Integrating Japanese Eastern medicine with Western medicine.

I want to talk about my specialty, “Breathing.” You might wonder, “Breathing?”

It is the most common activity in human activity from the moment we birth, and we breathe more than 20,000 times a day. Imagine, if your breathing is not functioning properly, it can deeply affect musculoskeletal systems such as the neck, shoulders, and lower back, due to the accumulation of stress from repetitive patterns. Additionally, as I will explain later, it seems to be closely related to personality and anxiety as well.

Because breathing is performed unconsciously, many people may not have taken the time to think about what constitutes proper breathing or to engage in breathing exercises.

When we think of breathing patterns, in general, breathing is often divided into three types: “shoulder breathing” (breathing with elevated shoulders), “chest breathing” (breathing with the chest), and “diaphragmatic breathing” (breathing with the abdomen).

Diaphragm at Houston Museum

Shoulder breathing

Shoulder breathing is a breathing method where the shoulders are raised while inhaling. Except for specific situations such as immediately after exercise, this is clearly an incorrect breathing method. The proper movement should involve pulling down the diaphragm to draw air into the lungs, but with shoulder breathing, the shoulders are raised and air is taken in, resulting in a significant burden on the neck, shoulders, and lower back. This burden increases even further with over 20,000 repetitions daily. If you constantly feel shortness of breath, oxygen deprivation, or persistent fatigue, you may be experiencing shoulder breathing, and it is important to correct it immediately. The causes of falling into shoulder breathing are diverse, and I won’t go into detail about the reasons or remedies here. If you suspect that you are experiencing this, I recommend consulting with a certified PRI provider in your area.

Chest breathing

Chest breathing has been taught in practices such as Pilates and singing for a long time. While it may not be entirely incorrect, it seems to emphasize only expanding the chest, deviating from the natural and proper way of breathing for the human body. It’s not just about expanding the chest alone.

Abdominal Breathing

Abdominal breathing is generally considered good. However, based on my experience, I think many people misunderstand and perform abdominal breathing incorrectly. Unfortunately, it seems that even those who recommend and teach abdominal breathing often have a limited understanding of what it actually entails. For example, many people believe that it is correct to have the abdomen expand when inhaling or to breathe using only the abdomen. In such cases, the ribcage and thoracic cavity do not expand, and only the abdomen protrudes, resulting in limited air intake into the lungs. Even I, before studying breathing in depth, had a limited understanding that abdominal breathing meant simply expanding the abdomen. The term “abdominal breathing” itself can lead to misunderstandings.

Breathing correctly?

So, what exactly is correct breathing? I believe it is “breathing where the diaphragm takes the lead, and the entire thoracic cavity expands” as a cascade of activities from 1st rib external rotation. It might sound complicated, but let me give you a good example. Take a look at top-level swimmers when they come out of the pool, such as in the Olympics. You will notice that their breathing is not characterized by a protruding abdomen but by the expansion of the entire thoracic cavity, like a balloon. What is often misunderstood about “breathing” is that people tend to have a strong emphasis on the front of the chest, imagining only the expansion of the chest in the anterior direction. However, correct breathing involves the expansion of the thoracic cavity in all directions, including front, back, left, right, and 360 degrees when taking a deep breath.

So, how can you develop proper breathing? First, there are two patterns for people who cannot breathe correctly: those who have difficulty exhaling and those who have difficulty inhaling. I believe that addressing each pattern’s specific issues can help improve breathing.

Exhalation difficulty “too much air in your chest”

Let’s start with the pattern of “difficulty exhaling.” Mammals, including humans, have their lungs surrounded by the musculoskeletal system, and no matter how hard we try, there are limits to the expansion of the ribcage. However, many people become fixated on “inhaling” and neglect the importance of exhaling. Imagine an accordion’s bellows: if you constantly try to play the instrument with the bellows fully extended, the actual air exchange becomes limited. It is by contracting the bellows that you can take in more air. Individuals with a condition called “barrel chest,” where the ribcage expands like a barrel, or those with a condition called “pigeon chest,” where the sternum excessively tilts upward, experience overinflation and struggle to exhale properly. I have also noticed that individuals who have had respiratory diseases like asthma in the past tend to fall into this breathing pattern as they constantly focus on “inhaling.” By the way, people who use this breathing method often have a tendency to keep their bodies tense, leading to increased sympathetic nervous system activity. This results in heightened body tension, making it difficult to relax effectively, making difficult to sleep soundly. When the sympathetic nervous system is overly active, it can lead to irritability and affect one’s personality.

PRI balloon exercise

So, what can you do? Let’s focus on learning to exhale properly. The key here is to exhale fully. Many individuals who struggle with exhaling mistakenly believe that they have fully exhaled when, in fact, a significant amount of air remains in their lungs. It’s important to learn to exhale until your sternum drops down and your ribcage are full internally rotate. I recommend using a balloon for this exercise. The balloon provides resistance, making it easier to feel the muscles involved in exhaling and to develop a sense of fully exhaling. When you strive to squeeze out every last bit of air from your lungs (without tensing up your system), you’ll feel the muscles between your ribs, the muscles around your abdomen, and the muscles below your buttocks engaging. Activate these muscles involved in exhalation and practice exhaling more and more. As you become capable of exhaling properly, your body will naturally relax, and your oxygen exchange capacity will improve, reducing the need for excessive inhalation.

As a side note, using a balloon for this exercise efficiently trains the muscles around your abdomen and ribcage, which helps to slim your waistline. So, it is the most effective exercise for toning your waistline (doing crunches alone won’t slim your waist). Additionally, the muscles involved in exhaling work in coordination with the pelvic floor muscles. Therefore, individuals who have difficulty exhaling often have challenges with proper activation of the pelvic floor muscles, which can be related to issues such as urinary incontinence and frequent urination. Exhaling exercises can be beneficial for individuals facing these problems as well.

Inhalation difficult “diaphragm is too weak to expand the chest”

Now let’s discuss individuals who have difficulty inhaling or “people who can’t breathe in.” One important thing to note is that if you can’t exhale properly, you won’t be able to inhale properly either. So, first, work on being able to exhale effectively. Many individuals who struggle with inhaling often have weak diaphragm and intercostal muscles. However, in my experience, a significant number of cases where individuals can’t use their diaphragm effectively are due to their inability to exhale properly. Allow me to explain more clearly.

One example is the condition known as “Rib Flare” (see Figure 3). It refers to the state where the lower ribs have lifted due to the core muscles, which are responsible for suppressing the upward movement of the lower ribs, not functioning properly over a long period of time. The diaphragm is a muscle that pulls down the lungs, and it requires a solid foundation for that purpose. While the diaphragm is connected to the lower ribs and lungs, if the foundation provided by the lower ribs is not stable, the muscle lacks the support it needs to pull down effectively. As a result, the diaphragm becomes unable to exert force, leading to difficulty in inhaling properly.

Power Lung

By the way, the muscles that stabilize the lower ribs are the same muscles involved in exhaling. That’s why being able to exhale effectively is crucial. Once you’ve confirmed your ability to exhale properly, you can then focus on training the muscles involved in inhalation, such as the diaphragm and intercostal muscles. Using specialized equipment like the “Power Lung” is one option, but you can also try a simple exercise like inhaling through a narrow straw while creating resistance with your mouth. This can be done easily and effectively.

Breathing is something we do unconsciously every day, but its mechanics are highly complex.

It is the most essential action for animals to sustain life. It not only affects issues related to the neck, shoulders, and lower back but also posture, pelvic issues such as urinary incontinence, sleeplessness, Jaw issues, and even a person’s personality. I encourage you to listen to your body and observe how you breathe. You can also compare it with others. You may discover various insights. If you are experiencing any difficulties with your body, practicing proper breathing might surprisingly help resolve them.

Rib Flare

Flared Rib: It refers to the situation where the lower ribs have lifted. Normally, the core muscles, including the abdominal muscles, should prevent the ribs from flaring. However, with incorrect breathing patterns over an extended period, the ribs can lift. During pregnancy, the ribs can also be pushed outward, causing them to flare. In normal cases, the ribs return to their original position after childbirth. However, if there are issues with breathing techniques, the ribs may remain elevated.