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.

What Does Being Wiped Out After a Yoga Practice Mean?

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Isn’t it interesting that you can feel tired and wiped out after a vigorous yoga class, but this doesn’t necessarily mean that you created *strength* in your body in that yoga class?

Strength is actually a really specific variable. It means how much force a muscle can generate against resistance.

If we want to increase strength, we need to expose our muscles to higher loads than they’re currently used to so that they’re challenged to adapt and become stronger (generate more force).

If we move around a lot at a fast pace for 60-75 min in a sweaty yoga class, this might make us tired afterward - but this isn’t necessarily the same thing as *strengthening*. This is just tired.

In fact, when I do actual strength work in my yoga practice (loading my muscles for adaptations), the moves are usually done slowwwly and are hard & effortful in the moment I’m doing them, but then afterward I don’t feel crazily exhausted and wiped out.

I personally like taking a sweaty, faster-paced yoga class that makes me tired afterward (I really do! 😀) But I don’t really count that as *strengthening* work in my mind, because that’s something different.

What are some ways that you work on the variable of strength in your yoga practice?

Yoga Anatomy Images & How Muscles Work

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You know those yoga anatomy images you see where the muscles are shown in two different colors - one color is supposed to be “contracting” and the other color is “stretching”?

These pictures would have you believe that “contracting” & “stretching” are opposites - and that shortened muscles are contracting & lengthened muscles are relaxing.

Know what I mean?

I feel like I see these types of images in yoga books & on blogs all over, but did you know that our body doesn’t work like these pictures claim?

Muscles can actually contract through their entire range - when they’re short, mid-range, and long. Just because a muscle is in a lengthened state doesn’t mean it’s not working!

As our body moves into various yoga asanas, some muscles shorten while others lengthen - but ALL of the muscles on all sides of the moving joints are working, regardless of what length they’re at.

Instead of worrying too much about which muscles are “on” or “off” in our poses (or “contracting” and “stretching” as the yoga anatomy images label it), it’s more accurate to think of them all as “on”, because that’s how we move - through co-contractions.

Aaaand I don’t know why this picture I found of wheel (urdhva dhanurasana) doesn’t seem to depict the person with their palms flat on the floor. Maybe he’s supposed to be doing wrist lifts in wheel? (Which actually sounds cool and I want to try it!)

[Microblog]: Your Trippy Anatomy Geek Moment of the Day

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Here's a TRIPPY ANATOMY GEEK MOMENT for you: blood flows in our body through *blood vessels* (arteries, veins, capillaries, etc.), and these blood vessels form a complex network that fills our body from head to toe. The tissues of our body are nourished as the blood flows through these vessels (specifically the capillaries).

Now here's the TRIPPY PART (if that wasn't already trippy because how is our body so complex and amazing, right?) But anyway, the TRIPPY PART is that our *largest* blood vessels are so large that they need their *own* individual blood vessel system just to support them. So within the outer walls of our largest blood vessels, there lie tiny arteries, veins, and capillaries - an actual mini-blood vessel network within a larger blood vessel itself.

So the overarching blood vessel system that supports our entire body is in turn supported by a mini-version of itself. As my friend Maddy would say, that is so meta. 😜

These tiny blood vessels-within-blood vessels are called "vasa vasorum", which means - get this - "vessels of the vessels".

I hope you enjoyed your trippy anatomy geek fact of the day!

[Microblog] Our Bodies Are Naturally Asymmetrical

I don't know how many images of lungs you've looked at, but have you ever noticed that our two lungs are not symmetrical? Check out this medically-accurate image that shows that the right lung has 3 lobes while the left one has 2, and the left one is also a bit smaller than the right to make room for the heart.

Even though we sometimes hold up balance and symmetry as an ideal that we should strive for in our bodies, as though being "imbalanced" is inherently problematic, the truth is that our bodies are not actually evenly-balanced left-to-right to begin with. We don't need to look or feel even on both sides of our body in order to be healthy, functional beings. Asymmetry is a natural part of who we are!

[Microblog] A muscle isn't a muscle to your brain

We tend to think of muscles as the individual, isolated structures that we see in our anatomy books - the biceps, the hamstrings, the psoas (or to be super geeky, *psoai* if we're talking about 2 of them), etc. But did you know that this is NOT how your brain understands muscles?

Your brain doesn't actually know what a "psoas" or a "biceps" is. These are arbitrary names that we give to our parts so that we can learn and communicate about them (which is a good thing!) But the brain doesn't think in terms of individual muscles - instead, it perceives and directs *motor units*, which are tiny subsets of individual muscles.

In this sense, we could really think about each muscle as actually being made up of thousands of smaller muscles, which are where movement truly happens in the body.

Whoa man!

Three Alternatives to Pigeon Pose & A Brief Discussion About Stretching

(**Update February 2018: I have backed off the position I take in "Reason #2" of this blog post. Although passive, folded-forward pigeon pose doesn't offer much in terms of positive change for our tissues, I don't think it's as innately precarious for our joints as I used to (injuries generally happen from fast, strong, quick forces - not from a simple low-load stretch done for a bit.) So while I don't personally practice passive pigeon very often because I'd just prefer to do things that are more effective and more efficient for making change in my body - like the 3 great alternatives I feature in this post - I DO occasionally include it as an option in my classes again, and I don't fearmonger about the pose anymore today. Just FYI!)

I know I might be in the minority amongst yoga teachers, but even though yoga students tend to looove their pigeon pose, I have consciously chosen to forgo this pose in my classes for the past several years now. While I do teach variations of pigeon pose like reclined pigeon and standing pigeon chair, I don't generally teach the traditional version of this pose in which you lie in a passive, unsupported forward fold over the front leg.

 

WHY I SKIP PIGEON POSE - REASON #1

I have two main reasons for skipping pigeon pose in my classes. The first is that it doesn't offer much in the way of positive change for the tissues of the body. We generally tend to think of pigeon pose as a stretch designed to increase the flexibility of the hips. But we've actually learned quite a bit more from scientific research in recent years about how stretching works (although there is still a ton that we don't know!), and thanks to my brilliant mentor Jules Mitchell, much of this new information is making its way to the yoga community.

One of the biggest realizations that I've learned about stretching is that flexibility is a much more complex topic than we've generally learned from our yoga teacher trainings, workshops, books, and other studies. The prevailing approach to flexibility in most yoga classes (and in much of the health/fitness world in general) is that if someone lacks range of motion in a joint, the solution is to stretch the muscles and fascia that cross the joint to lengthen them out. Then we get longer tissues and voila! - we can stretch further in that direction. By this reasoning, the solution to the ubiquitous "tight hips" that many people claim to have is to simply stretch one's hips out in pigeon pose for a long time at the end of every yoga class - a practice that we yogis are quite familiar with!

But the assumption that in order to solve all inflexibility issues, tissues simply need to be stretched out does not take into account the many other likely factors that could be causing the inflexibility - factors that passive stretching does not actually address. It reminds me of pain science and how easy it is to attribute pain simply to structural factors like tissue damage, poor alignment, or dysfunctional movement patterns, when the bigger picture of pain is truly so much more complex than this. The brain's decision to output a pain experience is multifactorial and completely unique to each individual - and in the case of persistent pain, is actually rarely due to a single structural reason like tissue damage.

Similarly, if someone experiences what they would call "tight" hips ("tight" of course being a vague, subjective word with no single definition for all bodies), the possible reasons for this tightness are many and varied, from a restriction in the capsule of the joint itself (which would not be addressed by passive stretching) to issues in how the brain is coordinating muscle activity (more of a motor control/neuromotor issue that is also not solved by passive stretching). Therefore, when we as a yoga community assume that the solution to all inflexibility issues is to stretch our tissues out in poses like pigeon pose, we are missing a much larger picture of how flexibility, performance, and joint function works.

This image of pigeon pose that I found online makes me feel weird. :)

This image of pigeon pose that I found online makes me feel weird. :)

WHY I SKIP PIGEON POSE - REASON #2

With all of that said, this isn't the only reason that I choose to skip pigeon pose in my classes. Even though passive stretching is not the universal solution to inflexibility issues that we yogis tend to believe it is, it still has some nice benefits, and I certainly include some passive poses in my classes. But pigeon pose also happens to incorporate some precarious joint positioning for the front knee and hip with the added weight of the torso and upper body lying on top of them, which isn't necessarily beneficial for these joints. Although there are ways to modify the pose to support these joints in a healthy way, these options are rarely offered or taught in detail in most yoga classes. And even if they were, most yoga studios don't have enough props to support every student the way they would need to be set up for optimal loading of the front knee and hip.
 

THREE ALTERNATIVES TO PIGEON POSE

And so, without further ado, I present to you... three alternatives to pigeon pose! These are three excellent ways that a pose like pigeon pose can be practiced, but with the added benefit of positive change for the tissues of the hip and a more efficient path toward increased flexibility. You'll notice that all three examples incorporate some degree of muscle activation (versus assuming the poses passively). This is because research has suggested that strengthening muscles through their full range will result in more flexibility gains faster than passive stretching alone. This is likely because when we actively contract our muscles during a stretch, this signals our nervous system that this range of motion is safe, and our nervous system will therefore be more likely to allow more range of motion in the future. Additionally, when we contract our muscles during a stretch, we load our connective tissues via muscular force, which increases their load-bearing capacity (i.e. their strength) over time. Strong connective tissues equals strong, efficient movement, functional joints, and decreased risk of injuries in the future.

Consider offering these options as an alternative to traditional pigeon pose in your yoga classes, or if you find yourself in a yoga class in which pigeon pose is taught, consider trying one of these "pigeon-ish" poses instead. (Just for the record, I don't think pigeon is an absolutely terrible pose, and I would certainly not "judge" a yoga teacher for including it in their class - pigeon is extremely ubiquitous in our yoga community and it sometimes feels like our students almost expect it. But once you learn a bit more about current stretching science and the connection between strength and flexibility, you might be inspired to change up what you offer to reflect these new understandings.)

If you decide to experiment with these pigeon alternatives, notice how it feels to strengthen your hips instead of passively stretch them in this classic pose, and enjoy the benefits that these new movements offer to your body and mind! (Also be sure to check out the further reading resources listed below these videos...)

**Related: Keeping Your Yoga Teaching Current Online Training

 
 
 

Further Reading & Exploration

Blog Post: Resistance Stretching with Charlie Reid & Jules Mitchell

Related Online Workshop by Jenni: Re-Imagining Hip Openers: A Yoga Anatomy Workshop

Related Online Class by Jenni: Hips-Focused Practice #2

Related Blog Post by Jenni: Stretching Is In Your Brain: A New Paradigm of Flexibility & Yoga

Super Cool Anatomy Fact #53

 

(This is a little factoid that I shared on my yoga FB page, and I thought I'd also share it here on my blog because it's a pretty important concept for yoga teachers to understand. It's not a full blog post like my usual ones, but I have some more of those coming soon. :) )

SUPER COOL ANATOMY FACT #53: You probably know that your muscles move you around, but did you know that your connective tissue plays an important role in moving you around too? It's harder to picture because we know that our connective tissue doesn't actively contract like our muscles do. But our connective tissue actually stores what's called *potential energy* when it lengthens.

Think about this frog here. When this frog decides to jump, it first moves into a crouch, which stretches its tendons & other connective tissues, loading them with potential energy. When the frog releases this position, it certainly uses its *muscles* to propel itself forward, but its jump is hugely enhanced by the stored potential energy that was loaded into its connective tissues. It would never jump as impressively far if it didn't have its spring-like connective tissue to propel it much further than its brute muscle force alone could.

We humans rely on properties like this when we move too. It's therefore important to keep our connective tissue healthy for optimal energy storage and force transmission. One great way to cultivate healthy connective tissue is to integrate active stretching into your yoga/movement practice. When we strength-train our tissues at all ranges, we signal our connective tissue to grow stronger and stiffer ("stiff" being a good thing when we're talking about connective tissue!) We don't create healthy, efficient tissues by pulling on them and trying to make them longer - we create strength and resiliency in our tissues by making them stronger at all ranges.

Try thinking less about "length" and more about strength and efficiency in your yoga/movement practice and see if your flexibility magically improves anyway! My new hamstrings-focused online yoga practice is a great place to start if these ideas are newer to you. :)