Breathing: How Not to Die, and Feel Great Doing It.

Breathing Benefits in Physical Therapy

All good gardeners know, pick the low hanging fruit first. In the garden of health, there is perhaps no lower hanging fruit for health than breathing. If you want to live to be 100 years old you’re first going to need to survive the next two minutes. And that means breathing. But as it turns out, the way you breathe is almost as important as breathing at all. After all, what else do you do 22,000 times a day? Read on to find out how we use breathing in Physical Therapy at Well Balanced as well as how carbon dioxide and posture can help you live longer, better, and with less stress. 

The Nose Matters:

Noses are made for breathing, and that’s just what you should do. But the only way to really tell if nose breathing matters, is to not do it for a while. At least that’s what James Nestor thought. In his best-selling book Breath: The New Science of a Lost Art, James tells the story of the worst 10 days of his life. For a week and a half, he lived with silicone plugs in both nostrils, forcing him to breath exclusively through his mouth. He experienced almost immediate onset of brain fog, bad breath, anxiety, stomach upset and dehydration. He also started to snore, developed sleep apnea, and had a significant rise in blood pressure. Fortunately for James, all his symptoms resolved as soon as he returned to nasal breathing. As James so courageously demonstrates, the way we breath can dramatically affect our health metrics. This is true in the short run, but even more powerful over time. From ADD, to asthma and even psoriasis. Making the switch to nose breathing is a physical therapy breathing benefit that can positively impact just about every aspect of your health. To learn why your nose is the ultimate breathing machine, read on!

We know breathing through the nose warms, cleans and humidifies air before it reaches your lungs. But the real magic of a nasal breath is not what goes in, but what it keeps in. And what it keeps in, is carbon dioxide. When you exhale through your mouth, you simply blow out a higher proportion of CO2. If that doesn’t sound important to you, consider your body has pretty much no idea how much oxygen it has. It only knows how much CO2 is in your blood. When you feel the drive to breathe, it’s not from lack of oxygen, but rather accumulation of carbon dioxide. Most healthy humans almost always have enough oxygen, but the drive for that next breath comes from the buildup of CO2. Breathing out too much carbon dioxide can lead to a downward spiral, where you have less and therefore become accustomed to less. This leads to a drop in tolerance, and the tendency to blow off even more CO2, further lowering your tolerance. You may feel the urge to breathe, when you don’t strictly need to, because the signal and ratio is off.  By breathing through the nose, you retain more CO2 and start to build back your tolerance. Building your tolerance to carbon dioxide can significantly improve your efficiency, endurance, and overall health.   

If you don’t believe me, we can just check out the animal kingdom for some answers. Consider naked mole rats. Naked mole rats are technically not rats, but the rest of the name suits them well. Moles live most of their lives underground with little oxygen available and much higher amounts of CO2 in circulation. Subsequently, their breathing rate is slower. Now consider the average life span of a mole rat is over 30 years. Compare that to the above ground porcupine, a close relative, whose average life span Is only 18 years. That’s nearly double the life span! If you too wish to improve your life span, you can either ditch the clothes and start digging, or simply build up your tolerance to carbon dioxide. 

To understand why this is, we must first understand the Bohr effect. This is a science-y way of saying carbon dioxide levels tell your blood what to do with oxygen. Whether to pick it up, or whether to drop it off. Ideally, picking up oxygen at the lungs and dropping it off at your hard-working muscles! This is a good recipe, especially while exercising. But then imagine, you’ve blown off a ton of your CO2 by over-breathing out of the mouth! This not only hurts your ability to pick up oxygen in the lungs but also impairs your ability to drop it off at the muscles. A proverbial double whammy!  

The main take away here, is that carbon dioxide is essential to your health. Mouth breathing blows off your precious CO2. This lowers your overall tolerance and reduces your body’s ability to deliver oxygen to your muscles and brain. This is a surefire way to increase your anxiety and lower your stamina. But there’s good news – even small improvements in CO2 tolerance can mean big improvements in stamina and overall health.  Nasal breathing is the first line of defense but stick around to find out how you can further dial in your CO2 tolerance. 

Speed Matters:

Anyone who has ever been to an “all you can eat” buffet knows, it is possible to eat too much. In the short term, too much food can leave you feeling bloated and ready for a nap. In the long term it can lead to things like excess body fat, increased risk of cardiovascular disease and diabetes. Though much less appreciated, breathing too much can have similar deleterious effects on your health. 

As James points out, the animals who live the longest have the slowest heart rates. And you guessed it, they also breathe the slowest. Humpback whales, for example, can swim for a full hour on one breath. Because you, your lungs, and your car are probably still smaller than a whale’s lungs, your ideal breathing pace is probably a bit faster. Somewhere around 6 breaths per minute to be exact. Multiple methods point to this range as being ideal for most people. Clinically, I find my patients show the highest Heart Rate Variability around 6 BPM.  

Six breaths per minute. Great, “but Aaron, does it matter how long I inhale”? You ask such great questions. The answer is that it depends on what you’re after. But here are a few things to consider – inhaling is stimulating. Like coffee, inhaling pushes you towards the sympathetic side of your nervous system. This is the fight or flight side of you. Think gasping in for air when you’re frightened.  Conversely, exhaling provides a nudge in the parasympathetic direction. This is your rest and digest side. Think “sigh” of relief. To use this to our advantage, we could turn the dial towards relaxation, simply by drawing out the exhale for longer. Or, by pausing after the exhale. Breathing methods that emphasize the exhale include 4-7-8 breathing, Buteyko and box breathing. If we wanted to move the dial towards wakefulness, we could emphasize the inhale. Examples of breathing methods which capitalize on the energizing effect of the inhale include Wim Hof, fire breath in Yoga, or holotropic breathing. Now that you know the difference, you can use breathing to help get ready for that big meeting, or to help wind down for bed.    

Posture matters: 

When it comes to breathing, posture matters. But perhaps not in the way you think. Most of us have heard to sit up straight and not slouch. Probably from mothers and well-meaning piano teachers. The truth is, there is no one perfect posture. Even the world’s most comfortable chair would start to suck if you sat in it for long enough. That’s why we say, “the best posture is the next posture”. In other words, the key to success is to stay moving. Movement helps circulate blood, lymph, and even helps pump gasses in and out of our lungs. Step one to perfect posture: move more. 

Step two of achieving perfect posture – we need to consider the diaphragm and under what conditions the diaphragm works best. The diaphragm is our huge dome shaped breathing muscle. There are 3 things the diaphragm loves: 1) being a dome. This may sound like a given, but trust me, it’s a big deal. 2) Hanging out over the pelvis. The pelvis has its own mini muscular floor that should mirror the action of the diaphragm. 3) Working on the left and the right. The diaphragm is naturally lopsided, and it’s significantly bigger on the right side. We need both sides to work together.   

When all these boxes are checked, we can breathe effortlessly, and move athletically with minimal limitation. A functional diaphragm can ramp up in time of stress, then perfectly wind down when it’s time to relax. If the diaphragm is working well, then all other ranges of motion in the body are likely maximized. Pressure is likely well regulated, and the nervous system can relax. Hopefully, by now, you’re starting to see the importance. If one of these rules were to be violated, the function of the diaphragm would certainly be impaired. This is where people start to compensate, using their necks and lower backs to ‘pull air’ into the body. Compensation is probably not a big deal in the short run, but a little bit of compensation times 22,000 breaths per day equals a lot of compensation over time. This can look like a forward head, increased lower back curve and sometimes an excessively flat middle back. These compensations tend to significantly limit range of motion and can lead to increased risk of hernias, anxiety, hemorrhoids, neck & back pain, and much more.  

The solution is to restore the three criteria and optimize diaphragm function as another breathing benefit of physical therapy. Fortunately, the Postural Restoration Institute has developed testing algorithms and techniques which determine which criteria are not being met, then help decide what to do about it. I would highly recommend working with a practitioner trained in Postural Restoration (PRI for short) to get thoroughly evaluated and to get your diaphragm pumping! That said, I’ll include one of my favorite exercises at the end of this document that’s designed to address all three!  

Breathing matters for just about every aspect of health. How we breathe moves us closer to our best selves, or deeper into disease. The key things to remember are: 

  1. Unless you’re running, and running fast, you should probably be breathing through your nose. 
  2. Breathing slowly helps build tolerance to carbon dioxide. 6 breaths per minute is ideal. 
  3. The diaphragm runs the show. Postural Restoration exercises can help you optimize your diaphragm, breathing and your health in general! 

If you found value in this information and want to know more, check out Breath: The New Science of a Lost Art by James Nestor, and The Oxygen Advantage by Patrick G. McKeown. If you would like to optimize your diaphragm and be evaluated by one of our excellent clinicians, head over to the appointments tab on our website:

Written by Aaron Barnard Doctor of Physical Therapy.