Breathing, Posture and Stretching

Author’s Note: This is part 1 of a three-part series. Pt. 1 focuses on breathing.

There are many recommendations we practitioners give over the years – drink more water, eat more vegetables, cut out dairy, or stop having cold smoothies every day for breakfast. While I do make these types of suggestions on a case-by-case basis, I find I keep coming back to the same three lifestyle pivots for all patients. In fact, it’s become such a big part of my practice it’s creeped into my own life and garnered an acronym – BPS: breathing, posture and stretching.

Breathing

Most patients in my practice begin on their stomach, with their head in the headrest. As I am working on them, the first thing I observe is their breathing. The table warmer is on. The room is warm. The music is relaxing. There is no reason that within the first five to 10 minutes of treatment, someone’s breathing shouldn’t begin to soften.

In his book Breath, James Nestor teaches us that by exhaling for six seconds and inhaling for six seconds, we move 5.5 L of air in and out of our lungs, which activates our parasympathetic nervous system. Picture someone in a deep sleep. Their breath is so long and so smooth. They are very much in rest and digest mode.

If I see a patient breathing at a fast rate after an acceptable amount of time, I inform them and wait to see if they can start to regulate it on their own. I then audibly mimic how fast they are breathing and ask them how it makes them feel to hear me breathing that fast. “Stressed” is the usual response.

Starting With the Exhale

When I teach the Eight Brocades qigong set, I like to trick people. I ask participants to take a nice, deep breath in. It’s usually not very deep and not very nice. It’s shallow. The key to a good inhale, I teach them, is a good exhale. The same lesson is taught to any patient whose breath remains shallow during treatment.

There can be some patients who have a hard time exhaling. This can be due to stress, an inability to “let go,” and even tight accessory breathing muscles located in the neck, trapezius, latissimus dorsi, and intercostals. Acupuncture is a great tool to soften this tissue; as well as massage. Massage can be timed with the exhale, which patients seem to appreciate.

A longer exhale also self-massages the organs in the abdomen. This improves digestion and defecation.¹ It’s no wonder the lungs are paired with the large intestine. Many patients who have symptoms in their abdomen don’t breathe fully and completely. Deep, slow breathing has also been shown to decrease pain and improve mood.² By teaching a patient to exhale deeply, I know that I am teaching them a valuable tool they can take with them anywhere they go.

Back to Basics: A Case Study

A patient presented to my clinic with a naturopathic diagnosis of small intestine bacterial overgrowth, for which treatment had begun seven weeks prior. Symptoms included general lassitude, muscle fatigue, and self-described tightness in the neck, trapezius and jaw. The tongue body was red with red prickles, with a thick, yellow coating, and was quivering. Both kidney positions were hidden on the pulse. During the first treatment, I noticed the patient’s breath was shallow.

After three treatments, there was no change and the patient began to feel hopeless in their recovery. They were suffering from daily headaches, poor appetite, soft, frequent stool, body aches, brain fog, waking throughout the night, exhaustion, depression, sadness, and feelings of loneliness.

Whenever a patient’s condition seems to be incredibly complicated, I remind myself to go back to the basics; back to my acronym. In this case, the patient’s breathing had not improved with my prescribed homework. (This can be due to the patient not believing there is value in it or, as previously mentioned, an inability to facilitate it completely themselves.) Breathing became the focus for the subsequent treatment.

Before I softened the neck, traps and lats with acupuncture, I used slow and gentle manual pressure and asked the patient to concentrate on their exhale. I did the same on the front, massaging from LV 14 through to GB 25 as the patient exhaled. Then I softened any tightness in the abdomen with needles.

Upon leaving, the patient exclaimed that they were feeling better already. I highly recommended continuing to breathe deeply. A couple of days later, the patient told me their physical and mental state had improved substantially, and that the dark cloud they had been battling was lifting.

References

1. Liu J, et al. Slow, deep breathing intervention improved symptoms and altered rectal sensitivity in patients with constipation-predominant irritable bowel syndrome. Front Neurosci, Nov. 4, 2022;16.
2. Busch V, et al. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing - an experimental study. Pain Med, 2012 Feb;13(2):215-28.