Leaving aside the profound effects of breathing pattern disorders on emotion and general health – individuals with poor posture (Lewit 1980), scapular dyskinesis (Clifton-Smith 2011), low back pain (Roussel et al 2007), neck pain (Kapreli et al 2009) and TMJ pain (Hruska 1997) – have all been shown to exhibit signs of faulty breathing mechanics, where the accessory respiratory muscles dominate over lower thorax and abdominal motion.

McLaughlin et al (2011) has demonstrated a connection between neck pain and poor respiratory chemistry that improved, together with reduced pain levels, following a program to address breathing dysfunctions alongside manual therapy to address thoracic cage mobility.


  • Reduced spinal support is observed during combined load challenge to the low back and during breathing challenge (e.g., digging) (McGill et al 1995)
  • After ± 60 seconds of over-breathing, both postural (tonic) and phasic functions of the diaphragm and transversus abdominis are reduced or absent (Hodges et al 2000)

Breathing retraining is not difficult – nor does it need to be time consuming
….and it is usually very successful in rehabilitating function and reducing or removing a huge variety of symptoms.
…and the key to the changes lies in learning how to exhale, because without effective exhalation, inhalation can never be optimal.

For many years I have taught pursed lip breathing methods – and advise two sessions daily lasting 4 to 5 minutes – comprising 30 cycles on inhalation/exhalation with emphasis on the latter being slow and complete (i.e. a pranayama yoga pattern)

More recently evidence has emerged of the value, in some cases, of following a similar pattern (30 cycles 2x daily) but using ‘power breathing’ where inhalation is against resistance (Janssens et al 2015)


In this study:

  • Individuals with nonspecific chronic low back pain (NSCLBP) have been shown to have suboptimal proprioceptive postural control (PPC) . 
  • NSCLBP is also strongly related to respiration and PPC is commonly impaired with compromised respiratory function.
  • Individuals with NSCLBP have increased diaphragm fatiguability as well as decreased lumbar proprioceptive sensitivity.
  • Breathing training used inspiratory resistance of 60% of maximal inspiratory pressure x 30 times, x 2 daily, for 8 weeks.
  • Compared with the controls, the inspiratory muscle training group demonstrated better postural control; increased inspiratory muscle strength; decreased LBP
  • Breathing retraining involved POWERbreathe Medic (HaB International Ltd., Warwickshire, UK), with the individual standing upright with the nose occluded
  • Resistance was added with each breath generating negative pressure of 60% of Pimax (maximal mouth pressure)
  • Participants performed 30 diaphragmatic breaths, 2 x daily, 7 days per week, for 8 weeks at a rate of 15 breaths per minute
  • Results showed increased reliance on back proprioceptive signals, improved inspiratory muscle strength and reduced severity of LBP

Successful breathing rehabilitation involves the following key elements:

  • Understanding the processes – a cognitive, intellectual awareness of the mechanisms and issues involved in BPDs and postural influences
  • Retraining exercises & protocols, including aspects that operate subcortically, allowing replacement of currently habituated patterns with more appropriate ones
  • Biomechanical structural modifications that remove obstacles to desirable and necessary functional changes
  • Time for these elements to merge and become incorporated into moment-to-moment use patterns

Read about this book at:




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  • Hodges P et al . 2000 J Physiol. 522(Pt 1):165-175
  • Hruska R. 1997 Influences of dysfunctional respiratory mechanics on orofacial pain. Dent Clin North Am. 41(2):211-227
  • Janssens L et al (2015) Inspiratory Muscle Training Affects Proprioceptive Use and Low Back Pain.
    Medicine & Science in Sports & Exercise. 47(1):12-19Kapreli E 2009 et al. Respiratory dysfunction in chronic neck pain patients. Cephalalgia. 29(7):701-710
  • Lewit K. Relationship of faulty respiration to posture, with clinical implications. J Am Osteopath Assoc. 79(8):525-528
  • McGill S et al.1995 Ergonomics. 38:1772-1792
  • McLaughlin L et al 2011 Breathing evaluation and retraining. Man Ther 16:51-52
  • Roussel N et al 2007. Low back pain: Climetric properties of the Tredelenburg test. J Manipulative Physiol Ther. 30(4):270-278