Better Breathing

lumbar spine neutral
We take around 23,000 breaths a day. We do it subconsciously, 24 hours a day, generally without thinking about it. But could you be breathing better? As a physiotherapist, I see lots of people with neck, shoulder and back pain. I would say the vast majority do not breathe well. They are 'upper chest' breathers. That is, when they breathe, they use their neck and shoulders muscles to assist their breathing. Others breathe through their nose rather than their mouth. Even the recent necessity to  wear a face-mask seems to  have added to peoples breathing issues. Our modern life stops us breathing well. If we are stressed (and given the current Covid-19 crisis many of us are) we often take small, quick breaths. Tight fitting clothes, ill-fitting bras, the desire to look thinner (and therefore suck your tummy in) all affect diaphragmatic breathing. Sitting for long periods at a desk, hunched over, makes it easier to use the neck and shoulders to breathe, but will add to neck pain when those muscles fatigue. If you can learn to "breathe into your diaphragm" (the large muscle between your chest and tummy) you can let the neck, shoulders and back muscles relax. You might also find you feel calmer because your parasympathetic nervous system is activated, setting up a 'rest and digest' response which opposes the 'flight or fight' response of the sympathetic nervous system. There is some evidence to show that slow, controlled diaphragmatic breathing can reduce the levels of cortisol (the stress hormone) in the saliva and affect the levels of another hormone, noradrenaline, in the brain.

Breath awareness

The first step to improving your breathing is to become aware of it. An easy method is in supine lying as shown in the following video.    

Set Up:

  • lying comfortably on your back, lumbar spine neutral, knees bent, feet hip width apart.
  • pillow at your head for comfort, as necessary.
  • place one hand, palm down, on the chest, over the sternum area and the other hand on your belly, over the navel. Upper arms should be relaxed on the floor.


  • breathe in and out several times.
  • observe what is happening under each hand.
  • ideally, the hand on the chest should stay quite still. The other hand over your tummy should rise and fall with your breathing.
  • if not, try to take your breathe down into the lower part of your ribcage. You are trying to feel your belly rise as you breath in and fall as you breathe out.


  • try to relax the neck and shoulders.
  • if you find the hand positions aggravate your neck and shoulders use a small weight on your belly. This will allow you to feel the belly rise and lower as you breathe with your arms relaxed by your sides.
  If you want to further improve your breathing once your awareness is better you could add in some timed breathing routines. There are many different techniques including butekyo and  pranayama but all methods seem to encourage a longer exhalation than inhalation with the use of counting. There are many apps available to lead you through guided breathing exercises. Or try this simple approach-
  • count to 4 as you breathe in through the nose, hold for the count of 2, then breathe out through the nose for the count of 6. Repeat for up to 3-5 minutes
  • If that is too hard, try counting  to 2 as you breathe in, hold for 1 count then breathe out through the nose over 4 breathes. Again you could repeat this timing for up to 3-5 minutes.
Remember, once you are aware of your breathing, you could practice diaphragmatic  breathing often through the day. If you are walking for example, you might breath in for 4 steps and then breathe out for 4 steps, through your nose. You could also practice your breathing as a way to settle your mind and body as you go to sleep. Ultimately breathing well can be done anywhere, at anytime, its effects are instantaneous and free.

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