Breathe

Breathing is the foundation for almost everything. Most obviously, it is the foundation of life. Less obviously, it is the foundation for physical therapy. Despite how essential breathing is, it is often overlooked.

One reason breathing gets missed is because it happens subconsciously. You don't have to think about it to keep you alive. But even though breathing is automatic, it's also something you can consciously control and change. This makes breath a powerful tool to influence your body, your emotions, and your stress response both immediately and over time.

Why Breathing Matters in Physical Therapy

Breathing is at the center of most (if not all) physical therapy interventions. You've probably heard cues like "breathe through it" during manual therapy or "use your breath" to get through a challenging exercise. While breathing is often framed as a way to tolerate something difficult, it's much more than that.

Breathing directly influences multiple body systems at once. Because of that, it can help the body shift out of protective or guarded patterns and into states where movement feels more available, coordinated, and efficient.

Breathing and the Respiratory System

Most obviously, breathing is a part of the respiratory system. It's necessary for airflow, gas exchange, and maintaining oxygen and carbon dioxide balance. Efficient breathing supports endurance, recovery, and overall energy levels.

But the influence of breath doesn't stop there.

Breathing and the Nervous System

Less obviously, breathing is closely tied to your stress response, arousal level, and nervous system regulation. Stress, pain, and high arousal tend to activate the sympathetic nervous system. This often shows up as faster and shallower breathing, increased muscle tension, and less variability in movement and physiology. Slower, more controlled breathing practices have been shown to support shifts toward parasympathetic activity - often reflected in improved heart rate variability and reductions in stress and anxiety symptoms.

This doesn't mean breathing replaces therapy or strength training. It means breathing can be a first step - one that helps your system feel safer so that movement, strength, and coordination become more accessible. A regulated nervous system moves better. When your system is less threatened, your body doesn’t need to guard as much.

Breathing and the Musculoskeletal System

Breathing isn’t just air moving in and out. Breathing also plays a key role in ribcage mechanics, posture, pressure management, and movement coordination. Your diaphragm, respiratory muscles, abdominal muscles, and pelvic floor all work together as part of a pressure system that supports your trunk and transfers force during movement.

This is why breath shows up so often at the beginning of PT exercises:

• It helps reduce global bracing.

• It supports efficient core activation without over-gripping.

• It improves rib and trunk mechanics.

Research in people with chronic low back pain suggests that adding diaphragmatic breathing to core stabilization can improve outcomes compared to core work alone. When considering pelvic health, breathing is frequently discussed as a key part of pressure management and pelvic floor muscle coordination.

How Breathing Affects Pain, Stress, and Sleep

Pain is multifactorial. Biology, stress, context, nervous system sensitivity, sleep, and many other factors all play a role.

Breath doesn’t “fix” pain on its own, but it can influence two major contributors:

1. Threat level: Slow diaphragmatic breathing can reduce stress reactivity and support a calmer system.

2. Body tension: When breathing becomes more intentional, many people notice less gripping through their neck, shoulders, jaw, abdominals, and pelvic floor. Less gripping often results in more movement options.

Because breathing practices can support relaxation and down-regulation, they’re also commonly used as part of wind-down routines for sleep.

Breathing Exercises for Home

Breath practices should feel calming. They should not increase dizziness or anxiety. If you feel lightheaded or stressed, shorten the breath, return to normal breathing, and try again later. If you have cardiovascular or pulmonary conditions, check with your medical team about what’s appropriate for you.

The Long Exhale Reset

• Gently and silently inhale through your nose for ~3–4 seconds

• Slowly and smoothly exhale through your mouth for ~6–8 seconds

• Repeat 6–10 cycles

360° Breathing

• Inhale and feel your ribcage expand in all directions: front, sides, and back

• Exhale fully and feel your ribs soften down, in and back

• Progress this by pairing the breath with movement- like squats, hinges, and reaching

Final thoughts

Breathing is simple, but it’s not trivial. It's the foundation that can help your body shift from guarded to adaptable, from braced to supported, and from overwhelmed to regulated. It's a great first step in managing pain, stress, and life.

If you’d like help figuring out what breathing strategy fits your body, I'd love to work on it with you at Indepth Physical Therapy. Schedule an appointment here.

References

1. Zaccaro A, Piarulli A, Laurino M, et al. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Front Hum Neurosci. 2018;12:353. Frontiers

2. Bentley TGK, et al. Breathing Practices for Stress and Anxiety Reduction. Front Psychiatry. 2023. PMC

3. Laborde S, Mosley E, Thayer JF. Effects of voluntary slow breathing on heart rate variability: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2022. ScienceDirect

4. Shao R, et al. The Effect of Slow-Paced Breathing on Cardiovascular and Emotional Outcomes: A Systematic Review and Meta-analysis. Mindfulness. 2024. Springer

5. Masroor S, et al. Effect of Adding Diaphragmatic Breathing Exercises to Core Stabilization Exercises for Chronic Low Back Pain. 2023. PMC

6. Li Y, et al. The impact of core training combined with breathing exercises on chronic non-specific low back pain. Front Public Health. 2025. Frontiers

7. Bø K, et al. Can you breathe yourself to a better pelvic floor? Neurourol Urodyn. 2023.