How the Way You Breathe Can Affect Injury, Pain, Anxiety and Well-Being

Note: The following is based heavily off of my training from the Prague School of Rehabilitation and the Postural Restoration Institute. For more information, I recommend the DNS Level 1 course and the PRI Postural Respiration course.


People from all types of lifestyles and demographics can suffer from pain and injury. Whether they are physically active or sedentary, old or young, healthy or unfit, injury can plague anybody. Although most people who are experiencing chronic pain have many differences, the one thing that they all have in common is that they breathe. Unfortunately, most of them are likely breathing in a suboptimal manner, and this may be having an effect on their health and well-being.


During inhalation, the diaphragm is supposed to concentrically contract while the internal obliques and hamstrings isometrically contract to prevent rib external rotation. During exhalation, the rectus abdominus and transverse abdominus are supposed to concentrically contract in order to internally rotate the rib cage. This process creates a Zone of Apposition (ZOA) that allows proper core stability and joint arthrokinematics to occur.


Unfortunately, over the course of time, many people develop compensatory breathing patterns that deviate from the optimal model, and this can lead to a wide array of negative effects on joint function, pain, and overall well-being. In fact, one study found that subjects with poor breathing patterns scored significantly lower on a measure of movement quality called the Functional Movement Screen (1). Luckily, research shows that with a small amount of concentrated practice, breathing patterns can be retrained and optimal habits can be naturally adopted (2-11).



Back Pain

When breathing is dysfunctional, this can often lead individuals to become stuck in an “extended” posture. The anterior core will reduce activity and the lumbar erectors will become overactive to maintain lumbar extension. Over time, this can become a major contributor to low back pain.


According to research, dysfunctional breathing is extremely common in patients with low back pain (12-20). When patients work on improving their breathing, posture changes and the angles of the lumbar decrease (21). Over time, this can lead to a dramatic improvement in back pain symptoms (22).


Neck/Shoulder Pain

When the diaphragm is underactive, nearby muscles such as the pectorals, upper trapezius, and SCM can become overactive in an attempt to assist with inhalation. This can be a common cause of neck tension or shoulder dysfunction.


Not surprisingly, research has shown that dysfunctional breathing is extremely common in patients who suffer from neck or shoulder problems (23-26).


Some research has even found a connection between dysfunctional breathing and Temporomandibular Joint Dysfunction (TMJ) and other orofacial pains (27-28).


Hip Flexibility and Pelvic Floor Dysfunction

When poor diaphragmatic breathing causes patients to become stuck in an “extended” state, this increase in lumbar extension will lead to anterior pelvic tilt. When the pelvis is in an anteriorly tilted position, this minimizes space in the hip socket and can decrease hip range of motion (29).


One study found that subjects who practiced proper breathing mechanics experienced improvements in hip range of motion (28).  Another study found that manual techniques directed towards the diaphragm can lead to apparent improvements in hamstring flexibility (31).


When it comes to the hips, the pelvic floor is particularly affected by the function of the diaphragm. Much research has found a strong connection between dysfunctional breathing, incontinence, and various pelvic floor disorders (32-35).


Ankle Instability

For patients who are stuck in an “extended” posture, excessive flaring of the rib cage will lead to an anterior displacement of one’s center of gravity. As a result, this can cause a shift towards the forefoot and may cause alterations in the function of the ankle joint. Research has found that individuals with chronic ankle instability are more likely to exhibit dysfunctional breathing (36).



It is well known that anxiety and panic attack disorders are associated with altered breathing patterns (37-44). Slow diaphragmatic breathing promotes activation of the parasympathetic (“Rest and Digest”) branch of the nervous system. When patients have weak diaphragms and adopt altered breathing patterns, however, this can increase drive to the sympathetic (“Fight or Flight”) nervous system and increase the body’s sensitivity to stressful events. Interestingly, studies have found that people who suffer from asthma are twice as likely to suffer from anxiety or other mood disorders (45-46).


Luckily, much research has found that practicing proper breathing can lead to short-term and long-term changes in the body’s susceptibility to stress, anxiety, and depression (47-54). Breathing practice has even been shown to reduce feelings of pain (55). Some experts have successfully utilized breathing training as a treatment for PTSD and panic disorders (56-57).


Interestingly, dysfunctional breathing has been associated with reduced ability to focus and perform during cognitive tasks (58). Studies have found that working on proper breathing can decrease test anxiety in students and improve overall ability to concentrate (59-61).

Cardiovascular Health

There appears to be a very strong prevalence of breathing dysfunction among heart attack patients (62-63). Luckily, breathing programs can be utilized to improve the health of the cardiovascular system. Research has shown that practicing proper breathing can lead to dramatic reductions in blood pressure (64-65). Other research conducted on subjects who had already suffered from one heart attack found that when subjects underwent a breathing program, they were less likely to suffer from future complications (66-67).


Proper breathing is extremely important for digestion to optimally occur. Dysfunctional breathing is a major factor in GERD and other digestive related impairments (68-71).


Amazingly, research has found that diabetecs who practiced diaphragmatic breathing experienced decrease oxidative stress and improved blood sugar levels after eating (72-73).



During long-duration physical activities, oxygen is extremely important in order to sustain stamina levels.  By strengthening the diaphragm, more oxygen can be inhaled during each breath. Consequently, it is not surprising that athletes who strengthen their inspiratory muscles experience significant improvements in cardiorespiratory endurance (74-80).



Overall, the benefits of training proper breathing patterns are extensive. Whether the goal is to improve movement quality, decrease anxiety, improve digestive and cardiovascular health, or enhance endurance, there is a good chance that practicing proper breathing patterns can offer value.



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