Breathing—A Physical Therapist’s Perspective


Breathing…. Should be easy, right? As it turns out, it is not as easy as one would think. And breathing while exercising? Even harder. Inherently, our bodies know how to do it, but sometimes things get in the way of doing it effectively. Underlying diseases or conditions such as Asthma, COPD; tightness to muscles and joints; and anxiety are some causes I have seen to prevent optimal breathing. Why is optimal breathing important? My journey in treating patients and clients as a Physical Therapist/ Pilates Instructor says it’s very important. And sometimes the most important exercise I first teach my patients’/clients’.

Over the years, I have treated many people with spinal conditions with back, neck, and rib pain. A majority of them have poor movement in the areas of the spine and ribcage, and poor breathing patterns. This can add to pain and feelings of stiffness in the back and neck. The spine is like a bicycle chain. Each link must do its part. When certain areas of the spine and ribcage become tight, there is overuse in the other areas and often pain. MINDFUL breathing as an exercise can help improve mobility, decrease tension by making the chain link work evenly, and help with reducing anxiety by mindfully focusing on the breath. This is not a new concept, however I feel one that is going to be more important to teach as stress in on the rise; anxiety on the rise; and the trend towards more immobility is on the rise with many working from home.

I use a combination of what I have learned with breathing thru my Physical Therapy experience as well as training as a Stott Pilates Instructor to take clients thru various breath exercises to work on any area of tightness in the spine and ribs; and then progress them to learning how to perform spine strengthening exercise while breathing effectively. Depending on my client’s needs this is often the first thing I do to center them, get their minds to calm and gently get them moving.


Start by sitting in a chair with your back supported, feet on the floor, hands in lap relaxed, jaw relaxed , mouth closed or gently open and then close your eyes.

First, I want you to take a deep breath and let your focus go to your lungs and how they lift up on the inhale, and then notice how your lungs and shoulders drop on the exhale. Do this at least 3-4 times. Be mindful of where you feel the breath move into your lungs and ribs.

Second, I want you to place your hands on your belly and breathe 3 times and let your breath go a little bit more to where your hands are; then hands go to the lower/outsides of your lungs. Do the same 3 time breath sequence thinking about your ribcage moving forward/sideways and backwards. Then the last position is with the hands to the upper chest just below your collar bones. Focus on sending the breath to those areas while being careful to keep tension out of the neck and jaw.

Once you have practiced all the areas, once again take a full breath without lifting the neck/shoulders and just visualize the breath moving to all the areas of your lungs and then visualize a balloon deflating as you push the air out. Try to let all tension go on your exhales. Perform this 3-5 times. Try this once a day or any time you are feeling you need a stress time out!

Debra Sawicki , MPT, Certified in STOTT PILATES®