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Okay, I couldn’t help myself. I love memes and this points out two issues:

  1. We don’t think about breathing!
  2. We do it wrong!

Let’s remember what we learned about our core from my previous post – it consists of the pelvic floor, deep abdominal muscles, spinal stabilizers and diaphragm.

With every breath, our pelvic floor and diaphragm are meant to work together, creating and regulating pressure.

It helps to think of our trunk as a pressure canister:

On an inhale, the diaphragm lowers, exerting pressure out into abdominal wall and down on the pelvic floor

On the exhale, the diaphragm rises as the abdominal wall moves in and the pelvic floor lifts.

When we exhale under normal conditions, this process happens without any effort or conscious attention.  But when demand for oxygen is high (exertion), a forceful exhale causes deeper abdominal contraction and pelvic floor contraction.


So how SHOULD we breathe?

Our body is designed to allow for deep, 360 degree breathing.  In other words, the ribs should expand and contract circumferentially and equally in all directions.  This allows for deep breath and full excursion of the diaphragm.

Watch yourself breathe in the the mirror.  What do you notice?  Is all the air going out through your belly?  Is your neck tense?  What about your shoulders…are they rising?  Do your ribs move out to the the side AND the back?  Or do your ribs not expand and contract at all?

Deep breathing while using the ribcage, abdomen and diaphragm activates our Vagus Nerve, helping us move into a calmer parasympathetic state (“rest and digest”).  We are better able to cope with stress, sleep better, have better bowel movements, feel less tension and have better sex.  Do you care enough about how you breathe now to read on???


What goes “wrong” in breathing? 

I often see a shallow or “paradoxical” breathing pattern, leading to emotional and physical repercussions. In a shallow breathing pattern, we use accessory muscles in our neck and chest that weren’t designed to direct our breathing.

These accessory muscles are meant for EMERGENCIES (“fight or flight”).  Shallow breathing places us in a sympathetic or “heightened” state, and our body feels anxious, ramped up and threatened.  How many times have we heard someone say, “just breathe” or “take a deep breath” when we were stressed or upset?  Now you know why!

Shallow breathing also increases our cortisol levels and does not allow us to fully rest, leading to more stress and tension.  Our bodies were never designed to use this breathing pattern for long periods of time.  Again, this pattern is designed for survival, not everyday life.  When you sustain this pattern, you end up with neck pain, headaches, jaw pain, numbness/tingling, and shoulder pain.


So What…?

Let’s take a quick look how this breathing pattern affects the pelvic floor and how it might lead to pain, weakness and leaking:

If we breathe in shallow pattern, our shoulders rise and we use the upper body to get air in; when the Diaphragm goes up on the inhale, then it HAS to come down on the exhale.

Remember: What goes up must come down!!

When we need to use a forced, strong exhale for exercise or when the demand is increased ( ie lifting, running, carrying your child) the diaphragm must be able to come up to allow for stability as the abdominal muscles contract and ribs rotate and lower.

As you see in the picture above, in the example on the left, the pressure is all going DOWN and OUT, creating excessive force on the pelvic floor and decreasing our core stability.  Over time, this pattern of loading and poor breathing leads to tightness/weakness in pelvic floor and then we begin to see symptoms like leaking, prolapse, hip pain, back pain , etc…


When does our breathing pattern tend to “break down”?

As I mentioned, anxiety and stress, the figurative “tiger in the room,” can lead us to adopt a chronic state of shallow breathing.  Working on mindfulness, meditation with movement, addressing stress and triggers, along with exercise and manual therapy to retrain the diaphragm, can all help restore the 360 degree pattern.

In regards to physical activity, we also see breathing break down when  demand is greater than our strength!

This includes any form of exercise we choose that goes beyond our ability to manage our pressure and maintain stress-free breathing – such as a long run when you begin to fatigue and lose form towards the end.  Other examples include:

  • Lifting your child overhead at the park because she just HAD to play on the monkey bars
  • Rearranging your living room furniture…by yourself
  • Going for that heavy lift or PR at the gym
  • Walking your dog, and they jerk the leash suddenly
  • Performing sit-ups and crunches where you experience bulging or doming in your belly


When breathing breaks down, it causes a cascade of effects throughout the entire body. 

I get asked all the time – so, what exercises can I do?

Here is my favorite, snarky response:

Can you do it?  Well, do you do it?  And do you do it well?

Can you lift and squat, carry and move while regulating pressure?  Do you notice your lower abs bulging or feel that you are bearing down on your pelvic floor?  Can you activate your glutes and not shove your hips forward in the socket?  Do you maintain good core pressure and keep your ribs over your pelvis?

Can you accurately answer these questions about yourself?  Probably not!

In order for me to answer those questions, I have to watch you move, observe your posture and breathing, and assess how you handle movement and load.

I teach my clients to learn to feel these things for themselves so they can become confident and understand when to push and when to slow down.  It is important to listen to your body and respect its limits.   We have to accept where we are now and not only focus on the our end-goals, but learn to appreciate the work and be grateful along the way.

Whether your goal is to play with your kids and work in the yard, get back to cross-fit, train for a half-marathon or just jog without knee pain, we all have the same foundations that must be established and built upon.   When we skip these steps, we become more susceptible to injury.

Here’s the good news – you are perfectly capable of doing any and all of the activities we just discussed, as long as your body has been trained and conditioned to handle them.  So if your body isn’t handling one of these activities well, the solution isn’t to stop doing that activity forever!  The solution is to improve your ability to perform and sustain those positions or activities by laying a good foundation, and breathing is usually a good place to start!