Getting Air Out (Part 2): How To Balance The System


As we discussed in my previous post, hyperinflation (over-breathing) causes system-wide excitation which may be useful in short bouts of exercise, but over time can be a rate-limiter to adaptation and resilience. By getting air out (exhalation/flexion) we can better achieve a balanced, neutral state.

The diaphragm can achieve a more normalized resting position rather than being pulled into a more horizontal, tonic position. Perhaps high resting tension in the diaphragm is an indicator of system-wide tension - those guys/gals that are always tight and fatigue-out early in high-rep schemes. Now I do think that balance is a moving target and the sum/goal should be a balanced system of managing the extremes even if it's not achieved in the moment.

So how do we swing the pendulum back towards neutral?  By getting air out. Here are a couple ways:

1) Recognition is the first step. Does you or your athlete's ribcage look like this, even at rest?

If so, c'mon man. It may not become apparent until higher level movements, typically ones involving arm and leg movements (such as overhead movements) in which exhalation and the ribcage-pelvic relationship is even further challenged. And that's a main thought here: we have to challenge competency with progressive demands - if all you do is blow up a balloon (despite its effectiveness) and give no further thought to breathing, the boat is missed. Let's suppose you can breathe at rest - a tall order for most - can you maintain neutral under load, with speed, changing targets? And even more appropriate for this topic - can you reclaim neutrality at rest?

2) Forced exhalation - this effectively recruits the abdominals and pelvic floor in a coordinated fashion providing centration to the ribcage and pelvis (reduces rib flare). The active contraction of the abdominals during resisted exhalation resists the action of the diaphragm and increases parasympathetic tone helping to decrease resting muscle tension. There are a ton of exercises out there using this principle (PRI being the foremost).  
  • I will typically start with pursed lip exhalation during movements - forcing air out through minimal mouth/lip opening. Breathing out thru a straw is another option here for an external cue. 
  • Then I will progress to blowing up a balloon (yeah you may get looks at first... until you up your squat max by 30 lbs and your hips don't feel so impinged at the bottom - then they'll ask you where you buy the balloons). Using resistance during exhalation slows the breath down and helps to balance sympathetic vs. parasympathetic state.  
  • Start first in flexed, unloaded positions (Quinn's videos below) and progress to upright, gravity-dependent positions. The rx for this depends on the needs and status - are you using it as a reset post-training or a reinforcer prior to exercise? Does the athlete need better neutrality before the session or did an extension-heavy session necessitate a down-regulation breathing pattern for the cool-down? That's your call. 

Here are some I like:



From my guy Dr. Quinn Henoch:
I will typically use these more on the cool-down, post-work side but, again, that depends:



3) Use breathing to maintain neutral: this goes along with forced exhalation but I will have clients actively exhale during the extension part of a movement as I have found that having them just brace down hard often stimulates breath-holding which is typically not beneficial during high-rep movements. Adding in the breathing component seems to centrate the core and recruit globally better than telling athletes to just "get tight."
  • During box jumps I will have clients exhale during the extension/jumping phase of the movement to prevent rib flare and overextension. Or during the concentric up-phase of a push-press as it helps to center the ribcage and tell you who is limited in overhead mobility. Use as you see fit based on the movement.
  • During mobility work: use forced-exhalation to optimize the diaphragm/ribcage position and allow better access to the hip flexors, for example, during a lunge or couch stretch (if you do that stuff). 
  • Squats (usually with low-weight, high-rep schemes: do NOT mess with pelvis-ribcage relationship while lifting heavy-a** weights. 

By swinging the pendulum more towards exhalation and getting air out, we can achieve both mechanical neutral (spinal position) and neurophysiologic neutral (autonomic nervous system balance) and reduce excessive tension/excitation from the system.

Contributed by Dr. Seth Oberst, DPT, CSCS

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