Strengthening muscles that normally receive little attention can make a monumental impact on your client’s health. For example, it is common to encounter an athlete with a chronic ankle problem. Every time that athlete injures an ankle, he/she goes through the process of healing and usually follows with a series of stretches to lengthen the injured tissue. Heat and massage are beneficial components of this recovery because they are key contributors to relaxation and circulation of and around the injured ankle. However, if this athlete does not continue his or her care with an ankle strengthening program, then he/she is sure to re-injure that same ankle. Strengthening is not something that applies only to athletes, it applies to everyone. Muscle development and strengthening are key to ensuring the integrity and longevity of our lymph and circulatory systems, our internal organ functions, our axial skeleton and our overall health.
One of our forgotten, yet essential, muscles is the diaphragm. The diaphragm is the large muscle just posterior to the rib cage that is used for respiration, and it is often disregarded as an involuntary muscle. Doug Alexander reminds us about the connection between diaphragmatic breathing and our health in the article “Coaching Your Clients,” published in the Summer 2005 edition of The Massage Therapy Journal.
Mr. Alexander explains a typical pattern called “apical” breathing. This is a tense pattern of breathing in which the diaphragm muscle is used less, while the neck and shoulder muscles are primarily relied on for respiration. Apical breathing recruits the upper trapezius, levator scapula, scalenes and sternocleidomastoid muscles for every breath taken. Repercussions of this type of breathing can be decreased oxygen intake and tightened, and thus shortened, neck and shoulder muscles. As many massage therapists are aware, these tightened muscles can lead to temple headaches, upper back, neck and shoulder pain, and the emotional state of carrying the world’s stresses upon one’s shoulders.
Learning to use the diaphragm for respiration can add a great deal of benefit to the health of your apical breathing clients. “Diaphragmatic breathing is inherently relaxing. It slows the body’s metabolism down, and draws the nervous system into a rest and relaxation mode,” says Mr. Alexander. “Good times to practice diaphragmatic breathing are at the beginning and end of the day; it can help us start the day with a feeling of relaxation and ease. At the end of the day, diaphragmatic breathing releases tension and helps set the state for deeper, more restorative sleep. Without this diaphragmatic practice at bedtime, apical breathers will go to bed with tense neck muscles, and then spend all night using their neck muscles to breathe, rather than relax and recover from the stresses and strains of the day.”
Restoration of normal abdominal (diaphragmatic) breathing can be accomplished by coaching your clients to engage their diaphragm. Have your client in a supine position while he/she places one hand on his/her belly (below the umbilicus), and one hand on his/her chest. Upon inhalation, have your client focus on belly expansion by being aware of the belly hand rising. Inhalation continues until he/she feels movement of the other hand on his/her chest. During the exhale, have your client focus on belly deflation, with that hand sinking towards the spine. This exercise can help strengthen diaphragmatic breathing. However, it may not be enough to break the cycle of apical breathing. Many apical breathers have difficulty learning to use their diaphragm (and thus strengthen it), or they forget about breathing into their belly when under stress.
Donna Fahri found that strengthening the actual diaphragm muscle can effectively break the apical breathing habit. In Fahri’s book, The Breathing Book, she suggests a diaphragm awareness and strengthening technique called sandbag breathing. Sandbag breathing uses a soft weight such as a sandbag, bag of rice or soft ankle weight on the belly, just below the umbilicus. According to Mr. Alexander, this weight “…increases the pressure inside the belly and places a gentle stretch on the diaphragm, causing it to dome upward slightly further into the thorax.” With your client supine, instruct him/her to gently push the sandbag up towards the ceiling with each inhalation. After a series of 10 sandbag belly breaths, Mr. Alexander advises his clients to allow the bag to slide off their belly. At this point they usually notice that they are unconsciously using their diaphragm more with each breath they take.
This diaphragmatic strengthening exercise can be slowly increased to include more repetitions, and can even include more weight. Adding more weight to the sandbag must be done slowly and gradually, as the diaphragm can become sore and fatigued from this exercise. Mr. Alexander says that when his clients do this daily for a few weeks, they naturally use their diaphragm more consistently when breathing. The more belly (or diaphragmatic) breathing a client does, the more rigidity is unloaded from his/her neck and shoulder muscles. Rigidity is reduced because the neck and shoulder muscles contract less, and thus, relax more.
While most people may not think of strengthening the diaphragm as an important component of health, Mr. Alexander helps us see that it is. Regular belly breathing can originate with the practice of strengthening the diaphragm muscle, and its rewards are multi-faceted. The benefits of increasing lung capacity with the expanded breath of belly breathing and the non-recruitment and thus relaxation of the trapezius, levator scapula, scalenes and sternocleidomastoid muscles can positively benefit any client’s health – especially those that have neck and shoulder tension.