Expert Q&A On Yoga & Breathing Misconceptions, Part 2 of 2

Welcome to Part 2 of my interview with Rich Severin, PT, DPT, PhD(c), CCS on yoga and breathing misconceptions! As you might remember from last week, I recently reached out to Rich because I had accumulated a number of questions regarding claims about breathing that I commonly hear in the yoga world that seemed questionable to me. As a physical therapist and board certified cardiovascular and pulmonary clinical specialist, I knew that Rich would have an extremely informed perspective from which to address my questions. (Please see Rich's full bio included at the end of this piece!)

Today I present to you the much-anticipated second half of our Q&A. Between these two installments, I feel that this is a very valuable and fascinating offering for yoga teachers who are interested in becoming more evidence-based in their teaching. I hope that you enjoy, and don't hesitate to share your comments and thoughts below!

 

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YOGA & BREATHING Q&A WITH RICH SEVERIN PT, DPT, PHD(C), CCS - PART 2 OF 2

 

QUESTION 4: Is there an alignment relationship between the rib cage and the pelvis (or between the diaphragm and the pelvic floor) that ensures optimal physiological function in the body? We often hear in the yoga & movement worlds that it’s important that the diaphragm be "stacked above" the pelvic floor so that these two structures can move in concert during breathing. If the rib cage and pelvis are habitually aligned in such a way that these two structures are not “stacked”, can this result in pain (especially around the spine and pelvis) and/or dysfunction in the body?

ANSWER: Everyone’s anatomy is unique. Everyone’s anatomy is slightly asymmetrical. Everyone’s. Our bodies respond and make adaptations to stresses over time as well. The ability to respond and adapt/remodel while preserving physiological function is how we’ve survived as a species for thousands of years.

The ability to respond and adapt/remodel while preserving physiological function is how we’ve survived as a species for thousands of years.
— Rich Severin

Now that’s not to say that sudden or gross changes to posture can’t result in problems. It can and most of that has to do with exposing the body to stresses and loads exceeding its capacity or without enough time to make adaptions. It’s also not to say that just because someone has a slight deviation from our socially constructed (and not biologically constructed) ideal posture they will have pain or dysfunction. So no I’m not certain that I would agree with that statement or line of thinking.

 

QUESTION 5: Is there a known causal relationship between specific patterns of breathing (for example habitual “belly breathing”) and specific core conditions such as pelvic organ prolapse and diastasis recti?

ANSWER: Like I mentioned above there’s a lot of things that go into disease and dysfunction. I wouldn’t ascribe one mechanism to any disease or dysfunction. There is some research suggesting that individuals with COPD might have a higher risk for urinary incontinence and pelvic floor dysfunction but that’s at the extremes of respiratory muscle dysfunction. I don’t think most people in yoga are at that level of disease. However if one were to bear down long enough and they had pelvic floor weakness/laxity I could reasonably see a prolapse develop. However even in that example it’s not a one to one relationship. I would caution against making that sort of relationship. 

 

QUESTION 6: In yoga class, we are always taught to breathe in and out through our nose rather than through our mouth. I can see how cultivating nasal breathing during yoga might slow the breath down and could therefore offer a meditative benefit to one’s practice. But are there significant physiological benefits to breathing through the nose instead of the mouth in a yoga practice - and in daily life in general?

ANSWER: Most people will generally breathe through their nose. Even those who use their mouth to breathe often still breath through their nose too. Nasal breathing is reflexive and as long as nasal airway resistance doesn’t get too high (like when you have a cold or congested nose), the lips maintain their seal and the tongue maintains contact with the back of the mouth cavity, you will breathe through your nose. Nasal breathing is innate and it allows us to warm, humidify and clean the air we breathe before it gets down to our lungs.

Nasal breathing is innate and it allows us to warm, humidify and clean the air we breathe before it gets down to our lungs.
— Rich Severin

The research is a bit limited and conflicting regarding whether mouth breathing or nasal only breathing is more efficient. Some studies demonstrate that nasal breathing is more energy efficient during exercise, however some have shown that there is no difference. Oral breathing definitely tends to dehydrate your oral passages and could make talking more challenging. 

 

QUESTION 7: If someone desired to change their habitual way of breathing (i.e. breathe more into their rib cage and less into their abdomen, for example), how easily can she/he re-set the way that their autonomic nervous system controls their ~20,000 breaths per day?

ANSWER: There’s a lot to unpack in this question. Without diving into too much respiratory physiology, the cadence and depth (pattern) of your breathing is automatically controlled by the respiratory control center in your brain stem. The pattern of breathing can be modified by various sensory inputs to activate different neural circuits of the respiratory control center to modify the pattern to match the stress, activity or condition the body is undergoing. The most notable and potent sensory input is the pH of your blood and concentration of carbon dioxide (CO2) which are monitored by nerves called chemoreceptors. When pH or CO2 gets too high or too low, breathing cadence and depth will respond instantaneously in order to maintain a cellular environment conducive to metabolic work to keep us alive. The body is incredibly efficient and effective at this process, and control of pH will always “win”. 

...the evidence that exists now does not suggest that we can change our pattern of breathing permanently due to the role breathing takes to keep us alive.
— Rich Severin

We can make temporary volitional changes to our breathing pattern. We can even temporarily stop breathing. However as I mentioned above the control of pH will always win. So while we can absolutely make these changes temporarily, the evidence that exists now does not suggest that we can change our pattern of breathing permanently due to the role breathing takes to keep us alive.

What many people might observe is that when one is stressed or in pain it usually results in hyperventilating or rapid breathing. This is due to our respiratory control center responding to the sensory and emotional inputs and thus selecting an according breathing pattern to match this “perceived threat”. By practicing slow breathing it may allow one to achieve a more relaxed state or distract themselves from pain or stress. If this relaxed state is achieved, the sensory input of a perceived threat has been absolved and different circuitry in the respiratory control center will be activated producing a more relaxed pattern of breathing. We’re finding that some of the circuitry used or involved in these breathing “programs” utilized might be hardwired. 

 

QUESTION 8: The term “breathing dysfunction” is a commonly-used label in the yoga & movement worlds these days. Do yoga and movement teachers with no concurrent medical training have the authority and expertise to identify and label breathing dysfunctions and disorders?

ANSWER: Breathing dysfunction is a bit of a nebulous term. We encounter this issue often in physical therapy practice too. Unfortunately this term is often used cavalierly and done without performing a reliable, valid and objective assessment of breathing performance such as spirometry (lung volumes), respiratory muscle performance, pulse oximetry or arterial blood gases, and markers of ventilatory efficiency during exercise.

Visual inspection and manual assessment of breathing function are very subjective and are not sufficient to determine if someone’s breathing is dysfunctional.
— Rich Severin

Visual inspection and manual assessment of breathing function are very subjective and are not sufficient to determine if someone’s breathing is dysfunctional. So unless those objective measures mentioned previously are being used I would strongly caution against labeling anyone’s breathing as dysfunctional; especially if they are walking and talking into your clinic or studio. Remember there are so many things involved with breathing and we generally do a pretty good job at it.

 

THANK YOU AGAIN TO RICH FOR HIS GENEROSITY IN SHARING HIS KNOWLEDGE AND INSIGHT WITH THE YOGA COMMUNITY. I HOPE YOU FOUND THIS INTERVIEW INFORMATIVE AND HELPFUL FOR YOUR YOGA PRACTICE & TEACHING! -JENNI


Rich Severin PT, DPT, PhD(c), CCS is a physical therapist and board certified cardiovascular and pulmonary clinical specialist. Currently he serves on faculty as a Clinical Assistant Professor at Baylor University in the Hybrid Doctor of Physical Therapy program and The University of Illinois at Chicago (UIC) Department of Physical Therapy as a Visiting Clinical Instructor. At UIC he also serves as the program coordinator for the Bariatric surgery rehabilitation program and is working on a PhD in rehabilitation science with a focus on cardio-respiratory physiology and obesity.  He earned his Doctor of Physical Therapy Degree from the University of Miami. He completed a cardiopulmonary residency at the William S Middleton VA Medical Center/University of Wisconsin-Madison and an orthopedic residency with a focus on clinical research at the UIC. He has made scholarly contributions and presented both nationally and internationally on topics relating to cardio-respiratory physiology and clinical practice. He is an active member of the America Physical Therapy Association (APTA), The American Physiological Society and several other professional and scientific societies. He serves on the board of directors for Cardiopulmonary Section of the APTA as the chair of the communications committee and as a member of the nominating committee. Dr. Severin is also a member of the APTA Cardiopulmonary Section Heart Failure Clinical Practice Guideline development team, the Specialization Academy of Content Experts, and the editorial board for Cardiopulmonary Physical Therapy Journal. Follow him on twitter @PTReviewer.

"To Correct Is Incorrect"

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Everyone is moving in the best way they can with the best tools they have.

There are no inherently bad movements.

Each person in a yoga class is a complex, dynamic organism compromised of numerous subsystems, past experiences, emotions, relationships, beliefs, and an extremely sophisticated nervous system.

Given that our movement emerges out of such unique complexity, how could we possibly know what and how to “correct” in another person’s movement?

As a yoga community, we could use to shift our focus away from “correct alignment”, and more toward exploration, self-knowledge, and helping our students *increase their movement options*.

These types of things can truly make positive change in our students’ bodies - which for me, is the main goal of my yoga practice & teaching!

[Microblog] You Can't Move an Area Well if You Can't Sense That Area in the First Place

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There are sooo many areas in our body that we don't sense well. This might seem surprising - I mean, we live in our bodies all day every day, so don't we know them pretty well? It's true that we connect to some parts of our bodies well - the ones we tend to use a lot, in the ways that we use them the most.

But have you ever stood up, barefoot, and tried to lift just your *left big toe* straight up off the floor? How did that go? Did your other toes want to lift too? Did your face scrunch up as you tried to figure out how to lift just that one individual toe by itself?

Or try doing some wrist circles (make fists and roll your wrists around) and notice: are you actually moving your actual wrist joints, or are your forearms twisting around, giving the appearance of wrist movement? Same thing goes for every other joint in your body! Can you consciously isolate and move that area through a controlled full range of motion? (Probably no.) Or do other body parts want to jump in and help, meaning that the single area you're trying to isolate and control isn't actually moving well? (Probably yes!)

You can't move an area well if you can't sense that area in the first place. Therefore the real pre-requisite to improving our mobility is to improve our internal image of ourselves - also called *increasing the clarity of the body maps in our brain*.

And how do we do that? Well through muscle contraction and movement, of course! But ideally through smart, intentional movements designed for increasing body awareness - like the classes in my online yoga class library, for example ($8.99/month & you can cancel anytime!)

Once we can sense all of our parts well, we can move them well! 👏🏼

[Microblog] Stability Does Not Equal Rigidity

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You know "stability"? As in "core stability", "spinal stability", "shoulder stability", etc? Yes, stability is important, but sometimes we treat stability as though it means we should hold parts of our body rigid and never let them move.

But the technical definition of stability is how well a system can return to an orientation after a perturbation - or in other words, how much *control over movement* there is.

We have stability in our body when we're able to control the ranges of motion that our joints have. That way our body can *move* (not hold rigid all the time), but if there's an element of control there, then there is stability.

Sometimes people are told by doctors, physical therapists, or other health care practitioners that they have "instability" or are "unstable" and therefore shouldn't practice yoga. But if a yoga teacher makes stability a priority (the accurate definition of stability, that is - not the inaccurate one that tends to lead to rigidity and movement avoidance!), then that teacher's yoga class could be a great place for that person!

If you don't have yoga teachers who focus on stability in your area, consider trying out my online class library, which features classes from myself and other special guest teachers who all make stability a priority in our yoga teaching. Your body might liiiike!

Common Movement Blind Spot #2: The Shoulder Blade & Spine Connection

In my first blog post in this series, I discussed the importance of motor control as an important aspect of movement to consider alongside the more commonly-emphasized categories of flexibility and strength. I also introduced the concept of movement blind spots - non-optimal habitual movement patterns that are directly related to motor control.

The potent tool that we can utilize to change these unconscious movement habits (and our new vocabulary word that we learned last time!) is neuroplasticity. Neuroplasticity is certainly a fancy-sounding term, but it simply means the process of forming new neural connections in the brain in response to novel stimulation; in other words, changing the brain! There are many ways we can encourage neuroplasticity, such as learning a new language or memorizing new information, but within the context of yoga, we use movement (and specifically new and novel movement) to re-wire how the brain perceives and moves the body. In my ideal world, all yoga teachers would understand the general concept of neuroplasticity and how it relates to what we do every day on the yoga mat.


COMMON MOVEMENT BLIND SPOT #2

If you missed the first post in this series, I encourage you to go back and read it before you delve further into this one. We want to make sure we’re clear on Common Movement Blind Spot #1 before we work with Blind Spot #2.

Today’s focus is the shoulder blade and spine movement blind spot. In this pattern, movement of the shoulder blades is unconsciously “glommed together” with movement of the spine. These are technically two separate parts of our body and we should ideally have the motor control to move each of them individually, but in most of us they tend to move them together like one big, undifferentiated body part without our realizing it.

Important note: there is nothing wrong with moving your shoulder blades and spine together at the same time, of course. What is non-optimal and worth working on, though, is the unconscious habit of always moving both of these spots together when we really mean to move them individually. If we lack the body awareness to differentiate between these two areas, we’ll be denied the benefits of movement options and variability that come with increased proprioception and motor control quality.

In this video, I fully address how to recognize and change this shoulder blade/spine movement blind spot. We cover a quick bit of anatomy followed by two potent strategies for changing this extremely common movement pattern. I really recommend watching the whole video - there are some great twists on a classic exercise at the end of the video that I think your body and mind will love exploring. This video is great for your own personal movement explorations, and it’s also a valuable tool to use when working with your yoga and movement students. I hope you enjoy!

Common Movement Blind Spot #1: The Rib Cage & Pelvis Connection

Welcome to the first in a series I’ve created on common movement blind spots! When we talk about restoring health and function to our bodies through yoga and movement, we often think in terms of two overarching categories: strength and flexibility. A third element of movement health that doesn’t always receive the attention it deserves, however, is that of “motor control”. Whereas strength has to do with our muscles’ ability to generate force (i.e. how heavy an object can you move?) and flexibility generally refers to our ranges of motion (i.e. how far at a certain joint can you move?), motor control pertains to how you do a particular movement - which muscles contract to move which bones at which joints, all orchestrated in the background by the nervous system. Put another way, motor control is the process by which our brain directs and coordinates our various parts in order to complete a movement.

Strength and flexibility are certainly important for us to cultivate, but they aren’t inherently useful qualities on their own; they need the direction that motor control offers in order to be truly meaningful for us.

 

WHAT IS A MOVEMENT BLIND SPOT?

 The way we coordinate the gas & brake pedals when driving without thinking about it is due to a helpful motor program created by our brain.

The way we coordinate the gas & brake pedals when driving without thinking about it is due to a helpful motor program created by our brain.

There are many movements which we perform so frequently that our brain has created set motor control patterns for how we do them. Think, for example, of the way you brush your teeth, coordinate the gas and brake pedals when driving a car, or walk down the street using your own personal gait pattern. These are all activities that we don’t have to think about consciously - we’ve repeated them so many times that we can now perform them virtually on autopilot. Movement programs like these are a helpful and necessary part of moving smoothly through our daily life. But we all also possess other less useful habitual movement patterns that don’t truly serve us in the long run. We are generally unaware of these less-than-optimal, ingrained patterns, and this is why they are called “movement blind spots”.

 

NEUROPLASTICITY: THE NEW FANCY TERM FOR YOGA TEACHERS TO KNOW

Because motor control patterns are by their nature habitual, they tend to limit our potential for movement variety. Therefore if we only ever move our body in habitual ways, we create an environment in which our brain can fall into a metaphorical “rut”, churning out the same unvaried motor tasks over and over again. I like to think of this in layman’s terms as having a “bored brain”.

When we ask our brain to move our body in new and different ways, however, this unique sensory input causes our brain to create new neural pathways in order to perform these movements. In contrast to a “bored brain”, I like to picture this as having an alert, engaged brain whose interest has been piqued. This process of forming new neural connections in response to novel stimulation is known as neuroplasticity, or the ability of the brain to adapt and change. Neuroplasticity is certainly a fancy-sounding word, but it’s a helpful one for us yoga teachers to know and understand. In fact, neuroplasticity may actually be an important key to the optimal function and long-term healthy aging of our brain.

The way that we bring awareness to our movement blind spots so that we can "break" these non-optimal movement patterns is through the powerful tool of neuroplasticity. And today’s common movement blind spot example will be an excellent start to this endeavor!

 

COMMON MOVEMENT BLIND SPOT #1: THE RIB CAGE & PELVIS CONNECTION

One of the most common habitual movement patterns that I see is the unconscious “glomming together” (my favorite technical term :) ) of the movement of the rib cage with the movement of the pelvis. Even though the rib cage and pelvis are two distinct body parts and they should be able to move independently of each other, most people always move them together as one big unit without realizing it.

I’ve included a video that fully addresses how to recognize and change this movement blind spot because it’s helpful to convey what I'm describing with a live demonstration. But I’ve also written everything I talk about in this video below in case you'd like to read about it as well:

HOW TO RECOGNIZE AND CHANGE THE RIB CAGE/PELVIS HABITUAL MOVEMENT PATTERN

Hands and knees is a great shape in which to explore this movement. If you were to ask most people to lift their chest forward and up in this position, they would happily comply, but as they lift their chest, their pelvis would also roll forward into an anterior tilt (their tailbone would tip toward the sky). If you were to then ask them to round their chest (upper and mid-back flexion), they would do so, but their pelvis would also roll backward into a posterior tilt. The same thing would happen if you asked them to move their pelvis instead of their rib cage - as they tilted their pelvis forward and back, their chest would also lift and round at the same time.

Do you see how this is a large, undiscriminiated movement pattern that is taking over what should be a smaller, more refined movement? Now moving the rib cage and pelvis simultaneously like this is not an inherently bad movement at all, but lacking the awareness that you move this way is not so great, nor is being denied the many other movement possibilities that you could be doing because you’re stuck moving in this one pattern all of the time.

Let’s now attempt to pique the interest of our “bored brain” by asking it to move our rib cage and pelvis in a way that is different from our habitual pattern. Come back onto your hands and knees. Do your best to embody a neutral spine and pelvis. Now try a very small movement of curling your tailbone just an inch toward the floor while your rib cage holds still (it will want to round, but try not to let it.) Then curl your tailbone back up toward the sky an inch. Continue this back-and-forth movement several times. With a bit of focused attention, are you able to stabilize your rib cage as you isolate this movement to just your pelvis? Don’t worry if it doesn’t happen right away - just keep playing with this movement until you feel some sort of change. Once you learn the motor control of moving your pelvis a small amount without the rib cage also jumping in, experiment with increasing the range until you can move the pelvis into a full posterior and anterior tilt without the rib cage also moving. Congratulations - you are changing your movement pattern, which is neuroplasticity in action!

Now let’s initiate the movement from the opposite direction. Come back to your neutral spine. Can you round your upper and mid-back into one inch of flexion without also moving the pelvis toward a tuck? Then lift your chest an inch toward extension without also lifting your tailbone toward the sky. As you become more skilled at this movement, slowly increase the range until you can move from full thoracic flexion to full thoracic extension while the pelvis holds still.

Once you’ve become a neuroplasticity master and have regained control of your rib cage and pelvis as separate entities, you might be interested in exploring your spinal movement and your brain-body connection in general more in-depthly in my recently-filmed online workshop Anatomy of the Spine for Increased Core Connection.

 

CONCLUSION

Working to change our movement blind spots requires slow, focused work that might seem “small” compared to the bigger movements that we’re used to in yoga and other movement systems. But an important takeaway message is that “small” does not mean “basic” when we’re dealing with human movement. Gaining control of our “smaller” movements is actually some of the most advanced movement work that we can do. And as much as we enjoy practicing the bigger movements that our bodies can do, these moves simply can’t offer us their fullest benefits unless we have a strong connection to our smaller movements as a foundation. The more we work on our motor control skills on and off the yoga mat, the more refined, graceful, and potentially pain-free our movements will become.
 

Related Post: Common Movement Blind Spot #2: The Shoulder Blade & Spine Connection

Related Post: A Biomechanics-Informed Response to Yoga Journal: We Do Not Need To Tuck Our Tail In Every Yoga Pose

Related Online Workshop: Anatomy of the Spine for Increased Core Connection