Who wants to be normal anyway?!

Who wants to be normal anyway?!

I do when it comes to breathing. I want to be distinctively average. I don’t want any distinguishing breathing features, “that Kelly, she sighs and yawns so much! It’s distracting, is she bored?!”, “have you heard Steve breathing? It’s so LOUD!” Not for me thanks.

I want my breathing to be so quiet and calm that I don’t ever need to think about it. I don’t want my breathing to make me feel uncomfortable or give me horrible symptoms such as anxiety or palpitations (again).

What’s fascinating is that a dodgy breathing pattern will actually alter the way your body functions – biochemically, biomechanically and psychologically.

What do I mean by that??

Well, I’m going to keep this basic – nobody is here for a biology lesson – but it’s important to have a grasp of homeostasis within the human body, and how breathing directly affects this.

Homeostasis is the ability to maintain a relatively constant set of internal conditions which are optimal for the body to function. In other words, lots of processes that operate within a set of upper and lower limits to keep the body working well – creating a nice, safe, happy environment if you will.

Breathing plays a crucial role in maintaining pH (I can see you all grimacing at the thought of GCSE Chemistry – oh the horror!!). pH is a scale which determines how strongly an aqueous solution is acidic or basic/alkaline. The scale goes from 1 (strongly acid, e.g. stomach acid) to 14 (strongly alkaline, e.g. drain cleaner).

Your body likes its pH to be somewhere between 7.35 and 7.45 – pretty neutral. What’s breathing got to do with it? Well, carbon dioxide which is produced by our working cells is an acid. Meaning the amount of CO2 we have in our body will determine our pH.

Most people with dodgy breathing patterns breathe ‘too much’ (oversimplification please forgive me) – either too fast or deep or they sigh or yawn because they feel like they can’t get enough air in. However it happens, the person ends up breathing out more CO2 than they ideally should and in breathing pattern issues this tends to go on for a long period of time.

If you have less CO2 (acid) you become a bit more alkaline. To maintain the pH balance the body then gets rid of something alkaline (bicarbonate). This is how low CO2 affects lots of other processes, because the body’s attempts to get you back to normal pH result in actual changes – your blood vessels constrict (cold hands and feet anyone?), your tissues don’t get enough oxygen (Brain fog? Exhaustion?), you can’t mop up your acid due to loss of bicarbonate (struggling to exercise? Easily fatigued?) and it keeps that fight or flight response switched on (feeling on edge? Just can’t relax?).

Then there’s the changes to your musculoskeletal system. Particularly you shoulder and neck muscles being used for breathing when they shouldn’t. You can end up with pain whether it be in your jaw, neck, shoulders or even low back. Poor biomechanics, poor posture, poor breathing patterns. They all impact each other, and it becomes a vicious circle. The changes to your musculoskeletal system can be significant and that is one reason why physiotherapists treat breathing issues. We understand how your body should be working and we can fix it.

Finally, there are the changes to how you feel. These physical changes mean that it is common to also experience psychological symptoms – feelings of anxiety, worry, or just wanting to burst into tears at times. Teetering on the edge of control. And it’s not necessarily your mind that’s the problem, it’s your body in an unhappy state, which is caused by how you breathe. I’ve had so many people say to me “I’m not an anxious person, I have no idea what’s going on!”, and once we’ve completed their assessment they say “now it all starts to make sense!”.

That covers the basic of what happens when breathing goes wrong. So, what should it look like? What is normal? What is ideal?

I always throw in a disclaimer here – everyone is different and what’s perfect for one person may not be for another. BUT, these are what I consider to be the normal parameters or what I usually aim for when assessing someone’s breathing.

Let’s start real simple…….

Your nose. You should breathe in and out of your nose at rest. In fact, you should always breathe through your nose unless you’re doing some exercise at a reasonable intensity.

Your mouth is for eating and speaking. Not breathing. Your nose is magic. Use it. It heats, cleans and wets the air. Your lungs like it that way. Your nose also produces nitric oxide – a potent vasodilator and steriliser. It helps with your gas exchange. Very important!

Next…..

Ideally you should breathe anywhere from 6-8 to 12-14 breaths per minute – this is what we call respiratory rate. A count of 1 includes an in breath and an out breath. Count over the whole minute rather than doubling 30 seconds.

I get a bit nervous when I suggest rates in this context. Everyone is different but anything over 14 may need slowing down. If your rate is up near the 20’s it’s definitely too quick. If you have an underlying lung disease you may well need to breathe this quickly due to the illness, but it doesn’t necessarily mean there isn’t room for improvement!

I breathe at 8-10 breaths per minute through my nose at rest to give you an idea of how a young(ish!), healthy(ish!) person may breathe.

Ok, so you’ve mastered the rate you tell me. You’re at 10 breaths per minute. Perfect I say. But when I take a look you are breathing at 10 breaths per minute but you’re shifting so much air in each breath. Filling your lungs to near capacity. That’s not right. See more complicated than just resp rate.

Volume or size of each breath is important too. If each breath is too big you’re probably dumping out a lot of CO2. Back to the breathing too much thing.

A very ballpark figure is 500ml. A healthy sized adult shifts about 500ml per breath. This is wildly inaccurate for some people but it gives you an idea. Each breath you only need about a Coke size bottle of breath. Not that much!

Meaning at rest your breathing should be barely noticeable. Just a gentle rise and fall of your lower ribs and tummy.

And that leads us nicely to……

The diaphragm. That big dome shaped muscle that splits your chest from your abdomen is for breathing (and other things but this is not the time to delve into that). Your chest should be still. Your neck and shoulder muscles doing nothing.

Some people may notice that their tummy moves gently forwards, some people may get more of a lateral lower rib movement. And that’s ok. But you should be breathing low into your chest/tummy not into your upper chest.

My last must do’s are…….

Relaxed, rhythmical, and quiet. You should have no muscle tension. No shoulders up by your ears. No jaw clamped shut. No abdominals pulled in. You do not need to ‘brace your core’ or contract your abdominals to exhale – it’s passive.

Each breath cycle should look and feel the same. In and out like the tide. Think beach in Barbados. In and out. Even. Gentle. Your out breathe slightly longer than your in. There may even be a short pause after your exhalation. Perfect.

And I shouldn’t hear it. If I can hear your breathing it isn’t right. You may have a congested nose. Or you’re pulling in too much air and too quickly. You may be breathing through your mouth. Or throat clearing or sniffing or coughing. You may be sighing a lot or yawning. Or forcing your exhalation. If you are doing any of that it needs to be avoided. And you may need some guidance on how to do that.

And that’s it. Easy! I wonder how many of you reading this could improve your technique?!

What I would say is that the journey back to normal rarely involves just changing your breathing patterns – it’s understanding the root cause. Why have you deviated from normal? Is it years of stress? Postural maladaptation from desk work or pregnancy or an old seemingly unrelated injury? Is it being driven by an underlying medical cause? Or even medication? Have you been exercising and breathing in suboptimal positions? Is it how you speak? Or do you have a job where you use your voice all day? Phone addicts – are you breath holding? The list is diverse and almost endless!! Each part of the dysfunction must be managed for long-term results.

If your breathing isn’t normal it’s so important to be rehabilitated by someone who understands the complexity of the issues. It is affecting your whole body and you need to work with those who understand every area. Hopefully, this helps your understanding of how breathing ultimately affects everything, and how those symptoms or niggles that you have may well be due to how you breathe.

My advice is make sure you are as close to the ‘normal’ as you can be but if something isn’t right go seek some advice – it might just change your life!

Breathe well,

Kelly