The Project Rheum

Healthy with Rheumatoid Arthritis

Take a Deep Breath: Slow Belly Breathing for Chronic Pain and Stress


IMG_4869What kind of breather are you? Do you breathe fast or slow? Deep or shallow? Do you hold your breath when you’re in pain? Have you “lost” your breath since your diagnosis? Do you check your breathing pattern throughout the day, or are you totally unaware of it?

I’m a chest breather. I don’t know exactly when this habit started, maybe when I was initially diagnosed with rheumatoid arthritis as a teenager. Even as an adult dealing with pain and the anxiety associated with unpredictable health can be enormously stressful. No doubt pain and stress interfere with breathing patterns, with respiration sometimes quickening and becoming shallow even in the anticipation of discomfort.

For many years I was totally unaware that I was drawing minimal air into my lungs. In fact I was drawing air into the chest area using the intercostal muscles rather than throughout the lungs via the thoracic diaphragm.

Do you know that most of us stop regularly engaging our diaphragms by the age of ten?

According to a report by Dr. Erik Peper and Rebecca Kajander published in Biofeedback, most people make a habit of thoracic breathing (or chest breathing), which is a shallow, ineffective breathing pattern that uses upper chest muscles and largely ignores the diaphragm. Chest breathing can cause shortness of breath, fatigue, irritation, headaches, and muscle tension in the upper chest, as well as increased feelings of anxiety and panic. So for those of us with RA or other health challenges already feeling stressed out or anxious about our condition, thoracic breathing doesn’t do us any favours. In fact, if left unchecked it can lower CO2 levels enough to lead to hyperventilation (or overbreathing), which is breathing beyond what the body needs to meet its immediate demands for oxygen and carbon dioxide.

To breathe properly you need to engage your diaphragm, the dome-shaped internal skeletal muscle under your rib cage that separates the chest cavity from the abdominal cavity. (For a good 3D view of the diaphragm, look here). In her book Breathing Into Life: Recovering Wholeness Through Body, Mind and Breath, wellness expert and author Bija Bennett writes “The dome-like diaphragm is so strategically located it is said to be a work of art. Your heart rests over it. Your liver and spleen lie below it. It’s attached to your spine. As it moves it encloses and touches all your abdominal organs. (It) interconnects your heart, your abdomen, your lungs, and your spine. And because of these relationships its movement profoundly affects your posture, digestion, elimination, and respiration. This is your diaphragm, the mediator of all rhythms – biological and emotional.”

Breathing with your diaphragm, also known as belly breathing or abdominal breathing, involves taking slow, relaxed and effortless breaths where you deeply inhale and exhale. As you breathe in, the diaphragm drops downward, pulling your lungs with it and pressing against abdominal organs to make room for your lungs to expand as they fill with air. As you breathe out, the diaphragm presses back upward against your lungs, helping to expel carbon dioxide. Breathing this way not only helps to properly balance oxygen and carbon dioxide levels in the body, but it also:

Reduces tension, stress, and anxiety
Reduces pain
Promotes relaxation
Maximizes energy
Improves focus and concentration
Increases circulation
Eliminates toxins
Strengthens immunity
Aligns posture
Improves digestion and elimination
Lowers blood pressure
Relieves insomnia

Not bad for simply using a muscle in our body the way it was intended.

To find out if you’re using your diaphragm, put your left hand on your chest and your right hand on your abdomen just below your belly button. Breathe in through your nose and you should feel your belly rise (and if your inhale is long enough you’ll also feel your rib cage and chest expand). Exhale through your nose and you should feel your belly deflate. If your left hand on your chest remains relatively still and only your right hand moves up and down with inhale and exhale, you’re on the right track. This is belly breathing. Newborns and young children use their diaphragms effortlessly, which you can see by the slow and easy rise and fall of their tummies when they sleep.

Diaphragmatic breathing encourages a slower respiration rate, and, as it turns out, slow breathing helps to relieve pain. According to Alex Zautra, Foundation Professor of Psychology at Arizona State, slow breathing provides a natural means for dampening activity in the stress system of the brain, leading to a reduction in pain. His research with fibromyalgia patients at Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center shows that these chronic pain sufferers report less pain while breathing slowly (unless they’re overwhelmed by sadness or depression). His research also suggests that slow breathing reduces the dominance of the fight/flight response within us, which calms the parasympathetic activation and allows for better regulation of emotions (like fear and anxiousness).

Kajander and Peper of Biofeedback give two thumbs up for slow breathing too as a way to relax. In their article they write that slow breathing results in mild increases in carbon dioxide which causes slowing of the heart rate, dilation of peripheral vessels, stimulation of gastric secretions, depressed cortical activity, and mild drowsiness, all characteristics associated with relaxation.

Your breath is a powerful tool for achieving optimal health. But only if you remember to use it! Being aware of how you breathe is important and requires simply checking in and following the path and sensation of your breath. This is an excellent first step to get you out of your head and into your body. Close your eyes for a moment and fully exhale. Begin by inhaling through your nose. How does your breath feel when it enters your nose and passes down your throat? Where does it go from there? Is it fast or slow? Does it feel blocked anywhere? Is it smooth? Steady? Irregular? Try not to judge how you breathe, simply observe and note how it feels.

When I first began practicing this exercise I noticed how often I held my breath because of joint pain and fatigue. Holding breath, although maybe appropriate in some yoga breathing exercises, increases the fight/flight response in the body, which sets up a whole host of unhealthy biochemical reactions, not to mention increased anxiety for those of us who are already anxious.

You probably know that breathwork is an integral part of tai chi, qigong, pilates and (chair) yoga. Controlling and coordinating breathing with movement ensures you breathe deeply. I recently signed up for chair yoga and I’m loving Pranayama (the rhythmic control of breath). In yoga terms, the level of prana (“aliveness” or “life force”) flowing through your body determines your body’s health, vitality, and youth. The belief is that any illness we have will ultimately be improved by increasing our reserves of prana. There are so many good breathing techniques, but “Ujjayi” Pranayama is one of my favourites. Ujjayi is sometimes called “Victory Breath” or “Ocean Breath.” The key to this exercise is to gently narrow the inside of your throat, which exaggerates the sound of your breath so you can hear it. (More on that below). As you slow down your breath and smooth out the flow, it begins to sound like ocean waves. The benefits? Ujjayi encourages belly breathing, quiets the mind, and with consistent practice eventually gives you an inner confidence that makes everything in everyday life (including your health) feel somehow easier to handle. Sign me up!

Although Ujjayi can be done sitting up and through yoga postures, beginners typically start by lying down on the floor. If you can’t get down on the floor because of your limited range of motion (please don’t try!), try it on the bed instead. Here goes:

Begin this exercise lying on your back on a yoga mat. Bend both knees and support them in this position with pillows or a few folded blankets (this allows your spine to relax beneath you). You may also want your head and neck supported by a folded towel or thin pillow. Arms should be relaxed by your sides with palms facing skyward. Take a few easy, natural breaths and feel your body soften under you. To feel the muscles of the throat involved in this exercise, clear your throat. Feel that? Or pretend that you’re fogging up a mirror. Now “fog up the mirror” with your mouth closed. Because this action slightly narrows your throat passageway, your inhale and exhale should sound like the ocean tide coming in and going out again. Keep your lips closed and continue breathing at your own easy pace while making this smooth and even soothing sound. Notice how your breathing rate naturally decreases and your belly rises and falls with your diaphragm. Try to stretch out the inhale and exhale a little longer. Start with 5 minutes or less a day and gradually work your way up to 20 minutes.

In Health,


Note of Caution: Don’t use deep breathing exercises if you have difficulty breathing or have medical problems with your lungs. People with low blood pressure may have to forego breathing techniques. If you experience any pain while breathing, see your doctor for a medical assessment.


2 thoughts on “Take a Deep Breath: Slow Belly Breathing for Chronic Pain and Stress

  1. Pingback: Banish a Bad Day | Obsessively Pretty Calm

  2. Pingback: Deep Breathing – Pain Management Resources

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