Breathing and Back Pain

The importance of breath, woman takes a moment outside to pay attention to her breath

Therapeutic Associates

It’s not a stretch to believe that poor posture and back pain can negatively impact breathing. When we slouch and let our shoulders round, let our head go forward, and let our pelvis rock back, it makes it difficult to allow the ribs and upper back to move normally to allow the diaphragm to move air in and out of the lungs. But did you know that the opposite is also true? Poor breathing can lead to poor posture and back pain! 

To understand how this works, let’s first explore how proper breathing works.

Breathing explained

So, what happens during normal breathing?

When you inhale, oxygen goes into the lungs and into the small air sacs called alveoli. There are small blood vessels, called capillaries, that wrap around the alveoli to gather oxygen. Once oxygen hits our bloodstream, Hemoglobin in our red blood cells picks it up and travels around to all our organs, muscles, brain, etc. for delivery. However, if we do not have enough carbon dioxide in our system, we do not get to use all that beautiful oxygen. If our carbon dioxide is too low, then the oxygen stays bound to hemoglobin and we don’t get the benefit of the oxygen we breathed in, so we think we need more.

Unfortunately, many people are not breathing ideally, and it disrupts this system. Research is varied on the numbers, but the most recent statistics show that 80 percent of people have a breathing dysfunction that is significant enough to impair full functional movement (Keisel 2020). In general, people are breathing twice as much as is physiologically healthy (Rakhimov 2021).  

So, what goes wrong? ​

Hyperventilation, also known as over-breathing, is breathing more than what is needed. This can be by taking big breaths or breathing very fast. When this happens, carbon dioxide is expelled from the body too quickly. Thus, we do not get the signal for the hemoglobin to release oxygen. Now when the oxygen is going down your arteries attached to hemoglobin, the hemoglobin does NOT release the oxygen to the tissues that are asking for it.  

You may think that all seems very complicated. Agreed!

 Wondering what it has to do with back pain? When your body does not get the oxygen it needs, you will feel it, literally! 

diagram of oxygen-carbon dioxide cycle during breathing

How breath affects pain

If muscles do not get enough oxygen, trigger points or “knots” will occur in the muscle (Chaitow 2014). This leads to lactic acid buildup in the muscle which makes it more painful. It’s not just muscle that is affected though. Fascia, or the spider-web-type material that weaves between organs, muscles, and under your skin, can also have limited oxygen and lead to swelling and in turn, pain.  

When carbon dioxide is lower than normal from hyperventilation, it also affects the chemical balance of the blood via the pH (how acidic or basic something is). When your carbon dioxide is low, the pH becomes more basic than normal which makes your nerves more irritable causing them to fire more frequently. This can lead to muscle spasms, increased reflexes and sensitivity to light and sound (Lum 1987, Timmons 1994).  

Have you ever had a massage and felt it was really helpful, only to notice that your pain is right back to the way it was a day or two later? Perhaps your breathing is perpetuating this cycle!

Okay, I get it! Now, what do I do about it? 

Proper breathing technique

To make things easier for your diaphragm to contract and your ribs and upper back to move, think about having good posture. Sitting on a chair with your feet on the ground, think about where your weight is on your bottom. Try rocking your pelvis forward and backward as far as you can and then stopping in the middle, you should feel like you are sitting on your pelvic floor muscles. Now lift your chest gently like you are displaying a necklace. If you slouch, you are hiding your necklace. If you lift your chest too high, you are shoving it in someone’s face. You want to just have it lifted enough so your shoulders gently fall back, and your ears are right over your shoulders.  

Now comes the breathing part. Try to nose breathe – both on the inhale and the exhale. This slows the breathing down and allows the carbon dioxide to stay in your body a little longer so you can better absorb oxygen. To take it to the next level, make your exhalation a little longer than the inhalation and focus on the first part of the exhalation being the slowest. This also allows a gas called nitric oxide to be absorbed into your body. Nitric oxide works as an antihistamine and is your first line of immune system defense.

I feel like I need more help than that … 

Great! There is a lot more we can do. Physical therapists treat a wide range of conditions, much more than musculoskeletal injuries.

Physical therapy for breathing and back pain

A physical therapist can assess you to see how your posture and breathing are related and how they may be causing back and neck pain. Working with a physical therapist, especially one certified in breathing behavior, can help you find an individually tailored treatment plan to help correct breathing dysfunction. At Therapeutic Associates, we have several therapists who are specifically trained in BreathWorks which utilizes biofeedback so we can see what your breathing is doing in real-time to tailor your treatment specifically for you.  

man has back pain while working at a desk

If you’ve been dealing with nagging pain in your body, have what feels like chronic low back pain, or simply want to learn how to improve your breathing for the benefit of your overall health and wellness, don’t wait – find a physical therapist near you today!  

Whether you’re having trouble picking up your kids, are missing out on activities you love, or are struggling with your daily routine, we know it can be overwhelming to try to choose a physical therapist. Direct Access means that you have the right to choose the physical therapist that best fits your needs. At Therapeutic Associates, we would be honored to partner with you on your healing journey.

Start your physical therapy journey today.

As physical therapists, we know the importance of movement for overall health and well-being. From injury recovery to achieving optimal performance, our passion is to help every patient reach their goals and live an active, pain-free life. Get started with PT today!

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