Top 5 Fridays! 5 Cues to Assist with Breathing Education | Modern Manual Therapy Blog

Top 5 Fridays! 5 Cues to Assist with Breathing Education

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Recently a reader from Down Under said he had some difficulty with cuing diphragmatic breathing. You can review a previous Top 5 Fridays I wrote on why diaphragmatic breathing may not be right for your patient (yet).

In the meantime, here are 5 (and more ways) to Cue Proper Breathing Patterns. Remember, breathing is a learned habit, and as such is context dependent.

1) Breathe slowly, but NOT deeply

  • most assume that deep breathing leads to relaxation, for some maybe, for others it may be overbreathing
  • as a review, overbreathing is giving off too much CO2, so the ETCO2 levels as measured by a capnograph (like the Capnotrainer) are lower than the normal measurement levels of 35-45 mmHg
  • since the pH of interstitial fluids, lymph, and the bloodstream are all regulated by the H-H equation (bicarbonate/CO2), having levels of CO2 that are too low can produce many unexplained symptoms
  • breathing slowly is more relaxing, however, it should not be forced, nor should it be too deep, as it may give off too much CO2
  • without an objective measurement, you will have to experiment with the patient at different rates, with pauses at the exhale and inhale possibly to find their most efficient breathing pattern
2) Breathe as quietly as possible
  • place headphones on the patient to block ambient sounds
  • instruct them to breathe as quietly as possible, the extra sensory feedback of increased auditory cues helps them use less effort for breathing
  • less effort often leads to more efficient breathing patterns and helps break a sternal breathing pattern
3) Stop negative thoughts about your breathing
  • you will not know how someone views their breathing until you ask them about it more in your subjective
  • often, those with breathing pattern disorders or who are overbreathing complain of an "air hunger" type loss
    • they feel they are not getting enough air
    • the solution is to breathe more deeply, thus contributing to lower ETCO2 levels, not higher
  • instruct them while that CO2 levels can be changed within 60 seconds or so, thus the ability to rapidly change the physiology and balancing the pH of almost every fluid in the body
  • empowering them may make them see breathing in a more positive light and stop catastrophization
  • have them imagine positive thoughts, persons, places, or things while they are breathing
4) Take smaller breaths, do not worry about how fast or slow
  • again, overbreathers often feel they are not getting enough air, but often need to shorten their breaths
  • most (including myself when first hooked up to a Capnotrainer) are surprised that their resting breaths can be very short with a slight pause at the exhale to maximize ETCO2 levels
  • again, without an objective measurement, it's more experimental with different rates as to what best reduces the patient's complaints
  • as a pattern, most patients will have to take much shorter exhalation than they thought, and/or inhalation
  • try it especially with a headache patient that comes in highly sensitized and unlikely to want or benefit from traditional OMPT
  • lying on top of a hotpack and working on slightly faster breathing rates with pauses at transitions between exhalation and inhalation is very powerful
5) Increase the transition between inhalation and exhalation
  • many patients with breathing pattern disorders abort their exhalation, meaning they start inhaling again before they should without a transitional pause
  • the transitional pause at inhalation allows for more gas exhange, and the transitional pause after a short, but effortless exhale makes sure to regulate the rate, as overbreathers who abort the exhale often are unable to control their breathing rate steadily over time
  • vary the time at 2-8 seconds of transition to let the CO2 accumulate
    • in my experience, most are not comfortable without significant practice with a longer than 2 second transition time

Remember, even with all these cues and education, you still may need to prep the body mechanically for proper breathing patterns. Here is a post of mine with links to other bloggers excellent writings on the Importance of Treating Breathing Pattern Disorders. Here is a post with some manual techniques that may assist with diaphragmatic breathing.

Btw, EDGE Mobility System is now selling Capnotrainers, if you are interested, contact me or visit the page!

Keeping it Eclectic...


  1. Great post. Have had some great success with the 4-7-8 (inhale-hold-exhale) breathing technique used in many recovery and regeneration performance programs including Stanford Athletics.

  2. Thanks John. I haven't heard that, but after my studies with Better Physiology, I would have a hard time giving someone with a breathing pattern disorder something so static. That would be like 3x10 for all resistance training exercises.