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Posted by on Jan 25, 2017

What does back pain have to do with breathing?

What does back pain have to do with breathing?

As a physical therapist, I’ve often associated low back pain with reduced exercise and possibly carrying a few extra pounds around on the abdomen. In fact, the standard care for low back pain (don’t stay in bed too long, start moving as soon as possible…) supports this association.

While I was attending a physical therapy course about women’s pelvic floor health, we spent a lot of time discussing the relationship between breathing and the pelvic floor. You may not know this but the “core” muscles are a lot more than the abdominal muscles. It’s now understood that the “core” comprises of the abdominal muscles (specifically the multifidus and transverse abdominis) but also the diaphragm, pelvic floor muscles, and even the glottis (which opens and closes the throat)! So, breathing and pelvic floor muscle function can show a lot more about your “core” function than your general fitness level and body mass index.

It’s now understood that the “core” comprises of the abdominal muscles (specifically the multifidus and transverse abdominis) but also the diaphragm, pelvic floor muscles, and even the glottis (which opens and closes the throat)! So, breathing and pelvic floor muscle function can show a lot more about your “core” function than your general fitness level and body mass index.

At this course, we reviewed an article supporting this notion. The title is “Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.” One of its authors is Paul Hodges, a very well-respected researcher who has been at the forefront of research about low back pain and “core” muscle function for years. This particular study is a longitudinal study, which means it studies a population over a long period of time, looking for correlation in symptoms to determine relationships. Three different age groups of women were studied, and incidence of low back pain and urinary incontinence, body mass index, physical activity level and history of asthma (or other breathing difficulties) were compared. What the researchers found was that body mass index and activity level was not associated with back pain across all age levels, although there was an association with older women. However, incontinence and poor breathing WAS associated across all age groups!

I’ve been paying a lot more attention to my client’s breathing after reading this article. Re-setting the breathing pattern may be a good way to help improve function of the entire lumbopelvic “core” muscle group. Here are a few things you can try:

Lay on your back with your legs propped up on a bolster. Place your hands, a sandbag, or a big book on your abdomen. Close your eyes or soften your gaze. Bring your awareness to the interface of your abdomen and your hands (sandbag or book). Without working too hard, bring your breath to this area with the inhale, softly let go on the exhale.

Move into child’s pose, but place a folded blanket under your belly so that your breath can’t move into your abdomen. This should feel tight and restrictive in the front. Come into child’s pose as far as you can with the blanket in place, and bring your awareness to the lower lumbar area. Your breath should follow your awareness.

Take a yoga strap, make it into a loop, and tighten it around your lower rib cage. In sitting or in child’s pose with your arms overhead, as you inhale bring pressure into the strap, widening the lower ribs. Release the effort on the exhale.

~Michelle Downing DPT, OCS, CFMT, RYT