What role do breathing exercises play in orthopedic rehab and in strength training?

                It seems like breathing is once again a hotly debated topic in the rehab & fitness worlds. Some think that breathing exercises are the greatest thing since sliced bread while others think they’re useless. My brilliant colleague Roderick Henderson posted a great video on the topic in early August and in this article I will give what I feel to be a balanced perspective on the topic.

Disclaimer: I will not be discussing breathing for people with cardiopulmonary disease in this piece – that’s another topic for another time.

Side note: as I was working on this article my brilliant colleague Adam Meakins put out a great article on breathing as well. If you haven’t read his opinion piece than give it a read.

                Believe it or not – I do see some useful applications for breathing exercises such as

1) A relaxation/recovery technique either as part of a post-workout cooldown and/or for a separate recovery session

2) To change patterns that are associated with pain

Anecdotally I have heard of people with rib and/or low back pain that find certain breathing techniques more or less comfortable than others. Anecdotally some people I work with who have rib pain find diaphragmatic breathing more comfortable than chest breathing. Some people I work with who have back pain that’s aggravated by extension find breathing more comfortable when emphasizing a 360 degree expansion of their belly (see video here by Chris Duffin for the technique https://www.youtube.com/watch?v=IZDVHVohtmE).

In those populations I have no problem with changing someone’s breathing technique to give them a way to breathe that’s more comfortable for them.

Side note: changes in pain with treatment can be due to a variety of factors so the caveat is that we have to be careful not to attribute changes in pain to changing a “breathing dysfunction¹.”

Side note #2: If you are a rehab professional who is working with a person who has pain with a given breathing technique you need to be cognizant to rule out any major orthopedic or medical issues that may be causing these problems including (but not limited to) a rib fracture or cancer. If you are a fitness professional DO NOT try to diagnose this stuff and please refer to a qualified professional – preferably one who understands lifting, pain science, and the biopsychosocial model. If you have trouble finding a good PT in your area that appreciates training message me – I’ll help you out as best I can.

3) To improve performance and/or comfort in a given exercise

If changing a person’s breathing patterns improves performance and/or comfort in a given exercise be it a squat, a deadlift, or an aerobic exercise session I have no problem with that.

In my article on core stability I discussed how bracing can be overdone and is only really relevant if you’re doing strength training or are in a lifting competition. This is more anecdotal than research based but I don’t know of any strength athlete/strength enthusiast that feels they can lift more in a relaxed state than in a “braced” state. For info on specific breathing & bracing technique I’m a big fan of Brian Carroll and Chris Duffin’s work.

Where we go wrong is

1) Assuming everyone in pain is in pain due to a breathing dysfunction and assuming that fixing people’s dysfunctions will cure everyone’s pain. Also the idea of a “breathing dysfunction” is problematic and without a definition as breathing, as is the case with many other movement variables, has a wide variation of “normal.”

2) Spending anymore than a few minutes of a personal training/S&C session on breathing when that time can be spent on more productive things.

So in summary there’s nothing wrong with giving people breathing exercises to help find less painful ways to breathe and/or improve exercise performance … assuming major pathology is ruled out. But understand that they’re not a panacea for everything and everyone.

Reference

1.          Hartman SE. Why do ineffective treatments seem helpful? A brief review. Chiropr Osteopat. 2009;17:10. doi:10.1186/1746-1340-17-10.