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Reverse Breathing

Can you breathe backwards? If you only consider your diaphragm’s movement, it is actually possible. Not ideal, but possible. I treated a gentleman this week who was diagnosed with emphysema last year. His breathing was shallow and very laboured and caused him a lot of fear and anxiety. The idea of any exertion frightened him. How can I take something so basic, so essential for granted?

As a yoga teacher I talk about breathing a lot, where you should send the breath, where you should feel it, how you should aim to control it. And maybe I take for granted that people know how it works, so here goes.

You should breath in and out through your nose (it’s a struggle for sinus sufferers, I know from life long experience). The nose is a humidifier and purifier, it stops large foreign particles from entering the respiratory system, and heats and wets the air for the lungs. From the nose the air passes through the vocal cords (this is where you contract the back of your throat during ujjayi breathing), the glottis (which closes the oesophagus or trachea to guide air or food where it needs to go), into the trachea. You can feel the cartilage rings of the trachea in the front of your throat if you gently glide your fingers up and down your windpipe. The trachea diverts into the left and right bronchi, which again diverts to bronchioli that gets smaller and smaller with each “root”. It looks like the roots of a tree. Physiotherapy makes use of the direction of the tree’s branches to drain mucus during postural drainage, usually paired with percussions. At the end of the bronchioli the alveoli sits gathered like tiny balloons. This is where the gaseous exchange takes place. So we are really zoomed in now, if you back it up, the left and right lungs take up most of the space in your thorax.

If you slide your index and middle finger backwards, just of your collarbone, press down slightly and take a deep breath, you’ll feel your first rib rising with the inhale. The right lung has three lobes and the left only two. Both lungs are surrounded by pleura, which helps maintain the pressure. Which is what the lungs use to expand. Healthy lung tissue is elastic, it expands on inhale and passively recoils on exhale. This is lost with emphysema. The lung tissue can still expand easily on inhale, but the recoil is lost. This leads to hyperinflation and may look spectacular on a chest X-ray, but in reality the air that is caught inside is cleared of oxygen and actually becomes stale and useless.

The intra thoracic pressure changes as the diaphragm moves. This beautiful big muscle is like a parachute that separates the thorax from the abdomen. It has muscular attachments to the sternum, ribcage and lumbar spine. The oesophagus, aorta and vena cava pass through the diaphragm and with trauma, pathology and pressure control issues (constipation, bloating, pregnancy, weightlifting) may lead to hernias. The diaphragm is innervated by nerve roots C3-4 via the phrenic and vagus nerve. This can lead to some weird and wonderful symptoms post surgery of severe, mystery shoulder pain that disappears as abruptly as it started. It also gives us direct access to the parasympathetic nervous system, by just breathing! The diaphragm dome moves down when it contracts during inhalation, increases the thoracic cavity’s volume and decreases it’s pressure. The pressure inside of you is lower that the air pressure and air follows its habit of moving from high to low pressure. Gas exchange happens and on exhale the diaphragm relaxes, the dome moves up, the volume decreases, the pressure increases and air does what comes natural again and rushes out of the nostrils again. It took me a few hours and YouTube videos to get that in biology.

When your diaphragm moves in the opposite direction (up on inhale, down on exhale) it is referred to as reversed or paradoxical breathing. Your posture, habits, hobbies and work can all influence your breathing pattern. Shortened pectorals and stiffness of the thoracic vertebrae and ribcage makes it more difficult to breathe deeply. This is all too common in our daily lives, where we are stuck in flexion over a phone, desk or steering wheel for hours each day. Using your accessory breathing muscles (in the neck) leads to shallow breathing. Shallow breathing is like never changing gears in your car. You have a beautiful vessel, designed specifically to give you the oxygen you need, you just have to slow down and take a deep breath.

Research studies into how pranayama effects specific disease, especially asthma, has shown good results. An with any yoga treatment, the benefit far outweighs the risk of harm. Pranayama, especially Nadi Shodhana (alternate nostril breathing), is often prescribed by Ayurveda doctors. I wonder how patients in the West will take similar advice.

You can start breathing better right where you’re reading this. Remember that if you are not used to taking deep breaths, you may feel light headed. So start sitting of lying down. When you get comfortable lengthen the duration of your exhales, so that its longer than the duration of your inhales. And remember always, breathing controls your state of mind.

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