Medical

Breathing

Diaphragmatic Breathing

What is diaphragmatic breathing and why is it helpful in reducing tension and stress?

Anatomy of the diaphragm

The diaphragm is shaped like an umbrella, separating the lungs from the abdomen, and is the main muscle in respiration or breathing. The principal function of the breath cycle which occurs thousands of times each day ( in a lifetime), is to allow oxygen from the atmosphere to be absorbed by our red blood cells, whilst at the same time exchanging carbon dioxide (CO2). There is a constant ebb and flow of these blood gasses, regulated by our nervous system, and controlled by the phrenic nerve which comes directly from the brainstem.

The phrenic nerve gets its name from the Greek word
phren, meaning mind. Interestingly its other meaning is muscle. This duel meaning is because the ancient physicians understood the relationship between the mind and the physical body, and saw them as indivisible and mutually interrelated.

The diaphragm has been called the muscular equivalent of an umbilical cord, for its capacity to contact our bodies with the outside world.

How the diaphragm works
On inhalation, the diaphragm muscle contracts, and pulls downward, making the ribs flare out slightly. It pulls the bottom of the lungs downward to bring in air. On exhalation, this releases and the air goes out.
This is something you do approximately 18 times per minute, 1,000 times an hour and almost 26,000 times a day – and you don't even think about it.
If you do think about your breath, it's probably only when you're short of it. For patients who want to explore the subject, we’d recommend a new book, Breath in Action, which has contributors from the worlds of science and the arts, exploring how an increased awareness of breathing can impact positively on health, confidence and stress levels.

One of its co-editors, Jane Boston, senior voice practitioner at the Royal Academy of Dramatic Art in London, says that paying attention to your breathing can be the best preventive treatment for numerous health issues – notably asthma and high blood pressure, and even aches and pains picked up from bad upper body posture. It can also lead to a better awareness of your sense of self.

"We tend to take sips of a breath," says Boston, "and hold it when we're anxious, both of which can have a ripple effect through the system. One bad habit, like shallow breathing, triggers another. Breathing incorrectly can make you more susceptible to lower back pain. On a philosophical level, breathing properly helps to keep the mind open, enabling you to think about who you are and what and why you're doing something. But primarily, if you breathe in the right way, you'll have better digestion, your balance will be improved, and you'll develop an optimum posture."

Abdominal Breathing

Learning how to breathe from the abdomen is very important; firstly, because the blood in the lowest part of the lungs is the richest in oxygen; secondly, if you emphasize your breathing on your upper chest and shoulders, this will exacerbate any difficulties you suffer with your lungs. So if you have chronic bronchitis, asthma or a stiff rib cage due to poor posture, you should work to strengthen your core muscles around your abdomen and lower back. This will assist in improved lung capacity and a more relaxed state of mind as an added benefit.

How to Breathe Properly

* Learn from Yoga to breathe as deeply and fully as possible through the nostrils. Do not mouth breathe at any stage in the breathing cycle as the composition of gaseous exchange is better when drawn through the nasal passages and turbinate bones of the sinuses. The cells lining the sinus region are called epithelial cells. As well as having fine hairs called cilia along their pathway, they act to both warm the incoming air, and produce nitric oxide gas. This gas relaxes the nervous system and naturally reduces stress levels. That’s how breathing techniques induce a natural feeling of well-being and at peace.

Find an image for the breath in your stomach such as a bellows. This is to help you visualize your breath coming from a deeper part of the lungs and helps reduce a tendency to shallow breathing. Use this image whenever doing breathing exercises.

*Relax your breathing mechanisms. Stand upright, plant your feet firmly on the floor a hip-width apart. Relax your shoulders and slacken off your joints – ankles, knees, hips and lower spine. At the same time, straighten up through the top of the head (called the vertex) to the ceiling, so that you feel loose but have the maximum height. Keep your head straight but allow it to slacken slightly between the atlas and the occiput.

* Breathe the right way round. Place both hands, one on top of the other, over your stomach and over the solar plexus. Breathe in to flatten the diaphragm and feel your stomach expand; breathe ‘out’ and suck the stomach gently back in with the ‘in’ breath.

* Practice wide breathing. Feel the lower chest and rib cage expand as you breathe. Place your hands just above your hips on your bottom ribs – you should feel these expand in and out as you breathe. There is a belt of muscle under your diaphragm and its those muscles that send the breath outwards. Practice expanding your breathing capacity regularly for 5-10 minutes daily, trying to keep to the same time each day for optimum results.

The benefits to regular practice include a more relaxed attitude to life, and an ability to appreciate the link between the old naturopathic adage of ‘a healthy mind brings a healthy body.’ Many patients notice an improved sleep pattern, more energy and improved memory and concentration levels when at work. We recently used this practice with several high level sportsmen and women who reported improved personal best performances, and an improved ability to focus on their pre-performance preparation.

Teach your children how to do it, too. It’s never too young to learn!

Complex Regional Pain Syndromes

People who are experiencing unexplained sudden and intense pain in their arms or legs, with associated burning with pins and needles may be suffering from a complex but increasingly common illness. Triggers set off these abnormal sensations, which are then amplified throughout the brain’s processing centers. These episodes can be set off by quite trivial events such as minor jolts, stretches or awkward twisting movements.

We first came across this condition several years ago having reviewed ‘Whiplash Injuries’ by Jack Rook who described the condition and how to diagnose it. As with other syndromes such as myalgic encephalomyelitis (ME) there are some authorities who have suggested it’s not a real illness, but simply a psychological condition. Only with reliable tests has ME been recognized as a genuine illness, and a treatment strategy to help sufferers. It’s similar with complex regional pain syndrome (CRPS) or its other title of reflex sympathetic dystrophy syndrome (RSDS).

Functional MRI which shows the brain’s anatomy, but also a visual map of what happens when it’s working in the world. The blood flow patterns seen in the living brain show that certain regions of the brain become active when stimulated. For example when we hear someones voice or listen to music, the temporal lobe at the side of the brain becomes active and then begins to send signals to some of the central structures located deep within the brain, such as the limbic system and the thalamus.

The current research in this complex illness is now assisting in understanding other severe or chronic pain pattern illnesses such as migraine, facial pain (Bell’s palsy), shingles (post herpetic neuralgia) and chronic post operative pain syndromes.

Chronic pain conditions affect many people in the UK. Many of the clues on what CRPS is, how it presents and how best to treat those affected, will help with other painful conditions. Some of the clinical approaches used to treat chronic pain recognize that there are general biochemical changes and irregular levels of neurotransmitters seen in many patients. These include poor breathing function, irregular sleep patterns, and poor nutritional factors. There is invariably a history of an inability to exercise regularly which brings with it poor posture and muscle tone.

Osteopathic treatment which incorporates an integrated physical therapy including acupuncture and nutritional approach can be helpful in managing CRPS, and has none of the side-effects seen in patients who have been prescribed long term anti-depressants and anti-inflammatory drugs from their GP.

Aspirin

Daily dose of aspirin … a sensible prescription?

    Professor Gerry Fowkes presented new research conducted by the University of Edinburgh at the European Society of Cardiology congress in Barcelona.
    His findings challenge calls for people over 50 to be prescribed aspirin as a matter of course because of its blood-thinning properties. It was found that instead of bringing about a significant reduction in heart attacks, a daily dose of aspirin increased the risk bleeding in the stomach.
    He said: "Our research suggests that aspirin should not be prescribed to the general population, although it does have benefits for people with established heart disease or other conditions." At least six previous studies have indicated that frequent doses of aspirin could lower the risk of heart attacks and have prompted many of the "worried well" to take the pills.
    Taking an aspirin a day appears to increase a person's risk of dangerous gastric bleeding as much as it decreases their risk of heart attack or stroke.

    The Clinical Trial Service Unit at Oxford University came up with similar findings:
    Health experts have been recommending for more than a decade that people considered at increased risk of cardiovascular disease (due to high blood pressure or cholesterol, obesity, advanced age or other risk factors) take one aspirin pill per day, as the medicine has been clinically shown to reduce the risk of serious vascular events in those people. This strategy, treating people with no symptoms of heart disease, is known as "primary prevention."
    An example of a serious vascular event is a heart attack, stroke or cardiovascular death. Many health agencies however, such as the National Institute for Health and Clinical Excellence (NICE), have shied away from issuing official recommendations. "There is no definitive guidance," said Steve Field, chair of the Royal College of General Practitioners, "and it makes it bewildering when you have a series of papers which then hint it would be beneficial to take aspirin." According to Mr Field, many patients are attracted to aspirin as a way to stave off heart attacks because the over-the-counter pills are very inexpensive. But the findings of the newest study, published in The Lancet, suggest that the risks of aspirin match the benefits in cases of primary prevention. Only in patients who have already had a heart attack or stroke does the benefit appear to outweigh the risk. "This important study does suggest people shouldn't take aspirin unless indicated by a confirmed diagnosis of heart disease", Field said.
    Because people who had already experienced a heart attack or stroke had such a heightened risk of further vascular events, however, the benefits exceeded the risks in that group -- roughly 150 serious vascular events prevented per year for every 10,000 people treated, with the same three extra gastric bleeds and one stroke from bleeding.




    Comment

    What would be enormously valuable is a long-term study comparing those taking asprin with another ‘Usual Suspects’ group who have made changes to their diet and lifestyle. Separate studies claim increasing omega 3 & 6 fats (oily fish and olive oil); selenium and other anti-oxidants; cruciate vegetables such as cabbage and brocolli; garlic and allium herbs; pomegranate, tomatoes, capscicums and foods with high lycopene content … all help reduce the levels of risk factors of heart disease… and without needing medication.

    Regular moderate to vigorous daily exercise of 30 minutes such as cycling, swimming or power walking has also been shown to increase not only feelings of general well-being, but at the same time reduce stress and cardio-vascular risk.