5 Ways Breathing Influences Low Back Pain

Breathing seems like such a simple thing, and it is in a sense. However, when you think about how many breaths we take a day, altering your breathing can have a huge impact. When I have a patient with low back pain, I’ll always look at their breathing pattern. 9 times out of 10, I find that they are chest breathing. This is not necessarily a ‘wrong pattern’, but it gives me some insight into how their full system is operating. To explore this, I’ll explain 5 ways breathing can have a role in reducing low back pain. 

The first way it can help is through movement. When someone is in pain, it’s almost instinctual to stop moving. The nervous system goes into a sort of panic mode and movement becomes sensitized. When you are laying on your back and just breathing, you are getting a gentle flexion and extension with each breath you take. Taking some time to do some intentional breathing will help the nervous system calm down as the spine is moving in a non-threatening way. 

Secondly, there is usually swelling associated with low back pain. Generally it is in the joint spaces between the vertebrae. Being still allows it to fester. The lymphatic system is responsible for mitigating swelling. It just so happens that there is a major collection tubule of the lymphatic system, called the cisterna chyli, that sits right under your diaphragm. So belly breathing (diaphragmatic breathing) works like a pump, every breath squeezes that tubule and moves swelling out of the system. 

I mentioned belly breathing. That is usually what I’ll recommend. That doesn’t mean the chest does move, it just means that the breath is initiated by the diaphragm rather than the chest. This has an effect on the nervous system. Chest first breathing is associated with the sympathetic system, whereas belly first breathing is associated with the parasympathetic system. When we are in a sympathetic state, muscle tone increases in preparation for a fight or flight response. Conversely, when we are in a parasympathetic state, the muscles are able to relax. Yet another win for breathing and low back pain. 

Speaking of muscles, there is a muscle that almost always gets irritated in low back pain; the QL (Quadratus Lumborum). This is a muscle that aligns the sides of your lumbar spine, and attaches to the pelvis, and the 12th rib. Because of this attachment to the rib, it has a role in creating a stable support for the diaphragm to move. If the diaphragm is not moving because of chest first breathing, the QL can stiffen and get irritated. 

One final way that breathing can help is through tissue pH. It’s been known for a while that tissue acidosis, (low pH) can cause trigger points and deep muscle pain. You can quickly alter your blood pH through breathing. As 02 rises you become more alkaline, as CO2 rises, you become more acidic. To leverage this, all you have to do is exhale longer than you inhale. I recommend aiming for 6 breaths per minute so each cycle is 10 seconds. So if you inhale for 4 and exhale for 6, you’re covered. In just a few minutes, you become slightly more alkalinic. You may get lightheaded, that’s from being in a mild phase of respiratory alkalosis. 

Breathing and Stress

Breathing and Stress

Breathwork has been a popular topic lately, and for good reason. It has a big return on investment. There are surprisingly many ways to breathe, and for something we do so often, a subtle change can have a huge impact. This article will focus solely on how breathing and stress are related. 

This really boils down to the autonomic nervous system. We have two divisions, sympathetic (fight or flight) and parasympathetic (relax and digest). Our nervous system can go back and forth between these systems and it’s not like a switch, but rather a spectrum. In other words, reading an email from your boss may be mildly sympathetic while getting into a bar fight is highly sympathetic. 

When in a fight, or running from a bear, you need energy, and quickly. Our bodies can burn fats or carbs (glucose) for fuel. Carbs are more readily available so the body would rather use carbs in an emergency situation. Cortisol is the hormone involved in the stress response. Its job is to liberate glucose from the muscles and liver into the bloodstream. This is a good thing for an emergency, however long term chronic secretion can lead to issues. For example, if you are chronically stressed, you will have high levels of glucose in the blood which can lead to diabetes. This is the link between stress and weight gain. 

Our body is always trying to maintain homeostasis, or balance. For example, breathing through the right nostril is tied to the sympathetic nervous system, whereas breathing through the left nostril is parasympathetic. Breathing through both maintains balance. 

A similar thing happens with breathing. We can breathe diaphragmatically (belly breathing) or with our chest. Chest breathing is more associated with sympathetic activity, whereas belly breathing is more parasympathetic. Just picture someone in a fight, their chest is usually heaving unless they are acclimated to fighting like an MMA fighter, and are relaxed. 

It is quite common to develop a chest dominant breathing pattern. This is likely a product of our environment. The constant hustle and bustle, financial stress, relationship stress, watching the news, can all trigger the sympathetic nervous system. This is a trainwreck for long term health. Chronically elevated blood sugar and high blood pressure. Not good.

You can easily test this on yourself. Lay on your back and breathe. What rises first? Chest or belly? If it’s your chest, you can be sure that you are in a more sympathetic state. You can use this as an exercise; focus on belly rising first. This is a great way to wind down the day, especially if you have difficulty falling asleep. This will quickly put you into a parasympathetic state. 

Additionally, the sympathetic state increases muscle tone which makes sense if you are about to get into a fight. However, if you are dealing with muscle pain, it could be from increased muscle tone. So if you are trying to reduce pain, seeking the parasympathetic state will help the muscles relax. This, in part, is why massage can help. It engages the parasympathetic nervous system. 

In our current climate, I think that most people should seek parasympathetic activities. Reading a book, going for a walk in nature, massage, yoga, etc. are all parasympathetic. Breathing has a rapid effect on the nervous system, and it’s free and readily available to you.

I should also mention that nasal breathing stimulates nitric oxide production. Nitric oxide is a strong vasodilator and can additionally enhance relaxation. 

Neck Pain? Check Your Breathing

Breathing may seem simple, but you’d be surprised at how many ways we can breathe. The human body has many redundancies, and that’s a good thing for survival. This is why we have two holes in our face; our mouth and our nose. That’s two ways to exchange O2 and CO2. We have a ‘backup system’ in case one isn’t working well. 

Before you read much further, do a quick self assessment. Lay down and put one hand on your chest, and one on your stomach. Breathe normally and just get a feel for which rises first, the hand on your chest or stomach. 

This is a quick test I do with a lot of my patients, and I find that the majority of people initiate an inhale with their chest. 

Breathing happens through negative pressure, air gets pulled in just like a fireplace bellows. We have two ways to do that. The diaphragm descends down as we inhale, which is belly breathing. Or, we can lift our chest up to pull air in, which is chest breathing. Ideally, the belly rises first, then the chest. 

Chest breathing is like a back up system. When we are exercising and need more oxygen, the chest will become more active to assist in getting more air. In that way, chest breathing is associated with the sympathetic nervous system. When you are really working hard and you stop to catch your breath, perhaps you put your hands on your knees. What you are doing is creating a stable base for muscles like the pecs and lats so that you can pull your chest easier. 

The main muscle of inspiration when breathing more with the belly is the diaphragm. If we bias chest breathing, we then use all the muscle that attach to the ribs to breathe with our chest. Herein lies the problem. When we only breathe with our chest, which is extremely common, the muscles that attach to the ribs can get overworked pretty easily. I find that the muscles of the neck, particularly the scalenes (on the side of the neck) end up getting stiff. 

Additionally, the tone of the muscles are controlled by the nervous system. When you are chest breathing, chances are the sympathetic nervous system is more active which increases muscle tone. 

So if you are feeling stiff in the neck, assess your breathing. If you notice you tend to lead with your chest, try focusing on some belly breathing. While you're at it, make sure to inhale through your nose and exhale a bit longer than you inhale, that activates the parasympathetic nervous system. Give it a few minutes and see how your neck feels afterwards. 

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