Paul Manley Back Pain and RSI Clinic

Paul Manley, D.O. (ESO 1980), M.A.O.(Manip), Registered Osteomyologist
For muscle and joint problems

Location Map (click): 46 Theobalds Rd, London, WC1X  8NW
Opening hours: 9am to 7pm. Tuesdays, Thursdays and Saturdays.

Anatomy and physiology for students of voice:

Technique for breathing correctly: how do we breath?

Some people eliminate anxiety symptoms and poor digestion simply by changing the way they breathe. A proper breathing technique is very important and requires practice. A proper technique can be learned for taking breaths in and letting breaths out - without making yourself feel dizzy. Once made a part of one's natural body rhythm, those feelings of the onset of an attack become less frequent, and in some cases, disappear.

"It is one of the very sad things in our culture that so few know the profound effect of regulating the breath" says Swami Jnaneshvara Bharati, teacher of yogic meditation.

In Dr. Andrew Weil’s Premier Issue of his newsletter, Self Healing, he states, "the most effective and time-efficient relaxation method I know is to practice breathing exercises regularly. My patients have used these simple techniques not only to centre themselves but also to address various health problems, from stopping panic attacks to improving digestion."

There is a whole science behind proper breathing techniques which goes back thousands of years. Practitioners of Yoga know that the connection between the mind and the body centres on breathing properly. The mechanics of all this is discussed on a separate page, but the recommended breathing method and some practice tips are shown here.

Whilst advice on breathing techniques varies from expert to expert, these factors are common to most of them:

  • breathe downwards into your diaphragm,
    not shallow "upper chest" breathing
  • inhale through the nose,
  • exhale through the mouth,
  • take longer to exhale than to inhale,
  • slow down! (reduce your breaths-per-minute)
  • practice until it becomes your natural breathing pattern.

Breathing: factors of great influence.

1. Raised intra-abdominal pressure

The amount of pressure maintained within the abdominal cavity whilst resting. If it is high, it may be due to fat, gases, digestive processes, aberrant breathing and speech patterns. It can also be raised in certain types of disorder such as liver, digestive and circulatory disorders.

The pathophysiological effects of raised intra-abdominal pressure include: reduced cardiac output; increased renal and systemic vascular resistance; decreased venous return; impaired visceral blood flow and altered respiratory dynamics.
Acutely increased intra-abdominal pressure causes a significant increase in intracranial pressure and a decrease in cerebral perfusion pressure. It is possible that this phenomenon may be why persons with chronically increased intra-abdominal pressure, such as the morbidly obese, suffer from a high frequency rate of intracranial hypertension.

2. Raised intra-thoracic pressure

The amount of pressure maintained within the thorax whilst resting. If the rib cage is too rigid, or has developed areas of fixity, it will affect the intra-thoracic pressure adversely. The pressure is added to by the amount of internal fat also, as well as by our breathing patterns, both conscious and unconscious. When parts of the dorsal or thoracic spine become affected by trauma or bad posture there is an immediate effect on the breathing patterns. These changes can be in the form of asymmetrical breathing patterns i.e. when leaning to one side due to a spinal lesion. The intra-thoracic pressure rise will then create a rise in the intra-abdominal pressure. The abdomen, if seen as a pressure chamber, acts as a support for the increased thoracic weight. When these two factors are present, it is inevitable that a rise in intracranial pressure will also result.

The pathophysiological effects of raised intra-abdominal pressure include: reduced cardiac output; increased renal and systemic vascular resistance; decreased venous return; impaired visceral blood flow and altered respiratory dynamics.
Acutely increased intra-abdominal pressure causes a significant increase in intracranial pressure and a decrease in cerebral perfusion pressure. It is possible that this phenomenon may be why persons with chronically increased intra-abdominal pressure, such as the morbidly obese, suffer from a high frequency rate of idiopathic intracranial hypertension.

3. Raised intracranial pressure

The skull is a slightly flexible container. This flexibility has several functions, the main one is to keep the intracranial pressure to a minimum.
It does this passively, by absorbing the shock of each artererial pulsation through its matter. Waves of breath induced pressure waves waft through the fluid world that your brain floats in. These waves nurture the central nervous system and constitute the third circulation of the brain, the cerebro spinal fluid system. Pressure can rise because of cranial trauma, crying, hiccoughs, coma, bleeding into the cerebrospinal fluid, spinal problems, posture, breathing and speaking patterns. Some breathing patterns will raise the intracranial pressure and some will reduce it. Either way it is worth looking into Yogic practices if we have the urge. They are very useful in exploring and developing ones degree of 'breathing consciousness'.The brain stem compensates for a rises in intracranial pressure by raising the blood pressure and heart rate and other factors in order to maintain the blood supply to the brain. The brain is the paramount organ of the body, its needs dominate all others.

4. How do we keep breathing whilst asleep?

It is not possible for a healthy person to voluntarily stop breathing. If we do not inhale, the level of carbon dioxide builds up in our blood, and we experience overwhelming air hunger. This irrepressible reflex is not surprising given that without breathing, the body's internal oxygen levels drop dangerously low within minutes, leading to permanent brain damage followed eventually by death.
If a healthy person were to voluntarily stop breathing (ie. hold his or her breath) for a certain amount of time, he or she would lose consciousness, but the body will resume breathing on its own. The buildup of carbon dioxide making the blood acidic is what makes one desperate for a breath rather than lack of oxygen. Hyperventilating causes an influx of oxygen that lowers blood acidity to trick the brain into thinking it has more oxygen.

5. Mouth breathing

refers to the state of inhaling and exhaling through the mouth. A healthy individual normally breathes through the nose while resting or doing light exercise, and breathes simultaneously through both the nose and mouth during vigorous aerobic exercise, in order to supply sufficient oxygen. Excessive mouth breathing is problematic because air is not filtered and warmed as much when inhaled through the mouth, as it bypasses the nasal canal and paranasal sinuses, and dries out the mouth. Mouth breathing is often associated with congestion, obstruction, or other abnormalities of the upper respiratory tract. Comorbidities include asthma, obesity, snoring, halitosis, and obstructive sleep apnea. Mouth breathing in public is sometimes considered to be less socially acceptable or attractive than nose breathing, as mouth breathers can appear to have a somewhat "slack jawed" look and can cause or exacerbate bad breath. Consequently, the term "mouth breather" may be used in a pejorative sense for someone lacking in hygiene or intelligence.

6. Sleep apnea

is a sleep disorder characterized by pauses in breathing during sleep. These episodes, called apneas (literally, "without breath"), each last long enough so one or more breaths are missed, and occur repeatedly throughout sleep. There are two distinct forms of sleep apnea: Central and Obstructive. Breathing is interrupted by the lack of effort in Central Sleep Apnea, but in Obstructive Sleep Apnea breathing is interrupted by a physical block to airflow despite effort. In Mixed Sleep Apnea, both types of events occur. Regardless of type, the individual with sleep apnea is rarely (if ever) aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. The definitive diagnosis of sleep apnea is made by polysomnography.
Signs of sleep apnea include restless sleep, and loud snoring (with periods of silence followed by gasps). Other symptoms are non-specific: stiffness, morning headaches, trouble concentrating, irritability, forgetfulness, mood or behaviour changes, increased heart rate, anxiety, depression, increased frequency of urination, bedwetting, oesophageal reflux and heavy sweating at night.

7. Why does sleep apnea happen?

In pure Central Sleep Apnea, the brain's respiratory control centres are imbalanced during sleep. Blood levels of carbon dioxide, and the neurological feedback mechanism that monitors it do not react quickly enough to maintain an even respiratory rate, with the entire system cycling between apnea and hyperpnea, even during wakefulness. The sleeper stops breathing, and then starts again. There is no effort made to breathe during the pause in breathing: there are no chest movements and no struggling, just stillness. After the episode of apnea, breathing may be faster (hyperpnea) for a period of time, a compensatory mechanism to blow off retained waste gases and absorb more oxygen. Causes are neurological, genetic, environmental i.e living in a high carbon monoxide environment, lack of expansibility of the lungs and, or ribcage and quite a few more factors including dehydration.

8. Musical medicine

Professor Graham Welch, Chair of Music Education at the Institute of Education, University of London, who has studied developmental and medical aspects of singing for 30 years says, “The health benefits of singing are both physical and psychological. Singing has physical benefits because it is an aerobic activity that increases oxygenation in the blood stream and exercises major muscle groups in the upper body, even when sitting. Singing has psychological benefits because of its normally positive effect in reducing stress levels through the action of the endocrine system which is linked to our sense of emotional well-being. Psychological benefits are also evident when people sing together as well as alone because of the increased sense of community, belonging and shared endeavour.”

9. Singing is a great work out

Regular exercising of the vocal cords can even prolong life, according to research done by leading vocal coach and singer Helen Astrid, from The Helen Astrid Singing Academy in West London. “It’s a great way to keep in shape because you are exercising your lungs and heart. Not only that, your body produces ‘feel good’ hormones called endorphins, which rush around your body when you sing. It’s exactly the same when you eat a bar of chocolate. The good news with singing is that you don’t gain any calories! Not only can it increase lung capacity, it improves posture, clears respiratory tubes and sinuses, and can increase mental alertness through greater oxygenation. It even tones the muscles of your stomach and back, that is if you’re singing correctly.”

10. Keep young and beautiful

“Another benefit is that it can keep you looking young as you’re gently exercising the muscles in your face,” according to Helen who looks 15 years younger than she is, “forget all those posh and expensive anti-aging creams, try singing instead!”

Singing even helps you live longer according to the findings of a joint Harvard and Yale study which showed that choral singing increased the life expectancy of the population of New Haven, Connecticut. The report concluded that this was because singing promoted both a healthy heart and an enhanced mental state.  Another study at the University of California has reported higher levels of immune system proteins in the saliva of choristers after performing a complex Beethoven masterwork.

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Please Call or Text Paul 24/7 on 07925 616 753
London location: 33 Chalton St, London NW1 1JD (Close to Kings Cross and Euston stations)