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Paradoxical Breathing

Many times, in my pain clinic, I would see people who, from the first moment they walked in, I could tell were stress breathers.  The signs were all there.

The subtle movement of their shoulder girdle, as they used accessory muscles for respiration, rather than their diaphragm.  The way they spoke, having not quite enough air for unhurried sentences.  The extra tension in their neck and shoulders.  Their feeling of pressing anxiety.

It would all add up to an unalterable fact: for them to really feel well and whole again, we were going to have to retrain their breathing.

It is a vital piece of the wellness puzzle.

One of the first things you learn as a biology student is the KREBS cycle, and how it regulates all energy in your body.

Something that is not driven home nearly as much is the far more useful fact of how breathing affects this cycle, and therefore our well-being.

It is the most obvious and subtle thing.

Even exceptionally light stress breathing can give you a feeling of being not quite in control.  Over breathing drops the carbon dioxide level in your blood, which slightly alters the pH level of your blood, which in turn affects the KREBS cycle and gives a general feeling of unwellness.

It can also hype up your adrenal glands, give you a feeling of dizziness, racing heart, air hunger, and half a dozen symptoms which all add up to you feeling awful most of the time.

It is a natural addition to having pain in an area, or stress.  But over time, unnatural breathing patterns start to become a major pain driver on their own.


With paradoxical breathing the chest and abdominal functions oppose each other.  On inhalation, the chest expands (moves up and out) while the abdomen moves in, elevating the diaphragm and decreasing lung volume. 

Another term for paradoxical breathing is chest breathing.

Chest breathing appears when body oxygen and CO2 levels become too low. As shown in the table below, chest breathing is even more common for people with chronic diseases, who breathe too deeply at rest.

More than 90% of sick people have upper chest breathing with increased minute ventilation, respiratory rates, and minute volume (i.e., automatic deep breathing at rest or taking too much air per one breath). Thoracic breathing causes four fundamental health effects that promote chronic diseases and lead to low body-oxygen levels.

Upper chest, reverse or paradoxical breathing causes pain and muscle dysfunction

Janet Travell, MD suggests that Reverse breathing may a source of the following
Upper chest breathing reduces blood oxygenation

The textbook, Respiratory Physiology (West, 2000), suggests that the lower 10% of the lungs transport more than 40 ml of oxygen per minute, while the upper 10% of the lungs transport less than 6 ml of oxygen per minute. Hence, the lower parts of the lungs are about 6-7 times more effective in oxygen transport than the top of the lungs due to richer blood supply mostly caused by gravity.

During thoracic breathing, lower layers of the lungs, which are most valuable in oxygen transport, get much less, if any, fresh air (less oxygen supply). This causes reduced oxygenation of arterial blood in the lungs and can lead to the so-called “ventilation-perfusion” mismatch (as in COPD or emphysema). Normal breathing is diaphragmatic, allowing homogeneous inflation of both lungs with fresh air, similar to what happens in the cylinder of a car engine due to the movement of the piston. Hence, during diaphragmatic breathing, all alveoli are homogeneously stretched vertically and get fresh air supply with higher O2 concentration for superior arterial blood oxygenation. In contrast, chest breathing creates problems with blood oxygenation. This leads to reduced cell oxygenation: the driving force of all chronic diseases.

Thoracic breathing causes lymphatic stagnation

Dr. Shields, in his study, “Lymph, lymph glands, and homeostasis” (Shields, 1992) reported that diaphragmatic breathing stimulates the cleansing work of the lymph system by creating a negative pressure pulling the lymph through the lymph system. This increases the rate of elimination of toxins from visceral organs by about 15 times. Why is this so?

The lymph system, unlike the cardiovascular system with the heart, has no pump. Lymph nodes are located in parts of the human body that get naturally compressed (squeezing) due to movements of body parts. For example, lymph nodes are located around the neck, above the armpits and groin area. Hence, when we move, stretch or turn the head, arms and legs, these lymph nodes get mechanical stimulation to push the lymph through valves. This is how the lymphatic system works. However, the lymph nodes connected to the stomach, kidneys, liver, pancreas, spleen, large and small colons, and other vital organs are located just under the diaphragm – over 60% of all lymph nodes in total!

Hence, nature expects us to use the diaphragm in order to remove waste products from these vital organs all the time – literally with each breath, 24/7. Hence, another problem with thoracic breathing is a stagnation in the lymph system and the accumulation of waste products in vital organs located under the diaphragm. (This effect is also mentioned in other sources, for example,

Thoracic breathing means low blood oxygen

People who are chest breathers always have deep breathing (large breaths) at rest or sleep and suffer from hyperventilation (breathing more than the norm). When we breathe more air, we get less oxygen in body cells. In fact, the slower your automatic breathing pattern at rest (down to only 3 breaths/min), the larger the amount of oxygen is delivered to your cells.

While healthy normal breathing is abdominal or diaphragmatic, it is very small in amount (only 500 ml of air per one breath at rest) so that healthy people usually do not feel their breath.

Find your type of breathing at rest

When you breathe during rest, do you breathe through your diaphragm or your chest? Find this out by doing the test below.

Easy test. Put one hand on your abdomen (or stomach) and another hand on a higher position—on your upper chest (see the picture on the right). Relax completely so that your breathing dynamic has little changes. Pay attention to your breathing for about 20-30 seconds with both hands in place. (You want to know more about your usual unconscious breathing and find out if you have chest or abdominal breathing.) Take 2-3 very slow and deep breaths to feel your breathing dynamics in more detail.

Now you know more about your usual breathing pattern. In order to be certain, you can ask other people to observe how you breathe when you are not aware of your breathing (e.g., during sleep, while reading, studying, etc.).

Learn how to stop upper Paradoxical, Chest or Thoracic breathing:

1.  Lie on your back.
2.  Place one hand on your chest.
3.  Place the other hand on your belly.
4.  Breath in deeply, pushing your belly high (just like a baby inhales).
5.  Hold for 3 seconds.
6.  Exhale slowly, sucking your belly button into your spine.
7.  Hold for 6 seconds.
8.  Repeat for 10 or more times.

Now stand and repeat this process.

Next, walk and repeat this process.

Now, sit and repeat this process.

This will be a difficult change and will likely take 1 week to 6 months to learn.
I suggest you put post it notes around to remind you.
It took me three weeks to learn.

When you sleep, your body does this perfectly.

The immediate result is your scalene muscles in your neck will return contractions by 18,000 contractions.  
Reduced headaches, arm pain, etc.

Steve Maschmeyer