As we discussed in my previous post, hyperinflation (over-breathing) causes system-wide excitation which may be useful in short bouts of exercise, but over time can be a rate-limiter to adaptation and resilience. By getting air out (exhalation/flexion) we can better achieve a balanced, neutral state. The diaphragm can achieve a more normalized resting position rather than being pulled into a more horizontal, tonic position. Perhaps high resting tension in the diaphragm is an indicator of system-wide tension - those guys/gals that are always tight and fatigue-out early in high-rep schemes. Now I do think that balance is a moving target and the sum/goal should be a balanced system of managing the extremes even if it's not achieved in the moment.
So how do we swing the pendulum back towards neutral? By getting air out. Here are a couple ways:
1) Recognition is the first step. Does you or your athlete's ribcage look like this, even at rest?
If so, c'mon man. It may not become apparent until higher level movements, typically ones involving arm and leg movements (such as overhead movements) in which exhalation and the ribcage-pelvic relationship is even further challenged. And that's a main thought here: we have to challenge competency with progressive demands - if all you do is blow up a balloon (despite its effectiveness) and give no further thought to breathing, the boat is missed. Let's suppose you can breathe at rest - a tall order for most - can you maintain neutral under load, with speed, changing targets? And even more appropriate for this topic - can you reclaim neutrality at rest?
2) Forced exhalation - this effectively recruits the abdominals and pelvic floor in a coordinated fashion providing centration to the ribcage and pelvis (reduces rib flare). The active contraction of the abdominals during resisted exhalation resists the action of the diaphragm and increases parasympathetic tone helping to decrease resting muscle tension. There are a ton of exercises out there using this principle (PRI being the foremost).
Here are some I like:
From my guy Dr. Quinn Henoch:
I will typically use these more on the cool-down, post-work side but, again, that depends:
3) Use breathing to maintain neutral: this goes along with forced exhalation but I will have clients actively exhale during the extension part of a movement as I have found that having them just brace down hard often stimulates breath-holding which is typically not beneficial during high-rep movements. Adding in the breathing component seems to centrate the core and recruit globally better than telling athletes to just "get tight".
By swinging the pendulum more towards exhalation and getting air out, we can achieve both mechanical neutral (spinal position) and neurophysiologic neutral (autonomic nervous system balance) and reduce excessive tension/excitation from the system.
As followers of my blog (now in 110 countries — waiting on you, Greenland) have surely begun to appreciate - I have a thing for breathing. Watching clients and athletes breathe, it becomes apparent that one's breathing pattern is just such an important indicator of system readiness and neutrality. Charlie Weingroff calls breathing a keyhole into the nervous system which I think is perfect. Without a normalized and balanced breathing system, movement variability suffers typically causing loss of adaptability - a rigid system - and movement patterns default to high-tension strategies (more on that later).
One of the most common breathing patterns we see is the hyperinflated pattern. Essentially, the athlete is in a state of excessive inhalation - breathing on top of breathing - with inadequate exhalation. They just can't get air out efficiently. This hyperinflated pattern of breathing can be asymmetric (typically see the left rib-cage flared more than the right) or symmetric (both rib cages flared) as described by the Postural Restoration Institute. While these differences are important, particularly to the physio, hyperinflation has consequences regardless of symmetry.
Given the anatomic link between the ribcage, diaphragm, and thoracolumbar spine it's important to think of this like an SAT analogy: Inhalation is to lumbar extension as exhalation is to lumbar flexion. In the hyperinflated state inhalation/extension >> exhalation/flexion contributing to system-wide issues in performance and loss of variability. Without access to the diaphragm (and the pelvic floor), the deep abdominals, and ultimately full spinal range (flexion), movements become rigid and "stuck": the athlete is the classic overextended, powerful but stiff dude who lacks sustainable movement (think spondy, pelvic floor dysfunction, neural tension, the list goes on and on...)
Taking it a step further: inhalation is to excitation and tension (sympathetic-dominance) as exhalation is to relaxation and inhibition (parasympathetic dominance). Inhalation yields excitation - why heart rate increases with inhalation and decreases with exhalation. The dominance of this fight-or-flight response is essential in short bouts of performance, but is pretty much awful if maintained for long periods of time as it prevents recovery and relaxation - both of which are important for system neutrality. As my dad always said, everything in moderation. With this hyperinflated state inhibition of muscles, particularly the extensors, is difficult and the athlete cannot get into and sustain a variety of movements because the nervous system is under constant threat. The increased pH of the blood due to decreased CO2 levels also contributes to a sensitive peripheral nervous system. No wonder people with persistent/chronic pain display this hyperinflated, stressed-out state - a threatened nervous system is often a painful one!
This hyperinflated state is a big culprit, in my opinion, for the high tension strategies I see so often in athletes. They just don't know how to dim or inhibit the muscles that aren't necessary for the movement. Ever walk on ice? Every muscle is tensioned to limit joint motion and decrease the risk you might fall - yeah, it's exhausting. Defaulting to these high tension strategies, when they aren't necessary, is like walking on ice. The system is rigid and movements are more taxing - everything other than max effort is typically a struggle in this state and they fatigue out early. These people always feel tight, though they probably have plenty of muscle excursion.
Clearly, exhalation needs to be emphasized for a balanced, efficient system. By emphasizing flexion-biased breathing patterns, the system can approach a balance. pH levels can be normalized and beneficial training effects can be realized without adding rigidity to the system. By facilitating ribcage over pelvis mechanics, the diaphragm and pelvic floor can return to their normal resting length and function allowing the diaphragm to act like the diaphragm. I think many of our barbell-based strength training systems lend us towards this hyperinflated state so some reset movements likely need to be thrown into programming.
So what to do about this? That's coming in a near future post but - spoiler alert - it involves forced exhalation, flexion and developmental patterns, and some recovery strategies. In the meantime here's my earlier post on diaphragmatic breathing for recovery.
Improving Breathing and Performance (Part 4): Breathing and Stress - How to Shut Down and Recover Your Nervous System
We've already discussed how to increase performance with breathing and bracing strategies during movements (I highly recommend checking out Part 1, Part 2, and Part 3 to get the whole picture), but what about when the training, competition, mission, or workday is over? An inability to shut down, sleep, and recover is not only frustrating to that individual which further amplifies the stress, but is also untapped potential for performance gains. Recovery may be the most important part of your workout.
In normal diaphragmatic breathing, the heart rate accelerates when breathing in and decelerates when breathing out. This Heart Rate Variability (HRV) is a glimpse into the balance of the nervous system. When athletes are in a constant state of sympathetic dominance, the heart beats like a drum and does not have a normal variability. This is exacerbated by heavy upper chest and neck breathing (discussed in detail in Part 1) and poor diaphragmatic activity resulting in chronic over-breathing. Loss of HRV is even found to be predictive of mortality in those with heart conditions.
Improving Breathing and Performance (Part 3): How to Breathe and Brace Without Loss of Mechanics During High-Rep Movements
In Part 1 of this series, I discussed how mouth breathing can alter head-neck control. In Part 2, we talked breathing during max effort. And as we discussed, holding your breath (with appropriate mechanics) is a natural, physiologic method for maximizing spinal stiffness and force output under very heavy loads. However, holding your breath during repetitive movements is not only metabolically costly, it is also mechanically inefficient - and most of our daily movements involve the need to breathe under sub-maximal load and for more than one repetition. So for Part 3, we need to establish how to breathe during high-repetition, serial movements without loss of mechanics.
To move more efficiently we need to have a global bracing strategy during high-rep movements (which, face it, submax repetitive movements are what make up daily life and most athletic movements) in which spinal control is never lost and efficiency is high.
Think about breathing into a steel canister - this will allow breathing to occur where it's most effective (the diaphragm) without having to reconstitute spinal stiffness after each breath. The goal is to never lose position nor stiffness, while still being able to breathe under load. Chest breathing will accompany this when demand requires it - and that's okay to supplement the diaphragmatic breathing - but a proper bracing strategy will always apply. This will take some time and mental energy to master during training but will pay dividends in terms of injury prevention and performance (which are synonymous in my opinion).
There a ton of advanced breathing assessments and techniques out there but we can lop off a lot of dysfunction if we follow this basic principle of an appropriate and reproducible breathing/bracing strategy.
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!
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.