One of the most common breathing patterns we see is the hyperinflated pattern. Essentially, the athlete is in a state of excessive inhalation – breathing on top of breathing – with inadequate exhalation. They just can’t get air out efficiently. This hyperinflated pattern of breathing can be asymmetric (typically see the left rib-cage flared more than the right) or symmetric (both rib cages flared) as described by the Postural Restoration Institute. While these differences are important, particularly to the physio, hyperinflation has consequences regardless of symmetry.
This is an asymmetric rib flare. And yes, it happens in jacked up people too – this isn’t only a skinny gym noob problem. Courtesy: hruskaclinic.com
|
The picture on the right indicates a flared ribcage and overextended lumbar spine
|
Taking it a step further: inhalation is to excitation and tension (sympathetic-dominance) as exhalation is to relaxation and inhibition (parasympathetic dominance). Inhalation yields excitation – why heart rate increases with inhalation and decreases with exhalation. The dominance of this fight-or-flight response is essential in short bouts of performance, but is pretty much awful if maintained for long periods of time as it prevents recovery and relaxation – both of which are important for system neutrality. As my dad always said, everything in moderation. With this hyperinflated state inhibition of muscles, particularly the extensors, is difficult and the athlete cannot get into and sustain a variety of movements because the nervous system is under constant threat. The increased pH of the blood due to decreased CO2 levels also contributes to a sensitive peripheral nervous system. No wonder people with persistent/chronic pain display this hyperinflated, stressed-out state – a threatened nervous system is often a painful one!
Clearly, exhalation needs to be emphasized for a balanced, efficient system. By emphasizing flexion-biased breathing patterns, the system can approach a balance. pH levels can be normalized and beneficial training effects can be realized without adding rigidity to the system. By facilitating ribcage over pelvis mechanics, the diaphragm and pelvic floor can return to their normal resting length and function allowing the diaphragm to act like the diaphragm. I think many of our barbell-based strength training systems lend us towards this hyperinflated state so some reset movements likely need to be thrown into programming.
So what to do about this? That’s coming in a near future post but – spoiler alert – it involves forced exhalation, flexion and developmental patterns, and some recovery strategies. In the meantime here’s my earlier post on diaphragmatic breathing for recovery.
– Seth
Hi Seth!
Are there any courses you can recommend, either online or in person, to delve into breathing patterns? I’m an occupational therapist and I think this is so key with many of my clients, including the chronic pain ones you mention. Would love to learn more about it. Interesting post!
Thanks,
Tyla
Thanks for reading Tyla. I highly recommend reading Recognizing and Treating Breathing Disorders by Chaitow. Postural Restoration Institute is probably the foremost out there as far coursework with this topic – they am have some powerful techniques. I also recommend reading Kolar’s various work regarding breathing. We can also learn much from yoga and mindfulness schools’ approach to breathing. McGill and Hodges also have published a lot on this.
Hope that helps and email me if you’d like some specific resources
Thanks Seth!
Hi Seth,
Great post, I really enjoyed the read.
Quick question though. If you aren’t exhaling properly wouldn’t you decrease pH due to INCREASED levels of co2 in the blood?
In a hyperinflated state, air exchange is inefficient and CO2 is blown off more due to an increase in respiratory rate to compensate for poor exhalation capacity thus lowering PCO2 in the bloodstream. This then induces an alkaline pH (increases it) which can potentially reduce O2 delivery to tissues via Bohr effect. Over time this can lead to a reduced capacity to buffer, sensitizing the system, including the sensitive nervous system (peripheral and central).
Thanks for reading dude.
Hey Seth,
Thank you for the explanation! I did not consider ventilatory rate in this equation.
Keep up the great work.
Hi Seth,
I am a bit late commenting this article, but I have noticed the same kind of thoracic cage asymmetry in chronic smokers. Would you consider the hyperinflation described here as a possible culprit for this case? From my point of view, smoking inevitably causes disruption of normal breathing patterns.
Thanks,
Joel
Joel,
Yea absolutely. Chronic smoking invariably causes COPD which is obviously obstructive meaning that they cannot get air out. So if one cannot exhale fully they will stay inflated. This is oftentimes no different in a stress response in a non-smoker. Smoking profoundly changes the breathing pattern both mechanically and physiologically. Thanks for reading and commenting!
Hello. Is there a follow post about treating this? Thanks