Breathing Exercises and Back Pain

A recent article in Spine looked at the effectiveness of yoga therapy on chronic low back pain.  The study reported dramatic improvement in terms of pain, depression and decreased medication use (Spine (Phila Pa 1976). 2009 Sep 1;34(19):2066-76.)

One specific component of yoga therapies (and also related disciplines like Tai Chi and others) is breath therapy. 

A study from 2005 by Mehling et al. highlights the potential for breathing exercises to be helpful with back pain. (Altern Ther Health Med. 2005 Jul-Aug;11(4):44-52.)  This study looked at a group of patients with chronic low back pain.  The study participants received either traditional PT or breath therapy exercises taught over the course of about 6-8 weeks.

The authors of this study found that both groups improved in terms of reported pain.  Data “suggested improved coping skills and new insight into the effect of stress on the body as a result of breath therapy.” (Altern Ther Health Med. 2005 Jul-Aug;11(4):44-52.)  

My question as I read studies like this is why is this an either or situation?  I have a PT referral form that has a check box for breathing exercises.  I often check this box when I send folks out for therapy.  However, rarely if ever do patients ever come back and report working on breathing exercises. 

Dr. Andrew Weil is an expert in the area of integrative medicine and has a lot to say about the positive effects of breathing exercises on back pain.  He is quoted as saying:

 “I recommend breathwork to almost all patients that I see. There is really nothing that is out of range of this technique. I’m impressed by the power of breath and its ability to correct specific health problems and promote our general wellness. Proper breathing is a master key to good health.”

In other contexts Dr. Weil has written:

In Buddhist and yogic traditions, people claim to have reached an enlightened state by doing nothing more than paying attention to the rising and falling of their breath. What easier way could there be to reach such a state? Especially since breathing - following the ebb and flow of your breath - is an intrinsic part of meditation. By paying attention to your breath, you will rapidly change your state of consciousness, begin to relax, and slowly detach from ordinary awareness. Try to focus on the point between your in-breath and out-breath that is dimensionless, and glimpse the elements of enlightenment in that space.

Following is a description of some basic breathing exercises (as illustrated on the website http://www.amsa.org/healingthehealer/breathing.cfm ). 

ABDOMINAL BREATHING TECHNIQUE:

Breathing exercises such as this one should be done twice a day or whenever you find your mind dwelling on upsetting thoughts or when you are experiencing pain.

• Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This helps to reinforce that goal of having the diaphragm is pulling air into the bases of the lungs.
• After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7)
• Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs.  It is important to remember that we deepen respirations not by inhaling more air but through completely exhaling it.
• Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). At this rate our heart rate variability increases which has a positive effect on cardiac health.

In general, exhalation should be twice as long as inhalation. The use of the hands on the chest and abdomen are only needed to help you train your breathing. Once you feel comfortable with your ability to breathe into the abdomen, they are no longer needed.

USING BREATHING EXERCISES TO INCREASE ENERGY:

If practiced over time, the abdominal breathing exercise can result in improved energy throughout the day, but sometimes we are in need of a quick "pick-up." The Bellows breathing exercise (also called, the stimulating breath) can be used during times of fatigue that may result from driving over distances or when you need to be revitalized at work. It should not be used in place of abdominal breathing but in addition as a tool to increase energy when needed.

This breathing exercise is opposite that of abdominal breathing. Short, fast rhythmic breaths are used to increase energy, which are similar to the "chest" breathing we do when under stress. The bellows breath recreates the adrenal stimulation that occurs with stress and results in the release of energizing chemicals such as epinephrine. Like most bodily functions this serves an active purpose, but overuse results in adverse effects as discussed above.

THE STIMULATING BREATH:

This yogic technique can be used to help stimulate energy when needed.

• Sit in a comfortable up-right position with your spine straight.
• With your mouth gently closed, breathe in and out of your nose as fast as possible. To give an idea of how this is done, think of someone using a bicycle pump (a bellows) to quickly pump up a tire. The upstroke is inspiration and the downstroke is exhalation and both are equal in length.
• The rate of breathing is rapid with as many as 2-3 cycles of inspiration/expiration per second.
• While doing the exercise, you should feel effort at the base of the neck, chest and abdomen. The muscles in these areas will increase in strength the more this technique is practiced. This is truly an exercise.
• Do this for no longer than 15 seconds when first starting. With practice, slowly increase the length of the exercise by 5 seconds each time. Do it as long as you are comfortably able, not exceeding one full minute.
• There is a risk for hyperventilation that can result in loss of consciousness if this exercise is done too much in the beginning. For this reason, it should be practiced in a safe place such as a bed or chair.

This exercise can be used each morning upon awakening or when needed for an energy boost.

I anticipate having some video in the relative near future to better illustrate the technique for some of these and other breathing exercises.  As with all things, any new exercise should be undertaken under the guidance of a physician.

Comments

[Eric Jackson]

Dr. Mangrum,

Thank you for all your articles, this one in particular. As a wellness professional I have followed Dr. Andrew Weil's advise for years personally, and recommend his health related advise others as well. It's nice to see that you are open to the practical application of something as simple as breathing exercise for back pain.

Sincerely,

Eric Jackson, Exercise Physiologist, EIRMC

[Catherine Chu]

I really enjoy all of your articles. As a chiropractor I have recommneded breathing exercises to patients in the past, but I haven't done so in a while. Your article reminded me and the science proves that simple exercises such as breathing can have a positive effect.

Thank you for educating patients as well as practionners.

Catherine Chu, BSc, DC