Sometimes the simplest changes produce the greatest results. We study and study to wrap our minds around complex concepts. While there is nothing wrong with that, sometimes complexity makes us miss the simplicity in front of us. Or, better said, right inside of us.

You breathe every second of every day, but likely without placing your attention on it. It just happens. This life-giving force has the power to heal, but often goes under the radar instead of being given the acknowledgment it deserves. It is a tool in your therapeutic toolbox that gets dusty even though its versatility can facilitate the repair of stressed tissues.

How often do you bring breathwork into your practice? How often do you bring it into your life? Perhaps a reminder of the vast and profound benefits of this simple practice on a few of the key systems of the body, as well as an overview of some simple techniques, will encourage you to add it in both contexts.

Anatomy and Physiology of Breath: A Simple View

Breath is the movement of air into and out of the lungs. The primary function of breath on a physiological level is the exchange of gases in order to sustain life processes in the body by giving oxygen to the organs and tissues, and removing waste gas. The exchange happens in the lungs as well as in the capillary beds throughout the body.

Breath requires the movement of two cavities of the body—thoracic and abdominal. Both change shape in the process of breathing. However, only the thoracic cavity changes in volume as air is pulled into and then released from this space. The diaphragm is the divider between the thoracic and abdominal cavities and is the primary muscle of respiration.

When you inhale, the diaphragm flattens, and ribs lift and expand by way of the external intercostals to make room for air to be drawn into the lungs by a suction force. The scalenes, sternocleidomastoid, pectoralis major and minor, and serratus anterior assist this action. Simultaneously, the abdominal cavity descends down and forward, causing the abdomen to swell outward. When the thoracic cavity increases in volume with air, the space of the abdominal cavity has to shift in order to make room, so when an inhale causes the belly to expand, it’s a surefire sign that it is deep rather than shallow.

While exhalation is primarily passive, when you exhale (especially consciously), abdominal muscles push the abdominal cavity back toward center and up. The diaphragm releases, ribs release, and the rib cage narrows with the help of the internal intercostals. Air is released (and can be consciously pushed) out of the body. The actions of these muscles in the processes of inhalation and exhalation are collectively known as the respiratory pump.

Why Does It Matter?

Research into the physiological effects of deep breathing have illuminated significant effects on the respiratory, cardiovascular, lymphatic, and autonomic nervous systems. While an entire article could be written on each of these, let’s simply explore a few of the effects of breathing on these systems of the body.

Deep, Conscious Breathing

Deep and conscious breathing increases oxygen to the brain, which supports the most vital system of our body—our central nervous system. Deep, conscious breathing also:

Affects the balance between oxygen and carbon dioxide levels in the blood, therefore affecting the balance of the “nutrients in/waste out” process that takes place in all cells of the body.

Assists to balance the sympathetic and parasympathetic systems. Sympathetic response shallows and speeds the breath and prepares for action. Parasympathetic response induces calm and restoration.

Stimulates neurological sensors (called baroreceptors) on the wall of the descending aorta. When pressure is applied during exhalation, baroreceptors are signaled, which prompts the hypothalamus (responsible for heart rate and blood pressure). The tension tells the system less pressure is needed, and blood pressure and heart rate can be lowered. This is one reason conscious exhalation breathing patterns create a calming response.

Conversely, stimulates an increase in heart rate on inhalation, which can be invigorating to someone who is sedentary due to factors such as obesity or depression. This is one reason conscious inhalation breathing patterns create an invigorating response.

Engages muscle actions that, by way of deep fascia, create a pull (a stimulus) to the cranial and sacral parasympathetic nerves and induce a calming response.

Employs the respiratory pump to support venous flow back to the heart (which can have a hard time on its own thanks to gravity and insufficient muscle contraction in people who are more sedentary).

Creates a positive external force on lymphatic trunks, deep lymphatic ducts, and the cisterna chyli, which influence movement of lymph through the cleansing process.

Creates more movement in the accessory muscles of breathing (scalenes, sternocleidomastoid, pectoralis minor) that are commonly already locked into a dysfunctional place due to poor posture, therefore supporting our hands-on work in supporting healthy change and unwinding constriction.

These bullet points only scratch the surface of the physiological effects of deep breathing. Additionally, the breath is intimately connected to the mind and emotional state. When the breath is agitated, the mind is agitated, and the body follows. But that is a story of its own for another day.

Incorporate Deep Breathing Into Your Sessions

Following are four breathing exercises that are easy to incorporate into your sessions. I recommend informing your client you will be using breathing technique(s) in your session and demonstrate the technique prior to them getting on the table. This way, they can remain in a calm and peaceful state of mind rather than reverting to their thinking mind in the midst of the session. If you feel any trepidation around verbally guiding a client through breathing exercises, practice on a client with whom you feel comfortable or with a trusted colleague, teacher, friend, or family member until you feel confident in your communication skills.

1. Basic Diaphragmatic Breathing

This breath practice can be maintained throughout the session, or as the client desires. Of course, attention to the breath will come and go. However, the client can return to this breath as they wish. You can encourage the breathing by engaging with it yourself. It is wonderful for creating a rhythm to your strokes, encouraging the client to breathe deeply, and creating a grounded, centered, present energy to your work.

1. Instruct your client to exhale fully before beginning.

2. Next, instruct your client to inhale deeply through the nose, directing the breath into the belly so that it moves outward like a buddha belly on the inhale and deflates on the exhale.

3. At the top of the inhale, ask the client to retain the breath for 3–5 seconds.

4. Then, ask the client to exhale.

5. Repeat.

2. Square (or Box) Breathing

This technique, known as sama vritti pranayama in Sanskrit (sama vritti means “same or equal fluctuations”) is excellent for bringing balance or equanimity to the body and mind.

1. Instruct your client to begin breathing slowly in and out through the nose, directing the breath into the belly so that it moves outward like a buddha belly on the inhale and deflates on the exhale.

2. After two or three simple breaths—and at the end of an exhale—instruct the client to inhale to your count of four seconds. Say aloud, “Inhale 1, 2, 3, 4.”

3. At the top of the inhale, instruct your client to hold their breath for four seconds. Say aloud, “Hold 1, 2, 3, 4.”

4. Instruct the client to exhale to your count of four. Say aloud, “Exhale 1, 2, 3, 4.”

5. At the bottom of the exhale, instruct your client to hold their breath for four seconds. Say aloud, “Hold 1, 2, 3, 4.”

6. Repeat 5–10 rounds or until the client signals to you they feel complete. Note: You should determine a signal, such as a slight hand raise or opening the eyes, during the session intake.

3. Exhale-Crunch Breathing

This technique stimulates the cisterna chyli, which supports lymph movement from the lower extremities.

1. Instruct the client to begin taking slow, deep breaths into the belly.

2. On an exhale, instruct the client to “huff” the air out (as if they are blowing out birthday candles) while simultaneously lifting the head and shoulders off the table in a slight abdominal crunch.

3. Release back to the table on the inhale.

4. Repeat up to three times.

4. Ha Breathing

This is a Hawaiian breathing technique used for increasing vital energy while relaxed, as well as enhancing healing work during bodywork sessions. It can be done seated prior to a bodywork session or lying down during the session. The key to this technique is to make the exhale twice as long as the inhale.

1. Instruct your client to begin breathing slowly in and out through the nose, directing the breath into the belly so that it moves outward like a buddha belly on the inhale and deflates on the exhale.

2. After two or three simple breaths and at the end of an exhale, instruct the client to inhale to your count of four seconds. Say aloud, “Inhale 1, 2, 3, 4.”

3. Allow a short pause.

4. Instruct the client to exhale through the mouth while making an extended sound “Haaaaaa” to your count of eight. Say aloud, “Exhale 1, 2, 3, 4, 5, 6, 7, 8.”

5. Allow a short pause.

6. Repeat 3–5 rounds.

Just Breathe

It is reported the average human uses only 25 percent of their breath capacity. By simply supporting improvement in the efficiency and capacity of the breath, you can begin to heal all areas of your physical body as well as support the same in your clients. Movement, by way of the breath, supports life.

Resources

Archer, Pat and Lisa A. Nelson. Anatomy and Physiology for Manual Therapists, 2nd ed. (Boulder: Books of Discovery, 2021).

Russo, Marc A., Danielle M. Santarelli, and Dean O’Rourke. “The Physiological Effects of Slow Breathing in the Healthy Human,” Breathe 13, no. 4 (December 2017): 298–309, https://doi.org/10.1183/20734735.009817.

Tucker, Lindsay. “How to Practice Sama Vritti Pranayama (Box Breathing).” June 27, 2019. www.yogajournal.com/practice/sama-vritti-pranayama.

Surging Life, “Ha Breathing Technique: Ha the Huna Breath of Life Infuse with Energy,” accessed March 2021, https://surginglife.com/ha-breathing-technique-ha-the-huna-breath-of-life-infuse-with-energy.