recoil" of the lungs and rib cage expels the inhaled air.
    • The abdominal muscles, which are considered secondary breathing muscles.  The abs assist with exhalation by further pushing air out of your lungs. And when you take air in, your abdominal muscles stretch to allow more space in your trunk.
    • Intercostal muscles, which are sets of criss-crossing muscles located in between ribs.  Mostly, the intercostals expand the volume in your rib cage when you inhale. 

    While other trunk and core muscles participate in the breathing process, too, these are the biggies (and the most valuable players, as well.)

    As mentioned earlier, circulation is the event of transporting oxygen all over the body and collecting carbon dioxide to remove it from the body, by way of the lungs. Circulation would not be possible without the pumping action of muscles, but other physiological processes are at work here, too.

    So the next time you inhale during exercise, movement or as a therapy client, consider the way your lungs, rib cage volume, diaphragm, abs and intercostals participate.

     Working in harmony with the natural rhythm of ventilation may fast tract your pain relief efforts.  Here are a few tutorials to get you started:


    Kendall, Florence Peterson, McCreary, Elizabeth Kendall, and Provance, Patricia Geise. Muscles Testing and Function with Posture and Pain. 3rd. Baltimore, Maryland: Williams & Wilkins, 1983.

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