Key Points

• A heightened awareness of breath is essential for any type of massage or movement therapy.

• To work to maximum efficiency, therapists should be aware of the importance of deep breathing and know when to inhale and exhale.

• Helping and coaching clients to be aware of their breath through a session allows them to get the most out of their time on the table.

Breath is the most necessary and important element required for life. We can survive without food for over a month and without water for about a week, but we can’t survive without breath for more than a few minutes.

Breath is the bridge to interconnectedness—to ourselves, to others, and to the universe—and is considered by many as an extension of spirituality. People, animals, and plants all breathe, and since all forms of life are connected to each other, then our entire planet, as one organism, is constantly breathing. With this in mind, let’s look at how we can increase awareness of our breath, and how we can work with the breath of others in dynamic bodywork.

Breathing patterns and breathing techniques are commonly taught in conjunction with yoga, physical training, weight lifting, martial arts, swimming, running, and other body movement activities, yet breathing awareness is largely absent from many training programs in massage and bodywork. Consequently, many massage therapists, physical therapists, and other bodyworkers have minimal awareness of their breath as they work, and not enough attention is paid to the breathing patterns of those they work with. A heightened awareness of breath is essential for any type of massage or movement therapy, and it is especially critical in floor-based dynamic modalities such as traditional Thai massage, shiatsu, and others. When commonsense breathing concepts are applied to any physical movement, quality and ease are enhanced. The concepts presented here are offered as an attempt to help to bridge that gap and encourage a deeper awareness of breathwork for professional practice.

Breath Awareness

It’s clear our emotional and neurological states affect our breathing, and conversely, our breathing affects our emotional and neurological states. Our ability to relax is related to the parasympathetic part of the human nervous system, which works in conjunction with the vagus nerve—a long, sensitive cranial nerve that connects the brain, lungs, heart, and digestive tract. Breathing in healthy individuals is involuntary, and it happens naturally because of another important nerve, the phrenic nerve. This bilateral nerve starts in the neck and descends through the thorax until it reaches the diaphragm. When the body needs to breathe, the brain sends information along this nerve, telling the diaphragm to contract. Although the phrenic nerve controls both voluntary and involuntary breathing, humans get accustomed to the involuntary trigger to breathe, and as a result we don’t maintain full awareness of our breathing patterns. The most important way to take care of our breath is to simply become more aware of it. When we take note of how we breathe, we can regulate and override irregularities, restrictions, and tension, and become healthier and less stressed.

The Stages and Types of Breathing  

It’s important to understand and recognize each of the four stages of breathing: (1) inhalation, (2) inhalation plateau, (3) exhalation, and (4) exhalation plateau. The two plateaus are rests, or stages of inaction, and they’re necessary parts of the breathing process. The inhalation plateau, when the diaphragm assumes a downward position, may last longer if you take a full deep breath, and shorter if you take a quick, shallow breath. The exhalation plateau is longer than the inhalation plateau, and the beginning of this stage can provide a wonderful sense of ease. But if we stay there too long, we feel tension and need to inhale again. When we stay aware of each of the four stages of breathing, we can begin to enjoy each stage individually and be aware of the alternating rest and tension that is part of the natural breathing process.

There are three types of breathing: breathing with the stomach/abdomen, breathing with the chest or midsection, and breathing from the uppermost chest near the clavicle. Stomach breathing is the healthiest and most relaxed way to breathe; chest breathing is less complete and rejuvenating, but still a common form of breathing. Breathing into the upper chest is the least healthy form of breathing, and those who predominantly inhale into and exhale from this area have severely restricted breath, often resulting from physical or neurological impairments. It’s important to recognize the predominant type of breathing in ourselves and in the people we work with. Once we have that awareness, we can work with our breath and the breath of others to make adjustments and modifications.

Awareness of the stages and types of breath is an important element of some forms of meditation. Focusing on breath helps maintain a peaceful state of mind, and this is of great importance to those who work in the healing arts because it usually results in increased sensitivity.

Breath Awareness in Daily Activities

Before we begin to work with other people’s breath, we need to raise awareness of how we breathe in situations involving body movement, weight displacement, stretching, lifting, and other daily activities. Take some time to examine your own breathing patterns and see how little or how much attention you pay to your breath.

Think about the following daily activities. Are you aware of how you breathe when you do them?

• Bend down and tie one shoe, then stand up again after you tie it.

When you tie your shoes, do you always exhale as you bend down and inhale when you stand up again? Do you ever subconsciously hold your breath when you’re doing the actual tying? Don’t—just keep on breathing!

• Lift a piece of heavy luggage and place it onto an airport conveyor belt about 10 feet away.

Do you inhale when you’re lifting, and exhale when you’re putting it down? And do you continue to breathe in and out as you carry it and walk over to the conveyor belt?

• After parking a car, open the door, swivel your body, put your feet on the ground, get out of the car, and come to a standing position.

When you swivel your body, how are you breathing? When you come to a standing position, are you inhaling?

Once we bring awareness to the way we breathe as we go through our normal, everyday activities, we can begin to focus on how to work best with clients in therapeutic bodywork.

Awareness of breath in massage and movement therapy is of primary importance. It should be the first thing you notice in yourself and in your clients before you begin to work, and you should maintain that awareness throughout every session. Without awareness of our breath, we can strain ourselves, create and maintain tension in our bodies, and even transfer tension to the people we touch. Without awareness of our clients’ breath, we can increase their level of discomfort and deny them the opportunity to fully relax during a treatment. 

To begin to examine breath during treatment, we must consider the way the therapist breathes while executing a technique, as well as the way the client breathes while being compressed, twisted, or moved in and out of position.

Awareness of the Therapist’s Breath

When you coordinate your breathing patterns with the execution of techniques and the movements of both bodies, your work can become easier, more graceful, and more effective. Stay aware of your breath when you move your body on the mat and while you move your clients’ bodies. It may seem obvious to do this, but time after time, therapists breathe inefficiently as they work. Here are some simple reminders:

• Exhale when you move away from your center (when you twist, pull, or bend).

• Inhale when you return to your center or to the starting position.

• Exhale when you apply downward or forward pressure.

• Inhale when you release the pressure or return to the starting position.

• Inhale when you apply upward pressure or pull a body upward.

• Exhale when you return to the resting or starting position.

• Inhale when you lift or suspend any part of a body.

• Exhale when you return to the resting or starting position.

Coordinate Techniques with the Receiver’s Breathing Patterns

One of the biggest mistakes we can make is to work mechanically with clients, without being fully aware of their breathing patterns. It wouldn’t be comfortable or effective, for example, if you compressed someone’s abdomen while they were midway through an inhalation. That could create a dynamic of struggle and tension, not one of ease and tranquility. Because of this, try to “lock in” to your clients’ breath as soon as they lie down. Before you even touch them, study the rise and fall of their abdomens, observe their breathing patterns, and make a plan to execute your movements and techniques in coordination with their breath. From time to time during the session, check the client’s breathing before you move or apply pressure. Once you are locked into your client’s breath, you can concentrate on your own breath.

Breathing is an involuntary reaction, but to work to maximum efficiency, we should be aware of the importance of deep breathing and know when to inhale and exhale. In general, clients should exhale when pressure is applied to them, or when their bodies are dramatically moved from one position to another. Ideally, they should be inhaling when the pressure is released, or when their bodies are returned to the starting position. A skilled therapist coordinates all movements with the breathing patterns of the receiver, rather than constantly reminding a client how and when to breathe.

Breathing for Comfort and Self-Protection

When we work in massage, or in any type of professional care that requires close contact between two people, it’s important to be aware of the ways that physical contact, bodily odors, and breath may affect the receiver. Naturally, it’s always wise to shower before a session, or at least wash your hands and face, brush your teeth, and change into clean clothing. It’s also important to make sure your breath and breathing don’t affect your clients in negative or intrusive ways. Smelling a therapist’s breath or feeling it on their bodies is generally unwelcome and unpleasant for a client. Because of this, whenever you execute techniques that require very close physical contact, take care to not exhale in a direct path onto or over a client’s body or face.

The opposite is also true: Take care to not inhale when your client exhales in a path toward your face. This may sound obvious, but it takes effort to maintain breath awareness as you work. Whenever a client exhales heavily as a result of stress release, emotion, or physical movement, try to exhale at the same time. The potential for energy transference is strong when doing deep abdominal work, including working the psoas and stomach pressure points, and in floor work while doing compressions of the legs toward the head, and crunches from supine to sitting position. When you execute these types of techniques, try to always turn your head slightly so it is not in a direct line with the exhalation of your client.

Coaching and Helping Your Client

If you notice your client is breathing irregularly or taking very shallow breaths before you begin a session, you might suggest that they take a few slow, deep breaths. Sometimes this small suggestion can help clients more fully relax before you begin work. During a treatment, if you want to make sure your client is breathing in a way that will be conducive for an upcoming pose or body movement, you can softly ask your client to inhale and exhale at the appropriate time. Most of the time, however, it’s best to coach good breathing by example: Just breathe in a louder-than-usual way, and your client will usually respond and become more aware of their own breath.

It’s best not to speak more than necessary during a session. Part of the beauty of massage and bodywork is that it allows the receiver and the therapist to remain in a meditative state. Occasionally, when you notice your client’s breathing is restricted or incomplete, you can remind them to take a deep breath, and then wait for their exhalation to begin (or continue) your movement. For the most part, however, just wait for your clients to inhale or exhale before you begin a new move. Don’t repeatedly ask them to control their breathing, since this can be distracting and can minimize their ability to fully relax during the session. Be patient and allow them to always feel as comfortable as possible.

As you work with the client in supine position, keep an eye out for facial expressions that signal discomfort or pain, and be sensitive to body reactions such as tightening muscles or “holding.” Naturally, you should apply a lighter touch in these sensitive areas, and in some cases, you might also suggest a simple visualization exercise. One of the most common visualizations is to direct breath to a sore spot while inhaling, and to imagine the soreness being released while exhaling. Inhale clean energy, and exhale stagnant energy. Inhale peace, exhale tension.

Essential Breath

It is truly amazing how a greater daily awareness of breath can lead to improved health and a more peaceful state of mind. The first step in recognizing breath restrictions in others is to be aware of your own breath and breathing patterns. Pay attention to the way you breathe when you’re nervous, frightened, or doing mindless daily chores. Remind yourself to breathe deeply and to exhale slowly and peacefully. Stay aware of the length of your plateaus after each inhalation and exhalation. Recognize your dominant type of breathing, and train yourself to adjust it whenever necessary.

As you work in massage and bodywork, try to coordinate your breath, movements, and techniques with the breathing patterns of the receiver. Don’t hold your own breath when you’re executing a strenuous pose. Inhale when you need strength and stability. Exhale when you return a heavy limb to the table or the floor. Wait for the client to breathe in a way that will increase effectiveness of the technique you are about to do.

Enhanced awareness of breath helps sustain and increase the longevity of a professional practice in the healing arts. Breath awareness allows us to work with more comfort and ease, and this relaxed state is automatically transferred to the people we touch. Healthy breathing patterns reduce stress, increase oxygen in the blood, lower blood pressure, and make our work easier to do. I hope these simple guidelines and concepts help you work with more awareness, ease, sensitivity, and effectiveness.