Paradoxical vs. Diaphragmatic Breathing: Learn Proper Breathing

A common pattern of incorrect breathing, paradoxical breathing, high chest breathing, chest breathing, thoracic breathing, accessory breathing, and reverse breathing. This type of breathing can be thought of as the opposite of the physiologically correct way to breathe.

Paradoxical breathing is marked by rapid, shallow breaths that make the shoulders rise excessively. The diaphragm, rather than the chest muscles, is the main muscle of breathing. The chest muscles and other muscles are ‘accessory’ muscles, which explains why high chest breathing is sometimes called accessory breathing, as noted above. This will be discussed further below.

Recommended: Guide to Stress Reduction by L. John Mason

The excellent video below shows a 2D animation of the diaphragm in action. Note how the diaphragm moves down towards the bottom of the ribcage and thus toward the abdominal cavity and visceral organs.

The diaphragm expands into the abdominal cavity thus pushing down on the abdominal organs and creating a vacuum in the chest cavity for lung expansion so that the lungs increase in volume. When the diaphragm then moves up it is simply relaxing due to elastic recoil in the alveoli.

Therefore correct breathing will involve the belly (just under the ribs) protruding and then the chest expanding. Paradoxical breathing involves the opposite pattern. Here the word paradoxical is used to mean “contradictory”, in that the pattern of breathing contradicts, or opposes, the action of the diaphragm. The abdomen moves up and in instead of protruding. This forces the abdominal contents upward towards the chest cavity thus opposing the contraction of the diaphragm downward. The abdomen moves up and in and the chest moves up and out. The diaphragm is elevated into the chest cavity and lung volume is decreased.

The image below is an animation that shows a typical shallow, chest breathing pattern. Notice that the stomach moves in and the chest moves up and out, to an excessive degree.

Prolonged high chest breathing can lead to many problems, including, after a while, such strained and overworked accessory muscles and back muscles that the expansion of the chest is restricted; leading to breathing that involves the ribs and shoulders moving up and down with almost no expansion.

This observation could be the root of the ‘chest expansion’ techniques which may simply stem from a desire to treat the symptom without knowledge of the cause. The chest is not expanding, therefore, we must ‘learn’ to expand the chest. The intentions here may be good but the resulting exercises would simply make the problem worse.

The Intercostals in Breathing

Chest expansion techniques incorrectly focus on the intercostal muscles of the rib cage. Having two layers, external and internal, the intercostals are the muscles between the ribs. There is some debate as to exactly how the intercostals work but they are chiefly thought to aid in inspiration (inhalation).

The external intercostals raise the ribs, increasing lung volume and helping to create a negative pressure. You can easily test this action by opening your mouth and throat and consciously raising your ribs. You should feel some cool air moving into your throat.

The different internal intercostals have a mixed role and are involved in the opposing functions of lifting the ribs and bringing them closer together.

As stated the exact workings and functions of the intercostals are not completely understood but chest expansion devotees should know that breathing is possible when these muscles are paralyzed. ¹Kendall, Florence P., Elizabeth K. McCreary, Patricia G. Provance, Mary M. Rodgers, and William A. Romani. Muscles: Testing and Function with Posture and Pain. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2005.

This is not to say that the intercostals are not important, as diaphragmatic breathing alone without the help of these muscles would be very inefficient. However, alone and with their correct action opposed by the diaphragm, they are ill-equipped to be the primary actors.

On the other hand, skipping over the intercostals so that the accessory muscles must move up in importance would be no better!

The Abdominals in Breathing

Another thing to look for with paradoxical breathing is trigger points in the abdominal region. The breathing pattern may be an avoidance of stretching the trigger points in the abdomen. Even if the cause was elsewhere as in prolonged stress, it is likely that trigger points may accompany a history of high chest breathing and treating them would hasten a return to normal healthy breathing.

The abdominals, including external obliques, rectus abdominis, and transverse abdominis, are selectively active during high breathing demands, the most active of which are the internal and external obliques and transverse abdominis. The action of the abdominals is most obvious when we exhale forcefully and suddenly.

During paradoxical breathing, the abdominals are being contracted during inhalation, as explained above. It is easy to see how this could lead to overworked and tight abdominals.

Also, if you’ve spent a great deal of time working on that six-pack abdominal trigger points may be even more likely to be a part of your poor breathing, not to mention other intra-abdominal and back pain.

Excess muscle tension is probably the main manifestation of stress so of course, in addition to abdominal trigger points, one should expect tight, overworked muscles and trigger points elsewhere such as the scalenes and trapezius. Serratus anterior trigger points are especially likely. Self-treatment for these is quite possible and effective. The Trigger Point Therapy Workbook by Clair Davies is the unparalleled self-care resource for this and should be consulted first.

Since pulling in the abdomen leads to a reflex contraction of the pelvic outlet muscles (“pelvic floor”) there may pelvic floor trigger points as well. ²White, Lucy, and Robert G. Ferguson. Clinical mastery in the treatment of myofascial pain. Philadelphia: Lippincott Williams & Wilkins, 2005 Unfortunately these muscles are situated inside the pelvis and cannot be reached for self-massage.

Fortunately, however, the magic of breathing is that learning proper breathing, and especially deep breathing exercises, not only helps to correct the physiological problems but also are a tremendous help in relieving the stress that led to them in the first place!

Accessory Muscles of Breathing

There is still some debate as to all the different muscles that act as accessory breathing muscles and a discussion of their various functions or suggested functions is beyond the scope of this article.

Among the many accessories of inspiration, however, the sternocleidomastoid and the scalenes are thought to be of particular importance. These neck muscles tend to be particularly active during periods of rapid high chest breathing and may develop shortness and trigger points.

Other muscles of possible importance are the serratus anterior, pectoralis major and minor, upper trapezius, lattisimus dorsi, erector spinae in the thoracic region, iliocostalis lumborum, and quadratus lumborum. ³Kendall, Florence P., Elizabeth K. McCreary, Patricia G. Provance, Mary M. Rodgers, and William A. Romani. Muscles: Testing and Function with Posture and Pain. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2005. These muscles may be at work in certain body positions, or during times of particular need and the over-activity of any of these muscles can lead to many diverse problems including shoulder disfunction and back pain.

It is well known, for instance, that overworked and shortened sternocleimastoid and scalenes lead to the head-forward rounded shoulder posture that is so common today. High chest breathing can contribute to this problem or this problem could contribute to high chest breathing.

However other problems can occur that one would never expect. Hand and wrist weakness may be related to scalene muscle trigger points, for example. Most strength trainees would never guess that their weak grip is related to their breathing patterns! Of course, if such a problem is found, many other related dysfunctions are possible. ⁴White, Lucy, and Robert G. Ferguson. Clinical mastery in the treatment of myofascial pain. Philadelphia: Lippincott Williams & Wilkins, 2005.

Proper Breathing Fallacies

There are a number of misconceptions regarding proper diaphragmatic breathing; two of which I want to discuss here:

1) With diaphragmatic breathing, the breath always should be centered in the belly. The chest should not expand and the shoulders should never rise at all.

“Belly breathing” is an improper term for the very reason that it is not about breathing “into your belly” but allowing the diaphragm to contract as it should. Although in normal, calm breathing such as you should be experiencing as you read this there is very little need for chest expansion, this does not mean that the chest never expands! In order to get a complete, deep breath the chest must expand. Since it is not always necessary to completely fill the lungs normal breathing will appear to be belly centered.

To understand breathing we must understand it both during times of calm, shallow breathing and during times of deep breathing as during vigorous exercise. Failure to differentiate gives rise to misunderstandings and statements like “the chest should not move”. This was even pointed out in Gray’s Anatomy way back in the 1800s.

A common exercise to check for diaphragmatic breathing is to place one hand just under the rib cage, on the belly, and another just under the sternum so that one feels the hand on the belly rise first and the hand on the sternum move out (and slightly up) second. Or, if you are just learning, simply feeling the hand on the belly rise with barely any movement of the upper hand.

However, another method to illustrate to yourself that diaphragmatic breathing is not centered in the ‘belly’ is to place each hand tightly upon the waist and squeeze. When you take a deep full breath both your fingers in the front AND your thumbs in the back should move out. That is, the entire “core” area is expanding not just a balloon-like area in your belly. The belly expansion is more apparent but you should be aware of the difference since many people are taught to distend the belly in an exaggerated fashion for deep breathing.

If you are engaged in vigorous resistance exercise, strength training, or muscle building, this exercise can also be useful for training yourself to tighten the core for heavy lifting. The common instruction is “take a deep breath until your belly fills up, then take some more, then engage your abdominals.” This instruction is wrong. While it is not necessary to ‘engage your core’ before heavy lifting, to reinforce your core, poking our your belly is not the key.

Instead, to practice, place your hands on your waist as described and learn to feel the proper expansion of the waist area when engaging the “core”. During lifting, you can even use a stretch band around the waist so that you can feel the waist area expanding against the band which is a very useful cue.

The advantage of this exercise is it teaches you to take just enough breath to help create the tight corset you want without attempting to artificially overfill the lungs, which cannot be properly filled by just poking out the belly anyway.

It is not necessary to take in more air than is comfortable when engaging in this way.

While bracing the core you should also actively engage the gluteals.

2) The belly and the chest should rise simultaneously during proper breathing.

No. This is also an incorrect way to breath. Although a good natural breathing rhythm will make it seem as though the abdomen and the chest expand at the same time, in fact, the abdomen expands first. This is something you must feel for yourself to really know the difference so you must first learn to breathe properly. Then, once proper breathing feels ‘right’ to you if you try to expand your abdomen and chest at the same instant, especially when trying to breathe deeply, you will see that this is not much different than high chest breathing and feels difficult and uncomfortable.

Learn the Difference Between Chest Breathing and Correct Breathing

Chances are, even if you are a chest breather some or most of the time, you do breathe correctly sometimes such as when you are asleep or during periods when you are most relaxed. Your body knows how to do it. Now you must become aware of it.

The first thing I suggest you do is to raise your shoulders up as high as you can and attempt to take a very deep breath. Once you see what that does to your breathing and how difficult that breath is you will see much more clearly what we are trying to accomplish here.

The second step is to show yourself how you are breathing now. The third is to show yourself that your body is capable of the correct breathing action on its own and to experience that difference.

1) Do the test with your hands mentioned above. Preferably, lie down on the floor (a firm surface is best) or sit up straight in a chair.

Place one hand just under the ribs on the abdomen and the other under the sternum on the chest. Relax and breathe normally (the way you normally do). If it helps, lie there for a while so that you return to your normal breathing pattern.

Now, as you breathe note which hand moves first.

If your belly hand rises first then you are breathing from your diaphragm. Great! If your chest hand rises first and the belly hand doesn’t rise or rises much less than the chest hand, you are breathing from your chest.

2) Take some breaths and then try to push all the air out of your lungs. You may need to bear down with the abdominals to completely empty the lungs. Do this a couple of times until you can get the lungs as empty as possible. Then relax and allow a normal full breath. Don’t breathe just allow yourself to breathe. Hopefully, you will experience a full diaphragmatic breath that will feel deep and relaxing. If not and you find that you take a deep shuddering breath into the chest, then you needed this article even more than you thought! In most cases, after emptying the lungs in a relaxed state, however, breathing should shift to a diaphragmatic pattern.

Take some time to focus on pulling in some deep breaths into the abdomen. If you have a hard time doing it, place a heavy book on your belly so that you can feel the abdomen pressing against the book as you breathe. Or, if this doesn’t work, lie on your stomach resting your head on your hands so that you can feel the abdomen pressing against the floor as you take deep diaphragmatic breaths.

Proper Breathing Exercise

Now that you’ve noted your breathing patterns you can learn to correct them. In the author’s opinion, practicing some rigid control over your breathing, in sessions, is at first a good way to start honing in the proper pattern. This differs from Mason, who recommends not to adhere to any sort of rigid pattern other than, of course, breathing diaphragmatically. However, Mason’s purpose is to teach relaxation and there are different schools of thought on the “concentration” aspect of relaxation. Even so, what I recommend is one of Mason’s exercises, which he calls “Three Part Breathing”.

Inhale:

1) Imagine that your lungs are divided into three parts, lower, middle, and upper. With this visualization firmly in place, you will begin to take deep, slow diaphragmatic breaths. You can keep your hands on your belly and chest if it helps.

2)Empty your lungs completely and begin to inhale, as slowly as possible, into your abdomen using only your diaphragm and filling only the lowest part of your lungs so that your chest does not rise at all.

3) Now, imagine, as you continue to breathe in, that the middle part of your lungs are filling and allow your ribcage to begin moving forward.

4) Now visualize the upper part of your lungs filling as you complete the breath so that your lungs are now completely full of air. The shoulder can move slightly up and back.

Exhale:

Don’t be fooled by all this focus on a proper diaphragmatic inhalation. The exhalation is just as important if not more important. Rapid shallow chest shoulder breathers not only fail to fill the lungs, but they also fail to empty them. A full exhalation encourages a proper diaphragmatic breath and in most meditative practices the exhalation is the KEY to relaxation, for good reason.

Exhale slowly and a without undue effort, letting your shoulders drop and the abdomen pull slightly in and down. I don’t recommend following any scripted pattern for this (we are just learning) but try not to focus all the effort on the abdomen first and instead initiate the exhale by imagining that you are starting at the top of the lungs. If you start with the abdomen without engaging the chest it actually becomes more difficult to completely empty the lungs. The only reason for doing this that it is the quickest and easiest way to empty the lungs because it is the correct physiological sequence.

Alan Watts describes this process “encouraging a full release of the breath – easing it out as if the body were being emptied of air by a great leaden ball sinking through the chest and abdomen, and settling down into the ground”. ⁵Alan, Watts. Way of Zen. New York: Vintage Books, 1989

Practice. Often. As you become more adept the sequence of motions should start to feel like one smooth continuous motion and eventually, you can drop the rigid control and simply allow yourself to do what comes without thinking. Take note of your breathing often in case you fall back into the rapid, shallow, chest, shoulder pattern.

Diaphragm Fluttering or Shuddering

In hard cases, a fluttering sensation in the diaphragm while practicing the techniques can be normal and should go away with practice. However, if you experience a constant rhythmic fluttering of the diaphragm muscle even when you are not practicing these new techniques and especially if this is accompanied by pain such as knife-like or shooting pains in the chest seek medical advice immediately. Such a symptom is unusual and I only mention it to differentiate between a little flutter accompanying hard breathing practice and spontaneous flutter on a chronic basis.

Please do not take this article as a substitute for medical advice. When in doubt, seek a professional.