Sandals - What You Need To Know

Anyone that has been through a PRI program knows that shoes are extremely important to the success of said program. The Hruska Clinic (the clinic that the creator of the Postural Restoration Institute, Ron Hruska, owns and works out of) puts out a biannual shoe list where they look at hundreds of different tennis shoes, breaks them into categories to help clinicians narrow down the options for our patients, then lists a few shoes in each category (see current shoe list HERE). Having proper footwear can make or break a program. For our patients who present in a pattern (or are not in neutral in one or multiple areas of their body), these shoes can kick start their program instantly getting them in to neutral and saving weeks of work! However, once our patients lift scores get to a 3 out of five or higher, they have some options in terms of footwear. Since spring has sprung and we know that our patients will be wearing sandals at some point regardless of lift score, we wanted to you know what to look for in a good sandal.

1) Avoid a heel. Having any height in your heel will push the weight of your body onto the ball of your foot. We are designed to bear our weight through our heels. When we are forced into an unnatural ankle and foot position, we must counterbalance our weight up the chain so that we do not fall forward. The most typical compensation for this is to lean back in the shoulders accentuating the curve in the lower back and possibly pushing the head forward. This can quickly cause lower back, shoulder, and neck pain. 

2) Choose a shoe that is attached to your foot. When we wear a shoe that hangs on our foot like a flip flip or a mule, we have to work harder to keep that shoe on our foot while we walk. This may include gripping the shoe with our toes, lifting our toes up excessively, or even rotating our hips so that our toes point slightly outward. All of these compensation patterns cause excessive and abnormal muscle use which can irritate many areas including our foot, ankle, knees, hips, and lower backs. Choosing a shoe that straps at or around the ankle will ensure that the shoe stays on your foot while walking and you don’t have to work as hard!

3) Try to find a shoe with heel support. Although this is quite a challenge, it can be done. Many people realize the importance of having good arch support in a shoe for good foot and ankle alignment. However, many do not realize that what really determines the arch’s position is the heel bone or calcaneus. If you are able to find a sandal that encompasses the heel and gives it some support via a more rigid material, your arch will be much more stable. 

4) Feel your arches. As mentioned above, managing your heel position is very important, but it’s still essential to have support under your arches. Try to find a pair of sandals that has enough arch support built into it that when you stand and walk you can feel the material of the shoe supporting your arch. There should not be a gap between your arch and the shoe. Additionally, there should there never be so much build up that it’s painful or you feel as though it’s pushing your weight to the outside of your foot. The ability to sense and feel your arches helps your body to utilize your glut max muscle. This helps to keep your lower back from overworking and can help to strengthen those very important gluts!

5) Go for comfort. Whatever sandal you chose needs to be comfortable. Think about the last time you wore a pair of shoes that gave you a blister. First of all, remember how much that hurt. Second, remember how strangely you walked to avoid rubbing the blister even more? It’s obvious that when you walk oddly to avoid pain, you’re not walking in a biomechanically correct way which can lead to form breakdown and pain.

6) Limit your use. No matter how many of the above boxes your selected sandals check, we all have a limit to what our bodies can handle with less than desirable shoes (aka not tennis shoes). Listen to your body when you wear your sandals. You’ll soon begin to notice how much time or activity you can tolerate in those shoes before your body starts to break down. Have a your tennis shoes at the ready for when you drive home after that wedding or only wear them when you’re going to a nice dinner and won’t be on your feet much. 

Written by Lesley Callaham, MPT, PRC      April 2, 2019

How To Stay Fit During The Winter... For Free!

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It can be so hard to keep up a fitness routine, especially in the winter! Cold temperatures, inclement weather, bulky clothing and rich foods which decrease our motivation - there are so many reasons why we typically slack on our fitness routine during the winter. Buzzfeed has put together a great list of free, YouTube work out channels that you can use as needed when your time is limited, it’s too cold outside, or the streets are bad (READ IT HERE). Feel free to use these are your primary fitness activities during the winter months or only when needed. I especially like that the list they compiled gives a lot of different options of types of activities as well as options for current fitness levels. 

Some things to keep in mind while you use these videos: 

1) Be careful with yoga. Yoga’s focus on mindfulness, mind-body connection, and breathing is something we love about this school of fitness. However, a lot of our patients are either already overstretched in certain muscles of their bodies, or their musculoskeletal systems are not in the right position to stretch a muscle without risk of injury. If you know you are hypermobile or really flexible, it’s probably a safe bet to NOT use yoga as your go-to fitness routine. Even if you feel like you’re very tight (especially in hip flexors or hamstrings), it’s not always appropriate to stretch these muscles. Sometimes you simply need to reposition areas of the body to allow these muscles to be restored to their normal length-tension ratio in order to assess what its true length is. See either Nancy or Lesley and we can answer this for you!

2) Always wear tennis shoes! Regardless of what the instructors say, most of us do not have perfect feet. Most of us have arches that are too low, some have arches that are too high, some have ankle instability from numerous injuries. Whatever the reason, our feet and ankles are not able to support our foundation and legs appropriately without support. This leads to poor posture above the line and can cause our workouts to be insufficient or possibly lead to injury. Always wear your PRI approved shoes with your orthotics if you have them. 

3) Breathe. When doing difficult activities, it is a normal compensation pattern to hold our breath (also known as a Val Salva Maneuver) to try to stabilize our core. This can not only lead to injury, but will definitely lead to poor form. Always breathe out through your mouth when performing the difficult part of the activity. Some people like to sigh out, count, or say a word to be sure that they are breathing. If you can hear yourself, you are breathing. Be sure to breathe in through your nose to avoid panting and overuse of your neck muscles. 

4) Stay grounded. Since we cannot fly, there is always a part of our bodies touching the ground - our feet, hands, lower back and hips, etc. Be sure to appreciate where the weight is through you body. For the most part, your weight should be through you midfoot and heel, your lower back should be flat on the ground and NOT arch up when doing abdominal work, the weight in your hand should not waiver during your plank. 

If you have any concerns before starting any of these activities or would like some guidance as you progress through them, just ask Lesley and Nancy. That’s what we’re here for!

Written by Lesley Callaham, MPT, PRC on March 5, 2019

Why Do Stairs and Squats Hurt My Knees?

Squatting and going up and down stairs are some of the most common irritants of knee pain. Have you ever wondered why? Is there anything you can do to ease the pain? To really understand this, we must first understand some anatomy and biomechanics. 

First, the anatomy: The knee cap is a bone called the patella. It is embedded within the quadriceps tendon. The quadriceps attach to the front of your pelvis and upper femur (thigh bone). It then runs down the femur, over the front of the knee joint (where the patella is located), and finally attaches to the front part of the upper tibia (shin bone). The patella is located where it is in order to protect the quad tendon from damage or tearing as it is compressed into the knee joint when the quad is stretched and knee is flexed/bent. The patella sits in a groove between the medial and lateral condyles of the lower femur to help stabilize it. 

Next, the biomechanics: Muscles connect two bones and move them. During a concentric contraction, the muscle shortens and the two bone move closer together. An eccentric contraction allows the muscle to lengthen slowly and allow the bones to move father apart with control. An example of these two contractions is a basic bicep curl. During the concentric contraction, your bicep pulls your lower arm and hand closer to your shoulder. The eccentric contraction is essential to slowly lower your hand back toward the floor. If we weren’t able to eccentrically contract our muscle, our hand would simply fall to the floor and we would develop an injury as a result. 

Squatting requires the quadriceps muscle to eccentrically contract as we lower ourselves to the floor (knees are bending) and concentrically contract to lift ourselves back up (knees are straightening). As we climb stairs, we use our quads concentrically to push ourselves up the stairs. Descending the stairs requires eccentric quad control to slowly allow our knees to bend with control and bring us down to the stair below us. Both of these activities are particularly challenging due to the amount of weight we are moving with each motion. 

In order for these motions to happen correctly, it is essential to have our weight in the correct place on our feet with these activities. 

When it comes to stairs, we typically have the weight mostly on the balls of our feet. This can be due to wearing heels, short stairs versus a long foot, needing to hurry up/down the stairs, etc. In order to go up the steps correctly and avoid knee pain, we need to place as much of our foot on the step as possible to allow our heels to get on the step or as close to it as possible. Then we need to push up the stair by pressing through the middle and back of our foot. If we push up through the ball of our foot, the quad has more load on it during the activity and presses the knee cap into our knee joint very hard. Going up the steps pushing through our heels also helps us use our gluts to push us up the step and not our lower backs!

To go down the stairs, we need to keep our weight on our heels as long as possible. For instance, if you are using your right leg to support you while your left leg is lowered down to the step below, you need to keep your weight on your right heel as long as possible. The second our weight transitions forward onto the ball of our foot, our quad turns on. If our quad is on, it cannot eccentrically lengthen and allow us to descend in a biomechanically correct way. If this is the case, you will simply press your kneecap into your knee joint as you essentially fall to the stair below you. If you start with irritated knees, it won’t take many steps for this to become really painful. 

We encounter essentially the same problem with squats, but luckily it is much easier to correct! Typically people will transition onto the balls of their feet when beginning to stand up straight. Keep your weight through your heels for the duration of the exercise and you should notice a dramatic improvement in your tolerance!

Written by Lesley Callaham, MPT, PRC on February 20, 2019

How To Breathe When Working Out And Running! Via

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There’s a great article on entitled How To Breathe When Working Out And Running! I wanted to share it with you all it gives some great, concise information. I love how to emphasize the importance of breathing during every type of exercise. However, I wanted to give a little more information or my thoughts on some of the topics in the article.

First, most of our patients are not performing dead lifts, therefore, I DO NOT RECOMMEND using the valsalva maneuver at all. This is a tool that can be helpful as they described, but only during certain activities and only with proper training. I want to be sure that anyone who reads the article does not think it’s appropriate to performing the maneuver when lifting lighter loads like an overhead press, leg press, or something similar. As the author writes in the article, it is appropriate to exhale slowly through pursed lips during the lifting portion of those activities. 

Breathing out through pursed lips is a great technique as it creates more resistance to an exhale and effectively makes you work harder to breathe out. This sets you up to more effectively use your abs (specifically your internal obliques and transverse abdominis) when exhaling. When we exhale with these muscles, our diaphragm is in prime position to be utilized during the next inhalation. This leads to more effective inhalation, better oxygenation, and less overflow into our lower back and/or neck muscles to help us get air in quickly. 

Second, the author describes that as we exhale our ribcages shrink. This should be, but isn’t always, the case. Depending on what exercise we are doing and what position we are in, we may not allow our lower ribs in the front to fully collapse or drop down during an inhalation. When this is the case, our diaphragm is not in a good position for our next inhale and we will compensate to get air in. This can lead to shortness of breath, poor endurance, fatigue/pain at the neck or lower back, and other problems. 

When you position yourself in a supine position (lying on your back), try to keep your lower back as close to the floor as you can get it. Use your abs to pull your lower ribs toward the floor and flatten your back. Try to keep your lower back as close to the floor as possible during your activities WHILE BREATHING. If you are on a bench doing chest work, you may need to keep your feet up on the bench with you. If you need or choose to put them on the floor, be aware that it will be much more challenging to keep your abs engaged and your lower back in a safe position during your activity. Be sure to exhale through pursed lips and drop those ribs toward the floor/bench as you lift. 

Lastly, I love the idea of paced breathing with cardiovascular work. I simply want to mention that just because the author suggested breathing in for 3-4 stairs as well as out for 3-4 stairs does not mean that it is a good pace for your individual body. Because you are doing cardiovascular work, expect to be slightly short of breath during that activity, but please alter your pace if it feels like you are starved for air or that you’re panting. Also, recognize that your pace will change from day to day. If you go into your work out feeling well energized and motivated, you may notice that you are able to ascend/descend 4-5 stairs during a breath without much effort. However, you may feel sluggish at your next work out and notice that you are starving for air at 5 stairs. No problem! Slightly increase your pace of breathing so that you are comfortable again. Listen to your body and react accordingly. 

Just be sure that, no matter what you’re doing with only a few exceptions, never stop breathing and breathe at a rate that feels comfortable to you!

Written by Lesley Callaham, MPT, PRC on January 22, 2019

How to Shovel (Through a PRI Lens)

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The snow is here! And there may be more snow on the way so it’s important to know how to shovel your drive and walkways without causing excessive pain or injure yourself. 

1) Wear good shoes - You’re about to lift a lot of weight so having appropriate footwear is important. A good foundation for your foot allows for proper weight bearing through your legs and overall alignment of your body. If you feel comfortable and the snow is not too thick, just wear your tennis shoes.  If the snow is deeper, wear snow boots with good, supportive or any custom orthotics you may wear. 

2) Choose a good shovel - We all know that tools can make or break a job so choose a shovel that won’t break your back! We like ergonomic designs where the handle is slightly bent so that the shovel blade is lower to the ground. This is useful so you don’t have to bend over so far to get your blade to the ground. It also makes scooping the blade under the snow easier.

3) Squat - Once your blade is under that snow, you’re going to have to lift it. Be sure to squat down BEFORE lifting the snow. Place one foot slightly ahead of the other and press through your heels, as if you’re pushing the ground away from you, while you straighten your knees and stand up. It’s similar to pushing the footboard away from you on a leg press machine. You may be able to rest your forearms on your thighs to help lift the heavy snow off the ground. 

4) Use your abs - Now that you have all that weight lifted you’re going to have to move it off to the side. Do this by using your abs! Their job is to tuck your ribs, round your back, and twist your body. As this post is through a PRI lens, we want you to use your left abs a lot more than your right. In order to do this, you’ll need to have your left foot ahead of your right with your left hand farther down the shaft of the shovel (closer to the blade). As you get ready to through your snow to the side, be sure that your left shoulder stays lower than your right (trunk slightly bent to the left) and sense and feel your left abs rotate your trunk to the left so that your breast bone ends up facing toward the left. Your abs should be the primary force rotating your trunk, not your arms! It’s important to switch your lead arm/leg while shoveling to avoid fatigue and overuse injury, but as mentioned before, shovel with your left arm and left foot forward most often. 

5) Pace yourself - shoveling is much more taxing to our musculoskeletal and cardiovascular systems than we like to admit. Realize it’s ok to take period breaks to avoid fatigue and give your system a rest!

6) Have realistic expectations - Lifting large amounts of weights for a long time is not something most people do on a regular basis. Be aware that you will feel muscular soreness after doing this. This is normal. Even soreness in muscles that PRI likes to inhibit (lower back muscles, pecs, biceps, etc.) will be sore and that is ok. Shoveling is not a specific, rehabilitative activity; It’s an activity that uses many, many muscles in the body in order to complete a difficult physical task. It’s even acceptable if the pain for which you are receiving treatment gets aggravated. We would like to keep that as minimal as possible using the above tips, but if your body cannot tolerating driving a car, making it through a work day, folding laundry, etc. without feeling pain, it is to be expected that shoveling will exacerbate it to some extent. 

7) DO YOUR EXERCISES! - Be sure to do at least one of your exercises immediately before and immediately after shoveling. The idea is that we want to begin this physically demanding activity with our bodies in the best possible position. It’s likely that we will lose our good position or begin using compensatory muscle groups as we fatigue with shoveling so ending with an exercise (or more) will help put our body back in the correct position and quiet down our overused muscles so avoid excessive pain. 

Written by Lesley Callaham, MPT, PRC January 15, 2019

How to Avoid Pain While Using Tech Devices

New Years is approaching and the time to make resolutions is looming. Integrate 360 PT recommends limiting screen time and/or maximizing proper positioning when using your devices!

Screen time is simply unavoidable these days, but the amount of time we are spending on our devices is causing a lot of physical pain. Here are some tips to let you stay functional with your tech while minimizing physical impact.

1) Start with a good foundation. It is easiest to use devices for any length of time while sitting. Be sure that you are sitting on a firm, but comfortable surface with your knees at hip height or slightly higher. Place your feet firmly on the floor or on a footrest if needed (for vertically challenged people like me!). Feel your sit bones on the seat and let your lower back round onto the backrest behind you. This positioning will make sure your pelvis is in a good, neutral position (ie not tipped forward or backward) and will let your spine build up from there and be in a good position as well. 

2) Put the screen in front of your eyes. If you’re working on a computer, make the top edge of the screen level with your eyes. This is also true if you’re using a large screened device like a tablet. If you’re using a smaller screened item like a phone place the center of your screen in front of your eyes. This helps you to keep your head upright and balanced over your thorax and avoid the forward head posture than can stir up neck, jaw, and shoulder pain as well as headaches.

3) Support your arms. Since you cannot hold that gadget in front of your eyes with just your arm muscles alone, prop your arms on something. It could be the desk or table in front of you, a pillow on your lap, etc. Just be careful to not “get lazy” and begin leaning on your elbows. This will cause your shoulders to hunch forward and end up in that same forward head position mentioned above. 

4) Don’t stress your eyes. If you have been prescribed a pair of reading or computer glasses, please use them! If you haven’t been to the optometrist for awhile and notice eye pain and/or strain when you read (especially on a screen) after some time, please go for your check up or at the very least pick up a pair of over the counter reading glasses you can get at any pharmacy. When we try to read without the proper prescription to help us out, we’ll over-stress our occular muscles which can trigger a headache. Once our occular muscles have been fatigued, we’ll start moving our heads slightly in order to try to help sharpen the image quality. This, yet again, leads to poor posture and pain. 
   Another thing to be aware of is that our eyes will eventually fatigue when used at the same distance for a prolonged amount of time (ie doing computer work without taking a break). Once this happens, our neurological system will essentially lock our musculoskeletal system into a pattern. It’s a bit like autopilot. Our brains have established that we won’t be using some muscles in our body and shut them down, while overly facilitating and using others. This will eventually lead to posture break down, muscle fatigue, and pain. This can be combatted by taking visual breaks via the 20/20/20 rule. Every 20 minutes try to look 20 feet away for 20 seconds. This helps to freshen our ocular and musculoskeletal systems and keep things fresh. An even better approach to this rule is to move around - go to the bathroom, get a drink of water, or just stand up and wiggle a bit. 

Written on December 26, 2018 by Lesley Callaham, MPT, PRC

Best and Safest Strategies for Pain Relief via Consumer Reports

Consumer Reports recently published an article entitled Best and Safest Strategies for Pain. You can read it by clicking the hyperlink of the title. We wanted to share it with you all because it’s filled with safe, conservative, proven techniques for pain relief. 

The theme of the article is that these strategies can avoid or minimize the use of, or boost the effectiveness of opioid medication. As opioid prescription is simultaneously booming and scrutinized, we wanted to be sure our readers had all of this wonderful information in order to avoid using unnecessary and possibly harmful prescription medication. 

Another reason we wanted to present this article is that a lot of these strategies are not described to our patients until they get to our office. Although it’s true that this information falls in the “better late than never” category, it would be great for people to try these techniques or begin utilizing them regularly before starting physical therapy as it will improve and speed the rehabilitation process. One of the tips listed in the article is that people who move and participate in minimal impact exercise are typically in much less pain than sedentary individuals. This is a major theme in our education with patients! There is a point at which you can push your body too hard and aggravate your pain, but we find a lot of our patients tend to quickly reduce or eliminate physical activity due to pain. Physical activity improves your cardiovascular fitness as well as improve blood flow and synovial fluid synthesis within joint surfaces. These benefits all speed healing. Let us or whatever physical therapist you are working with, help determine what types of exercises are appropriate for your body or how to modify certain activities you may already be doing that could slow your healing. We can also suggest healthy alternative activities you can partake in if your preferred activity is not appropriate at the moment. To be clear, please listen to your body when it hurts, but do NOT top moving!

We also want to point out that this article does not specifically recommend physical therapy as much as we believe is appropriate. Physical therapy can help with all of the conditions listed in the article. Additionally, Integrate 360 Physical Therapy’s use of Postural Restoration Institute (PRI) physical therapy is a global, integrated, and more functional form of physical therapy than you will receive in a standard outpatient office. Therefore, if you’ve tried PT before for your pain and not experienced the outcomes you want, please come see us and let us explain why we’re different and how our approach will differ from your previous experience. 

Written by Lesley Callaham, MPT, PRC December 11, 2018

Better Postures and Positions for Reading

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As the weather continues to worsen, we are forced to do more activities indoors. Hopefully, one of these activities is brushing up on your reading! Most of us love curling up with a good book and relaxing at the end of a hard day or during a snow storm, but it can be really hard to maintain good posture the entire time. Here are some tips to allow you to increase your reading time without increasing your pain:

1) Sit as much as you can. This is the most friendly position to read a book. Try sitting in a comfortable, but supportive chair. The chair should have a good back support without pressing into your lower back and exaggerating its curvature. Also, the seat needs to be short enough that only your thighs rest on it. If the seat extends beyond your knees onto your calves, use a large pillow to essentially bring your backrest forward and your knees can bend over the edge of the seat. Again, be careful not to exaggerate the curvature of your lower back when using this pillow. 
  In order to comfortably raise the book closer to eye level (so that you don't look down and assume a forward head position over time), place the book on a table, desk, or even a large pillow on your lap. This will allow your arms to rest on the surface and place less stress on your neck. 
  Remember that our bodies are not designed for sit for more than 20-30 minutes, so remember to take quick breaks in between chapters to switch positions, get a drink, or even go to the bathroom. Your body will thank you!
  *This position can be easily adapted to sitting in bed if you pad your lower back with a specially designed cushion or a few pillows. Remember to be sure you can feel your lower back rounding into the padding. Place a small pillow under your knees to keep your hamstrings and back of your knee joint pain free. Use a pillow or two on your lap to elevate the book. 

2) Choose good “lazy positions.” The above position will eventually begin to tire your body. In order to continue to sit comfortably without wrecking your body, try curling your legs up onto the chair seat so that your feet are located near your left hip. It will look like your side sitting or “mermaid sitting.” Be sure that your trunk is bent toward the left and more rounded on the right. Essentially, your left shoulder and hip should be closer together than your right shoulder and hip are. You can use pillows to support you in this position if needed. Continue to keep your book elevated with your table/desk/pillow. If you feel neck tension in this position, please get out of it right away. 

3) Lie Down. If you’re reading before bed, you are probably lying down. Lie on your left side with a pillow between your legs and lower left ribcage. Then, fluff your pillow up (or use multiple, thin pillows) so that your neck is bent slightly, and comfortably, up toward the ceiling. Your neck should now be slightly bent to the right. Using your arm to help stabilize it, lean your book on a pillow in front of you. Your eyes will be nearly horizontal so it’s much easier to read in this position than it may seem. 

4) Avoid bad positions. Do not lie on your back or stomach when reading. Either position will cause excessive stress to your neck and/or back. 

Happy reading!

Written by Lesley Callaham, MPT, PRC November 14, 2018

How Breathing Affects GI and Pelvic Health

First, look at these great videos from FXNL Media and Stockbridge Orthopedic Practice before reading the rest of this article. 

As one can clearly see in these videos, proper diaphragmatic breathing is essential for GI and pelvic health. When the diaphragm is able to contract and descend during inhalation followed by a recoil into its original domed shaped upon exhalation, the abdominal contents including the GI and pelvic floor muscles essentially get a massage. This massaging and pumping action helps to move food and gasses throughout the GI system. It also allows the pelvic floor muscles to cycle through ascended/descended positions and active/relaxed muscle tone. This allows the pelvic floor to be able to attenuate to the forces applied on it from the gut as well as the core during weight bearing activities. It also allows the pelvic floor to stay active all day long without fatiguing. 

When we develop compensated breathing patterns, our resting abdominal muscle tension plummets. Because there is no force from the abdominals to prevent this, our bellies then distend as we inhale instead of applying a healthy pressure down into the abdominal cavity. As that pressure begins to move forward instead of downward, our GI and pelvic floor no longer receive that important massage. This can result in a multitude of problems from constipation, gas, bloating, pelvic pain (with or without intercourse), urinary/gas/fecal incontinence, and even sacroiliac (SI) joint dysfunction.

Proper diaphragmatic breathing is the cornerstone of Postural Restoration Institute and is available at Integrate 360 Physical Therapy. Because of it’s attachment sites and constant use (about 22,000 times a day) diaphragmatic breathing is essential to avoiding and treating a seemingly endless list of problems including those already discussed in this article to anxiety and musculoskeletal pain of all manners (for more information on this please refer back to our previous posts). No other approach to physical therapy takes into consideration the importance of this muscle as well as its innate asymmetries that often lead to us developing our compensatory strategies around it. 

If you have pain (especially pelvic or women’s health in nature), GI dysfunction,  anxiety, or breathing problems and haven’t found relief in the past, please come in for an evaluation. Let the therapists at Integrate 360 Physical Therapy evaluate your body and your respiratory capacity and inform you how it is related to your complaints. We will discuss a plan of care and give you exercises to improve your breathing and your overall health! Don’t wait another day! Call us at 314-733-5000. 

Written by Lesley Callaham, MPT, PRC on October 30, 2019.

What Is Proper Diaphragmatic Breathing?

There is a lot of misinformation out there on diaphragmatic breathing. Considering how essential proper diaphragmatic respiration is to our overall health and success with a Postural Restoration Institute physical therapy program, we wanted to clear it up a bit. 

Diaphragmatic breathing is NOT belly breathing!

The diaphragm is our primary respiratory muscle and is positioned at the bottom of our ribcage. It attaches to the inner portion of our lower ribcage and the front portion of our lower (lumbar spine). At rest, it is supposed to be in a domed position within the ribcage. When we breathe in, the diaphragm contracts and flattens. This causes negative pressure within the chest and allows us to take in air. When we breathe out, the diaphragm relaxes and returns to its domed position (or at least it’s supposed to) and the air is moved out of our lungs. In order for this to happen, the internal obliques and transverse abdominis (deep abdominal muscles) need to be active to keep the lower ribcage in a proper position. For a more detailed explanation of this action as well as some cool visuals, check out our previous blog Balloons- Quite Possibly The Most Underrated Therapy Tool.

So, what is diaphragmatic respiration supposed to look and feel like? For a relaxed inhale, the lower ribs should move genially out toward the sides, or laterally. Then, the lower ribs will move slightly forward with the abdomen moving along with it in almost a 1:1 ratio. During a deeper breathe, the upper chest will rise slightly after the the lower ribcage and abdomen have begun their movement. 

This can easily be felt by lying on your back and placing one hand on your lower ribcage (just below your breastbone) and another hand on your stomach above your belly button. Be sure to do this when you’re either sleepy or meditating as it is more likely you are naturally diaphragmatically breathing at these times. Feel the gentle lifting and lowering of your lower ribcage and abdomen almost in unison. You should not feel one area moving significantly more than the other, particularly your abdomen moving more than your ribcage.

In order to belly breathe, those essential abdominal muscles must be turned off to allow the belly to be loose enough to take in breath. Once those muscles turn off, the diaphragm loses it’s foundation on which to work. Essentially, when our breath fills our belly, there is no way we are actually using our diaphragm. Additionally, if you think about it, it just doesn’t make sense to breathe this way. There is no lung tissue in the belly. Therefore, why would be focus on moving air into an area that our lungs are not?

If you lie on your back and notice that your belly moves first or farther than your lower ribcage, you need to correct the issue right away. Poor diaphragmatic breathing can cause anxiety, lower back/neck pain, pelvic floor or women’s health dysfunctions (such as incontinence, pain with intercourse, constipation, etc.), GI dysfunction, and many other problems. Typically, individualized, guided restoration of the diaphragmatic breath is needed. Simply doing online research and trying to fix the problem yourself will likely lead you to more misinformation or may cause you to adapt a new, non-diaphragmatic breathing pattern such as overusing the muscles of your neck. Diaphragmatic restoration can be achieved in as little as one visit with the therapists at Integrate 360 Physical Therapy so give us a call today at 314-733-5000!

Written by Lesley Callaham, MPT, PRC on October 16, 2018