In Part 1, I discussed why mouth breathing destabilizes the entire upper body via the loss of packed neck position. In Part 2 of this series on breathing and performance, we need to discuss breathing under max load. There is a growing interest in breathing mechanics and how it relates to human performance. The ultimate goal is to maintain stiffness and spinal control under load and breathing has a huge influence on these variables.

Here's the deal: The abdomen is essentially a canister with the diaphragm as the lid, the pelvic floor as the bottom, and the spine running thru it (think banana with a toothpick stuck thru it). There are 85(!) joints within this canister - all of which need to be appropriately controlled because as soon as we see a shearing or translational movement across these joints, force production is altered - a big problem when going for maximum effort.

So how do we stabilize under maximum load? We hold our breath.

Ever see someone take a huge breath of air and hold it when trying to push a wagon full of hay (okay that's a reference to me growing up on a farm) or lifting a couch. Of course you have, this is a normal physiologic response to a max effort - I dare you to push a car without this strategy.  With normal descent of the diaphragm, air fills the lungs and intra-abdominal pressure increases outward in all directions. By tightening down the abdominals, we simultaneously counter these forces with a global abdominal contraction directed inwards. Squeezing the glutes pulls up the floor of the canister - do not forget that the glutes need to be engaged prior to and during max efforts (glute insufficiency is a major culprit in stress incontinence). This dynamic stabilization allows equalized pressure across the spine to actively control and mitigate shear forces across the spine. This system also upregulates the nervous system for increased force output and increases heart rate and blood pressure, keeping tissues perfused and preventing you from passing out - great for that max performance.

This is important: you must counter the increased pressure from the held-in air with a STRONG abdominal contraction, otherwise you are only partially stabilized. This is probably why those with low back pain hold more air in their lungs during lifts - they lack a proper global bracing strategy with the abdominals and glutes and attempt to rely more on intra-abdominal pressure created from the greater volume of air. As a cue for global bracing, think about crushing the toothpick from all directions or tightening down on your spine. When do we see failed lifts or less than optimal max jumps? Often, it's when the athlete has exhaled too quickly prior to finishing the movement, throwing a destabilizing wrench into the system. Ask any accomplished powerlifter and they will tell you it takes considerable practice to brace under load. Doing heavy abdominal work, like tons of crunches, will NOT improve your ability to sustain and maintain intra-abdominal pressure - it's a completely different motor pattern.

Is holding your breath under max loads a good idea for those with a heart or vascular condition? Not so much (and I question whether they should be performing max lifts in the first-place) which is probably why you've heard of the cue to exhale during the concentric phase of a movement. In normal, healthy populations the breath-holding technique actually likely decreases the likelihood of blowing out a blood vessel by reducing the pressure gradient.  Thus, holding your breath under max load (Valsalva maneuver) is the best and safest way for healthy athletes to generate maximum stability for competition-level max efforts (vertical jump, Olympic lifts, taking a punch) without the need to take another breath.

But what about when we do need to take another breath?: While breath-holding is a physiologic response to max effort, what about submaximal efforts - like high-rep or serial movements - the ones we typically use in training and activities of daily living? We can't just hold our breath for these movements, otherwise you'd creep people out with a blue face while standing up from your desk chair - not to mention lose spinal control with each breath.

These serial, submaximal efforts are where mechanics break down and an effective diaphragmatic breathing and bracing pattern is crucial - we will address this in Part 3!

-Seth

This is the first in a multi-part series on breathing and performance. I think we can all agree that mouth breathing is not ideal. It ruins your date and makes you dread sitting next to a mouth breather on an airplane. But aesthetics aside, it significantly compromises the ability to maintain a packed neck position which, we discussed in the last post on jaw pain, alters the control of the head and neck.

Here's the deal: with chronic mouth breathing (present in >50% (!) of the population in some studies), the body naturally adopts a forward head posture as a compensation to maintain an open airway. This causes a tilt of the rib cage (overextension fault - we've established in previous posts that is a major no-go) to keep the chest upright. What we've seen clinically and in the research, is that once the stacked posture of rib cage over pelvis is lost, the diaphragm is at a mechanical disadvantage (becomes less efficient) and its synergy with the abdominals is lost - they both shut down. 
In order to maintain aerobic capacity with decreased diaphragm activity, we adopt a mouth-open upper chest/neck breathing pattern that is both ineffective and costly. This faulty pattern will rob you of performance and exercise capacity because you're increasing the work of the accessory muscles in your neck and upper chest which is metabolically very costly. With heavy breathing during training, we further challenge this system which is often exacerbated by the cue to "look up" during squats, deadlifts, etc. reinforcing this faulty mouth-breathing pattern.

Furthermore, the more you breathe (gulp) with the chest and neck, these muscles (SCM, scalenes, pecs) become quite stiff increasing the forward pull and shear on the cervical vertebrae - especially the scalenes as they attach directly onto the spine. It's pretty common to see this neck breathing pattern in those with cervical radiculopathy (impinged nerve roots) and TMJd. Weird that they often have a forward head posture too, right? (hint - it's not weird at all) The 1st rib can get chronically elevated as well, limiting overhead shoulder position. The overall result is a destabilizing effect and faulty mechanics in the entire upper quarter.

Here's the fix: Remember having tantrums as a kid and your mother would tell you to "breathe in thru the nose, out thru the mouth"? Mother was helping you out because by inhaling thru the nose you automatically adopt a more upright, packed neck position.

Try it: take a quick breath in thru your nose. You will automatically sit more upright and bring the diaphragm back into the breathing pattern (which also increases parasympathetic tone - helps you to calm down, your mother knew what she was doing). Now go back to mouth breathing: right away you notice your chest and neck rise instead of belly (diaphragmatic) breathing and your posture drops back into a forward-head, rounded shoulder look - not cool.

Clean up any mobility deficits in the anterior neck and chest (Kelly Starrett of mobilityWOD.com has some great ideas) and start breathing thru your nose. The best part - it's a reinforcing cycle: it's hard to breathe in thru the nose with a forward head so by forcing yourself into this pattern more, you are reinforcing a packed neck position. As we discussed previously, a better head-neck relationship improves jaw position and stability.

Improving breathing patterns is hard. I recommend lots of practice at nasal (aka belly) breathing first at your desk or lying on your back while in bed - it will help improve your head-neck position with breathing in an unloaded environment first. Then, as coaches, we can systematically challenge breathing and head-neck positioning in loaded and stressed positions once the athlete better understands this pattern.

More to come on breathing and spine control/performance!

-Seth (take a deep breath bro)