Back Pain and Breathing Patterns

Altered Breathing Patterns in Chronic Low Back Pain Patients

A very interesting paper was published in European Spine Journal this month entitled Altered Breathing Patterns in Chronic Low Back Pain Patients. Rousell and his colleague’s research proved that patients with chronic low back pain often experience altered breathing patterns while performing movements involving the core muscles. This is relevant for anyone who moves and has low back pain! Let’s define each of the patterns that were considered impaired:

Breath holding

Pretty self explanatory.

Paradoxical breathing

Chest wall moves in on inspiration and out on expiration (reverse of the normal movements).

Upper costal breathing

Upper chest moves with inspiration and expiration while the diaphragm is not properly engaged.

Mixed pattern breathing

Any of the above patterns mixed together.

Keep breathing

Dr. Stuart McGill from the University of Waterloo has proven through his research that increased intra-abdominal pressure (which occurs with breath holding) can help to stabilize the lumbar spine. However, he has also proven that it increases intradiscal pressure or the pressure that exists within our intervertebral discs, thereby making disc herniations more likely. Therefore, to remain safe while practicing yoga, be sure to KEEP BREATHING, especially during forward folds and abdominal strengthening poses.

Paradoxical breathing exists in people with chronic respiratory conditions or during respiratory distress.

Upper Costal breathing

Upper costal breathing involves utilizing the accessory breathing muscles to inhale and exhale instead of the diaphragm. This is most easily noticed if you see someone’s shoulders move up and down during breathing. This can be caused by a number of reasons and can be corrected by learning how to engage the diaphragm and intercostal muscles to achieve healthy inspiration and expiration. People who upper chest breathe often have tight scalene muscles as they are key accessory breathing muscles.

Ideal Breathing Pattern

The ideal breathing pattern was deemed to be costodiaphragmatic breathing. This pattern is defined by the ribcage displacing upwards, outwards and forward with outward abdominal movement (which is reversed on expiration). This means more than just breathing via the diaphragm; your stomach shouldn’t be the only area moving during breathing, your rib cage should move too.

Remember, as the air fills your lungs, the ribcage opens to accommodate for more air: ribcages are supposed to move, not just stomachs.

The core muscles that surround our lumbar (low) spine take on the shape of a cylinder with the diaphragm at the top, the pelvic floor at the bottom, the abdominals at the front and the back muscles bringing up the rear. If there is a sense of instability in the low back, it is thought that individuals alter their breathing patterns, using their diaphragm to aid in stabilization.

Therefore if you have chronic low back pain, you may be utilizing one of these abnormal breathing patterns to help stabilize your low back. Learning how to co-contract your lumbar spine flexors and extensors has been a proven technique to effectively stabilize the lumbar spine. Intra-abdominal pressure does stabilize the lumbar spine, but if this occurs unconsciously due to abnormal muscle patterns created by pain, it is not a healthy method of stabilization.

Working with a sports focused health care professional can help you learn the best method of lumbar spine stabilization for you.

Much research is still needed on this topic, but breathing patterns should be assessed in chronic low back pain patients as they could be perpetuating the problem.

Rousell et al., Altered Breathing Patterns in Chronic Low Back Pain Patients. European Spine Journal. Volume 16, Pages 1066-1020.

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