breathe – Essential Physical Therapy

July 14, 2020August 19, 2020

The Most Misunderstood Molecule, and How to Harness Its Power

Deeper, quieter, regular, slower.

Those are the general guidelines for focusing our attention on the breath. This awareness makes us feel calmer, more relaxed, and releases tension from our bodies.

But How? Why does changing our breath change our mood, and many other factors?

Research has shown that slower, deeper breathing reduces heart rate and risk for cardiovascular disease, as well as improves athletic performance. (yes, all you athletes out there, breathe slower to go faster).

The reason all these magnificent changes occur within us when we deepen our breath, especially our exhales, is because of a very special molecule that usually gets a bad rap.

I’m talking about good old carbon dioxide, CO2.

I know what you’re thinking…is she talking about the very same carbon dioxide that we are trying to reduce in our atmosphere to slow global warming? The same carbon dioxide that is considered a waste product of our bodies- something useless to to be rid of as soon as possible?

Well, yes, I am.

But what if I told you that this special little molecule was not only a useful component in improving your health, but an essential one for you to be able to thrive?

You see, for our bodies to get oxygen from our lungs to our tissues, we need carbon dioxide. To get a proper inhale, our receptors in our neck need to sense a certain amount of carbon dioxide in our bodies.

Not to mention, carbon dioxide is stored as bicarbonate in your blood stream, which is essential for maintaining the pH balance of your whole body.

Did I mention that carbon dioxide is critical in weight loss? Most of your body mass lost is due to breathing out carbon dioxide. In fact, more than 80% of weight loss is due to breathing out CO2, and only 15% or so is lost via sweat and urine.

So, if you’ve been dieting, exercising, doing all the right things and still not losing weight… you may want to look at how you’re breathing.

Let’s explore some of these in a little detail…

Firstly, how the heck does carbon dioxide help your body get more oxygen?

Think of carbon dioxide as the Fedex guy, and oxygen as your packages. When outside air hits your lungs, it makes it’s way down to alveoli, the tiny air sacs that interface with the blood stream. The oxygen molecules (packages) get loaded from the alveoli onto the red blood cell, which in this analogy is the Fedex truck.

The truck travels all over the body, delivering oxygen to all the cells as they all need oxygen to survive and flourish. When exercising, certain muscles need even more oxygen more quickly.

This is where our good buddy carbon dioxide comes in.

Oxygen cannot get off the truck unless there is a carbon dioxide molecule there to unload it.

When the oxygen gets to its destination, the carbon dioxide triggers the packages (oxygen) to be unloaded off the Fedex Truck (red blood cell), and be delivered to the cells (your mailbox).

The more carbon dioxide present, the more efficiently the oxygen can be offloaded to cells.

So, when you’re exercising and you really need to get oxygen to those tissues, perhaps try breathing slower instead of faster.

Why does the amount of CO2 in your body determine how you inhale?

I’m constantly telling my patients, don’t worry about the inhale! If you get a good exhale, the inhale will just come.

This is for two reasons, the first of which is purely mechanical.

When you exhale completely, the lungs become essentially “empty” of air, which creates a vacuum. New air has to flow in. It must follow the laws of nature! It must flow from the higher pressure (outside your body) to the lower pressure (inside your lungs). You don’t have to use your accessory muscles (aka your neck) to pull air in, it just goes in! Easy.

The second reason is neurological.

Deep in the reptilian brain, the most primal part of our brain that was present when the first creature crawled out of the primordial goo and decided to walk on land, there is a simple neural network that says, “breathe.”

This network senses levels of oxygen and CO2 in your body to decide when to inhale or exhale. Basically, when your body senses a certain level of oxygen in your body, that circuit makes you exhale. Similarly, when a certain level of CO2 is sensed, the circuit makes your body inhale.

Unfortunately, for many of us, this circuit gets messed up.

We breathe shallowly because we are less active, or stressed, or both, and we do this so much that we end up overriding the part of the circuit that senses CO2 and tells you to inhale.

We get stuck in this cycle of inhaling without ever getting to the bottom of our breath; we lose that primal trigger to inhale, so our inhales get all wonky, a.k.a. you end up pulling your ribcage up with your neck.

In addition to all these important factors, carbon dioxide is the main reason that you feel relaxed with deeper breathing.

Carbon dioxide makes you chill out.

Think about it. What do they tell you to do when you’re having a panic attack? Breathe into a paper bag. You’re breathing back in the CO2 you exhaled. Get that CO2 flowin’ baby!

Carbon dioxide relaxes you by causing your blood vessels to relax, which allows blood to deliver oxygen to all your tissues more easily.

Also, as mentioned above, CO2 lets your body unload oxygen from red blood cells to tissues.

These two factors together mean that your brain gets more oxygen and blood flow. This tells your body that you are safe, and you feel calmer and, well, more chill!

So how to insure that you get more CO2, but not too much?

The answer is simple, and I think you know what I’m going to say.

Breathe deeper, quieter, regular, slower.

5-6 seconds for each inhale and exhale, resulting in about 5-6 breaths per minute, is the ideal for balancing the CO2 and O2 in your body.

Below is a short video on how to do just that and harness the power of this special molecule.

Are you ready to breathe better to move better, to improve the health and resiliency of your lungs without any medication or procedures? Click the button below to find out if will benefit from working with Dr. Derya.

Book a FREE WellBody Screening Session

References

Aakash K. Patel; Andrew Benner; Jeffrey S. Cooper. Physiology, Bohr Effect.
https://www.ncbi.nlm.nih.gov/books/NBK526028/

Anders Olsson Blog https://www.consciousbreathing.com/anders-olsson/carbon-dioxide-training-extremely-harmonious/

Nestor, James. Breath: The New Science of a Lost Art. May 14, 2020 http://www.pathwaymedicine.org/control-of-respiration

June 24, 2020June 24, 2021

Why Is It So Important to Learn to Exhale?

Wait a minute, I already know how to exhale. I do it hundreds of times a day, without even realizing it! Why would I need to learn how to exhale?

Good question.

As I work with my patients, the comment I often get is, “wow, I didn’t realize that I was never really exhaling!”

But how can that be? Read onwards, my friend, and I’ll explain it all.

When we breathe, we have many degrees to which we can move air in and out. There is simple survival breathing, which is just enough air to keep us alive, some may call this a “shallow breath.” This is how many of us breathe when we are still and not moving.

If we spend a lot of time still and not moving, or if we have life events that put our nervous system in a state that tells us we are not safe, and we should be as still as possible as a survival mechanism, we can get stuck in a shallow breath.

“Form follows function and function follows form” is a tenet of how our physical structure adapts to our environment. When we don’t breathe deeply, our ribs and surrounding structures don’t move. When our ribs don’t move, it’s harder to breathe well.

Oh, well the solution to that is easy, just breathe deeper!

For some reason, our common societal belief is that to breathe deeper, we need to take more air in.

While this is true for some people, it’s definitely not true for many. And, almost EVERYONE needs to first get air OUT before you can effectively get air back in.

This Ribcage is Too Big!

Some ribcages are “hyperinflated.” Barrel-chested, military posture, ribs pushed up in the front, all these positions indicate that there is some dead air hanging out in those lungs, for who knows how many years.

How are you supposed to get new fresh air in if your lungs are already full of dead air?

These people can’t get air OUT.

Think of it this way. Your lungs are a balloon (this is a gross analogy, but just go with it 🙂 ). You fill the balloon with air (inhale), then let a tiny bit out (exhale). Next breath, you need to fill the balloon with air again because you need oxygen to survive. But still, you let out just a little. Over time, that balloon will get bigger and bigger, despite feeling like you need more and more air!

Of course it would feel like you need to inhale, because each breath in is so small since those lungs are already packed full. But what you really need to do is get that dead air out!

Getting a complete exhale, all the way to the bottom, gets that dead air out. For these individuals, when they feel that they have exhaled completely, they are often surprised to find that there was still more air in there to exhale.

Once that dead air is out, the ribcage and diaphragm positions can return to normal, and functional breathing can be restored.

This Ribcage is Too Small!

Some ribcages become rigid and small, collapsed in on themselves. They can’t get air in OR out. Their diaphragms can’t do the magnificent action they were designed to do, simply because there is no room to do it.

People with this kind of ribcage absolutely need to invite some expansion into their lives, but in order to do that, a diaphragm needs to be awakened and revitalized.

Achieving a complete, relaxed exhale triggers the reptilian brain to restore the breathing pattern that is primally wired within each of us.

Getting all your air out in a relaxed way is like a reset button for your nervous system.

When you reset in this way, you don’t need to try to get air in, it just flows in! You may need to do some specific exercises to open and expand your chest wall and lungs and bronchi (in certain places and directions, but I won’t get into all that here), but by simply getting your air out, you’ve already done an amazing thing for your whole system.

How does air just “flow in” after a complete exhale?

When you exhale completely, you let all the air out of your lungs. This creates a vacuum- air HAS to flow into that space due to the laws of physics- air will flow from an area of higher pressure to lower pressure.

It’s like when you open a hot oven and all the heat blasts out- the high pressure hot air must flow into the lower pressure cooler room. You don’t have to do anything the make the hot air flow out, you can’t even stop it flowing out! It just happens.

When we try to actively pull air in, we end up using accessory muscles, i.e. your neck. Just trust me on this one, you don’t want to breathe with your neck. Your neck has enough work to do already managing your head on the rest of your body. Using your ribcage to breathe is a much better way to go.

This Ribcage is Juuuust Right.

The human body is an amazing design! Sometimes it’s just hard to get out of our own way and let it do what it needs to do.

Allowing air to move out completely has so many more benefits than simply restoring ribcage and diaphragm position (although the restoration of those contributes to all these other factors I will share with you).

Benefits of Exhaling Well

Decreased heart rate (by stimulating “rest and digest” nerve fibers).
A more balanced inhale to exhale ratio, which reduces stress levels.
Reduced states of hyperinflation.
Improved digestive action of the gut.

So the question is, why wouldn’t you wan to exhale well?

Remember, exhaling is about softening, releasing, and letting go. Sometimes (or a lot of the time?) this can be harder to do than tensing, clinging, and holding on. So give yourself some patience and grace as you work towards a fuller exhale, and eventually a more expansive breath (and life!) as a result.

Here is a short video on how to get some air out, based on the primary breathing method from the Postural Restoration Institute, or PRI for short.

Be well, my friend!

Kindly,

Dr. Derya

May 18, 2020August 19, 2020

Improve Your Breath to Improve Your Life

I used to hate hiking and running. I was always the slowest one, gasping for air, my neck and shoulders for some reason aching and killing me. I could really relate to the term “sucking wind.”

It just felt like I couldn’t get enough air.

Even when I would diligently hike and run more often, I never got a sense that I could breathe better. I was getting better conditioned, but it always felt very hard. I didn’t understand why, even though I trained regularly, friends of mine who hardly ran or hiked at all would zoom past me up the trail.

I thought, “there must be something wrong with me.”

After I had a pretty severe bike accident, my symptoms became much worse. Instead of just feeling out of breath, when I got left behind in the group my lungs would literally close up. I couldn’t breathe. I thought I might die. “Is this asthma?” I thought.

These days, I am the one zooming up the trail.

I surprise myself at how sometimes, even after I haven’t been training at all, I can easily hike or run without getting out of breath. I never get that feeling of my lungs closing up. Now it’s way more enjoyable to run and hike, and I look forward to it! I feel that I am getting fitter and can go further each week.

So what was going on with me?

Two things. The first was poor lung compliance and perfusion, a.k.a. my ribcage and therefore my lungs weren’t moving well, which didn’t allow me to exchange enough oxygen into my blood stream.

So, even though I was constantly exercising, my tissues weren’t getting the oxygen they needed. No wonder I always felt out of breath!

Turns out the reason my neck and shoulders hurt while hiking and running was because I was trying to pull air in with my neck! My ribcage, lungs and diaphragm weren’t working well together to pump air efficiently in and out, so my neck and shoulders decided to take over.

The second thing holding me back was trauma.

Since my bike accident, if I exerted myself too much, especially with other people around, my body would go into a state of “freeze.” I would check out mentally, close off socially, my lungs would seize up and I would have to sit on the floor and gasp until I could get up again. I think some people might call this a panic attack.

I know now that my ribcage mobility and my trauma were related.

Because I didn’t breathe well in the first place, it was harder for me to breathe and sense the fluctuating rhythms in my body.

Through a lot of trial and error, I eventually found that PRI techniques, in addition to working with a skilled somatic therapist, I was able to overcome both of these obstacles. And because of the huge impact it has had on my life, I now I help others do the same.

The way our bodies work is NOT like a mechanical machine.

We can’t pretend that a breathing issue only affects our lungs. We are constantly affected by what’s going on inside of us and around us, both physically and mentally. We need to be able to shift side to side in our lungs, our bodies, our minds, and our spirits. Stuck ribcages prevent lungs shifting. Stuck mindsets prevent bodies shifting. Stuck beliefs and trauma prevent our spirits from shifting.

The reason overcoming stuck patterns in the body and mind is difficult is because it’s about softening and letting go.

This means allowing air in and out instead of forcing our bodies to breathe a certain way. Releasing tension instead of holding on.

So many of my patients struggle with softening and letting go (myself included).

If I tell someone to tense a muscle, they can almost always do that. But if I ask them to soften and relax a muscle, it is much harder.

Similar to how our muscles become rigid, our minds can do the same thing. Here’s an example:

Someone asks you about an issue that you are strongly against. Very likely, you get worked up and talk fervently about all the reasons you think it is wrong. But if you are asked to see where the other person is coming from, and why they might feel the way they do, it will probably be much harder for you to give an answer.

This is just one way we become rigid- with our beliefs. It’s much harder to change the way we think about something than it is to keep thinking what we always have.

Can changing the way our lungs move help us overcome trauma?

Trauma is a state of being disconnected from our bodies. It’s a survival mode where there’s no room for feeling, because before our feelings were so terrifying and painful that we don’t want to risk going there again.

Trauma lives in our bodies, not in our thoughts.

We can’t think our way out of trauma. But we most certainly can feel our way out.

Sensing the breath is one way to sense our bodies again, which is the first step to overcoming trauma. We must learn to sense the ever-changing flow that is always occurring in our bodies. And at the center of our bodies lie our lungs, whose function is to manage flow. Flow of air in and out, flow of oxygen to our tissues, flow of byproducts back out into the world.

*Please note that sensing the breath is not appropriate for everyone who is working with trauma. So, if you find that noticing your breath feels uncomfortable for any reason, take a break for now and consult with a provider to help guide you in this process.

Our lungs remind us of how connected we are to everyone and everything around us.

We use our lungs to create air for our voice so that we can communicate with others. The carbon dioxide that we don’t need is expelled by the lungs to provide nourishment to trees and plants. And those very plants provide oxygen back to the bronchial trees within us.

As Pocahontas said,

“…we are all connected to each other
In a circle, in a hoop that never ends”

(Sorry, couldn’t resist the Disney reference!)

Do You Find Yourself Holding Your Breath?

When we don’t breathe, we don’t shift. When we don’t let go, we become rigid. Letting air out is an excellent way to start bringing flow back into your body via the breath.

Most people think of the inhale as the main part of the breath. But an inhale is only as good as the exhale before it.

Think of it this way. If you didn’t get all your air out, your next inhale will not bring in much fresh oxygen! There’s just not enough room with the lungs partially full of old air.

Furthermore, if you don’t exhale all the way, your lungs and ribcage don’t get to move through their full range of motion. Now you are working towards rigidity in a pattern of half full lungs, and you are reducing the amount of flow in your body.

The less your ribs move, the less your diaphragm moves, the less massaged your gut organs get by the movement of your diaphragm, and you become more rigid in your digestion.

The less air you get out, the more your body shifts into a state of fear and tension.

Think of your lungs as a balloon. If you never exhale completely, that balloon keeps getting more and more filled with air, and you feel like you’re floating away from the ground. We need a sense of the ground to feel stable, supported, and, well, grounded!

One way to start creating more flow and learning to let go is by letting air out.

Notice that I didn’t say FORCING air out (which is what most of us tend to do). It’s about allowing the lower front ribs to soften down instead of cramming them down.

Here is a short video on how to find an exhale breath that will get your ribs and lungs moving again.

Think of this breath as a sigh. Like you’re getting into a hot bath, or arriving home after a long day and sinking into a nice soft couch. “ahhhhhhh.” After that first delicious sip of an ice cold drink on a hot summer day, “ahhhhhh.”

If you like, take note of how you feel before and after doing this breath for about 5 rounds of 5 breaths. Has the quality of your breath changed? How about the quality of your mind? Your mood? You may be surprised by the results.

To take this a step further and work on sensing your body in addition to sensing your breath, practice also feeling the places where your body touches the chair, and/or where your feet touch the floor. Notice if you’re tensing your shoulders or your face, and see if you can soften there.

More and more throughout your day, be aware of what’s happening in your breath and your body.

Just noticing your breath, and not even trying to change it at all, is an incredibly powerful technique. You can watch your body find it’s rhythm again.

*Again, If doing this makes you feel anxious or uncomfortable, consult with a provider who can help you work through the process of getting back in touch with your body.

So if you’re like me, and you’ve been trying really hard to get better but things still don’t feel right, breathing and sensing might be the missing link.

Don’t underestimate the power of finding the flow in your lungs, your mind, your spirit. Trust me, I’ve been there, and I’ve made it to the other side. And I know that if I can do it, so can you!

If you want to work with me on this or just have questions on next steps, feel free to send me an email or leave a comment below. Derya@MyEssentalPT.com.

April 16, 2020August 19, 2020

How do I Release Tension From My Body? 3 Quick And Easy Ways to Relax

It was my second year of physical therapy school, and I was sitting in the white and beige lecture hall. The room emulated the newness and grandeur of the medical campus, but lacked character or color. The course title, “Musculoskeletal 101,” was stamped in the top right of the slides, and today’s topic was Managing Dysfunction of the Cervical Spine. I was bent awkwardly over my desk, furiously taking notes when I had to take a break because my neck was just killing me.

The irony of this was not lost on me.

Even though in physical therapy school I was learning about all the cool ways to crack joints and push and pull on muscles, the tension in my neck was inescapable. I was seeing a physical therapist myself, who would stick needles in my ropey neck tissue, and I was spending my precious study time rolling all around on tennis balls and stretching in all the right directions to “loosen up” my neck. While these things helped for a short while (and some not at all)

I couldn’t help wondering if there was another reason I was getting so tense.

Did I mention that physical therapy school is one of the most stressful things I have ever done in my life? Long commutes, sleep deprivation, assignments that took longer than the hours I had to finish them, projects and social dynamics, constant testing, hours of note taking, clinical rotations with high expectations… you get the picture. I don’t regret any of it, it was an invaluable experience. But I DO regret not having the tools to help me manage my stress levels, because it was taking a huge toll on my body.

Why Do We Get Tense?

We tense our bodies as a way to protect ourselves. It just so happens that high stress levels cause your body to perceive threat and therefore seek protection. Another reason we get tense in our necks, lower backs and hips is to hold ourselves up when our core is not functioning well. Guess what? Stress triggers us to shunt blood away from our core and to our arms and legs (because if there’s a threat, you better be ready to run!)

This is what I call the stress-tension one-two punch.

It’s the double whammy that stress has on causing tension in our bodies. The first blow is the initial tension you get directly from the stress hormones in your body that are readying you to fight or flee. The second comes from the compensatory way your body carries itself when in a stress state.

Hold on a sec! My stressful scenario wasn’t one where I had to fight or flee, I was just bent over my computer hacking away at a keyboard like a madwoman on a diet of coffee and energy bars. Why would my body have to ready itself for anything?

Tension and Stress

The thing is that your body doesn’t know the difference between the stress of being chased by a mountain lion or the stress of your boss adding an extra pile of work to your already overflowing inbox.

Stress is stress! The same hormones are released, and the same responses occur.

Our systems to manage stress are a primal instinct, present since we were “wild humans,” if you will, and the threat of having to fight or flee for your life was a more common occurrence. The steady drip of minor stressors (emails, traffic, alarm clocks, board meetings) did not even exist yet.

We are designed to manage a stressor that is an immediate threat – it is something that we deal with and then it’s over.

You either get away from the saber toothed tiger chasing you down, or you kill it, or you die. Done. Your system takes a few minutes to an hour to return to relaxed muscles, deeper breathing, and an active core. You can rest, digest, and hold yourself up properly.

When we have that steady drip of stress, however, our body doesn’t know how to get back to that baseline “rest and digest” state anymore.

We’re constantly juiced with stress hormones that make our body tense, despite how many physical therapists or chiropractors poke our muscles or push on our backs. To get rid of that tension, we have to get to the source.

We have to help our nervous system relax.

A Nervous System Reset

Even though we can’t always change the world around us, we can certainly change ourselves. You may not be able to change your work situation, your commute, or your other stressors.

But you CAN take small actions that reprogram your nervous system to quickly get back to that place of calm, and by doing so let go of tension in your body.

There are lots of ways to reset your nervous system. Below are three of my favorites because they are:

Easy to do
Fast
Effective

One way is by balancing the right and left sides of the body with your breath.

Balancing Breath:

sit comfortably. Bring your right hand index and middle fingers down, leaving the right thumb, ring and small fingers up (see video below if this is tricky for you!)
Cover your right nostril with your thumb, and exhale completely through your left nostril.
Pause for a 4 count, then inhale through your left nostril.
Cover your left nostril with your ring finger, pause for a 4 count, then exhale completely through the right nostril.
Pause for a 4 count, then inhale through the right nostril.
Pause for a 4 count, then cover the right nostril with your right thumb and exhale completely through the left nostril.
Continue with this sequence for about 6 breath cycles. Then rest.
Do this 1-2x/day.

https://youtu.be/c6ay8f6bJHk

Alternate Nostril Breath: a simple way to balance the body

Notice how you feel before and after doing this exercise. With some practice you can do this quickly and easily to help your body relax and release tension.

Cupping the Eyes

Did you know that how you see the world affects how tense your body gets? No wonder most people who work at a computer all day develop back or neck pain (or both)!

By letting our eyes relax, our nervous system gets an immediate signal that we are safe, and our bodies relax as a result.

Here’s how to do it:

Lean your elbows on a desk or table. Place your head in your hands so that the perimeter of your palm rests on the orbit (boney part around the eye). You don’t want any pressure directly on your eye.
Close your eyes, and stare into the darkness behind your eyes.
Try to make your field of vision very wide, like you are trying to take in as much of the view behind your eyes as possible.
Notice the gradations of light behind your eyelids. You will notice that it is not all black, but rather that there are different grades of blackness and lightness.
Focus on the darkest areas, see if they get bigger.
Tip: if you don’t notice any different gradation of blackness, just keep focusing on the wide view behind your eyelids.
Stay for 2-5 minutes, then come back by lifting your head and slowly opening your eyes.
Do this 1-2x/day.

How to do it: Cupping the Eyes to Help your Body Relax

Notice how you feel after. Try to connect with and remember in that feeling of relaxation in your body.

Breathe!

When we are stressed, our breathing becomes shallow and rapid. Chances are, if you’ve been stressed for a while, you haven’t taken a full breath in a looooong time. And when I say a full breath, I don’t mean getting a lot of air in, I mean getting air OUT!

That’s right, when we are breathing shallowly, it’s the lack of complete exhales that prevents us from getting new, oxygen rich air to our brain and other tissues. If you can’t get the old stuff out, you can’t make space for something new (that’s a good metaphor for life, too)!

Here’s how to do it:

Sit comfortably.
Place one hand on your lower front ribs.
Inhale quietly through your nose.
Exhale completely through your mouth, making an “ahhhhh” sound.
Pause 1-3 seconds at the bottom of your exhale before inhaling again quietly through your nose.
Repeat 4 breaths. Rest and repeat 4 more cycles of 4 breaths.
Do this 1-2x/day.

Like I said, I wish I had known these ways to de-stress when I was in physical therapy school. I knew stress mattered, but I didn’t realize the incredible impact it was having on my body!

I hope this article prevents you from having to endure chronic tension in your body, and from having to constantly seek ways to release tension. If you can find the wellspring of calm and ease within, the body will follow.