Breathing Exercises

1. Side-Lying Breathing Technique: to promote 360 breathing
2. "Ha Breathing": for Pressure Management: How to Stop Being an "Ab Gripper".
3. Four Exercises to Help with Abdominal Distension. Also helpful if you have an Anterior Pelvic Tilt.
4. 90-90 Decompression: do this when you are anxious, stressed, tight, tense or injured.
5. Balloon Drill: to help you fully exhale
6. RIB CAGE MOBILITY ROUTINE : to improve rib cage expansion

Reminder: If you have pelvic floor issues, you need a breathing intervention! You need to work on the first 2 exercises (Side-lying and Ha Breathing).

1.Side-Lying Breathing Technique: to promote 360 breathing

Intent: rib cage movement and diaphragm expansion 360 degrees

Side lying is one of the easiest positions to get started in.

• • Lay on your side with a pillow or towel roll under the head to ensure proper shoulder positioning
  • If needed, place another towel roll or pillow under the rib cage for support and elevation.
  • Get into a C-shape because it promotes back breathing and expansion.
  • Put your hand on your side. Inhale deeply, focusing on rib cage expansion & direct the air and pressure down into the belly, back, and sides. Feel for 360-degree expansion.
  • If you only feel the belly expanding, curl into a ball.
  • Check for proper rib cage expansion by placing hands on the back and feeling for pressure and expansion.
  • Emphasize complete exhales, getting the rib cage down. Use your hand to help. Using an open mouth "ha" breath is best.
  • Do a nice deep inhale and feel the rib cage expand. Don’t shrug up.
  • Repeat the exercise multiple times, aiming for a comfortable and natural breathing pattern.

Reference: Pelvic Floor & Diastasis Course. December 2023. Dr. Sarah Duvall, PT, DPT.

2. "Ha Breathing" for Pressure Management: How to Stop Being an "Ab Gripper".

If you over grip with the external obliques when you exhale instead of using the intercostals, this produces a tremendous amount of pressure down on the pelvic floor. This can lead to pelvic floor dysfunction such as leaking when you cough or sneeze or increased prolapse. Learning to manage pressure is the number one thing you can do to improve almost all areas of pelvic floor dysfunction, including pelvic floor tightness.

Exercise intent: Avoid generating external oblique tension to prevent pressure on the pelvic floor.

This can help manage downward pressure on the pelvic floor and can help you close a diastasis

• • Sit comfortably, either in a chair or on the floor.
  • Let the belly hang out, consciously releasing any abdominal tension. If this is hard for you, it’s a sign you’re an ab gripper.
  • Place hands on the rib cage, focusing on the whole ribcage.
  • Inhale naturally, allowing the belly to remain relaxed. (Don’t shrug up).
  • Exhale with a relaxed "Ha" sound, using your hands to encourage the ribs to move in and down. Don’t engage external obliques. The belly stays fully relaxed. You shouldn’t feel any pressure down on your pelvic floor because you’re not generating any external oblique tension.
  • Now add a little over-pressure with your hands and inhale into your thumbs and feel a stretch across your sides and back. It feels nice! This exercise also promotes 360 breathing! Don’t be too aggressive with the overpressure.
  • Then exhale with a relaxed Ha.
  • Repeat the "Ha Breathing" exercise for 3-5 cycles.

This next exercise can help with that. It’s also great for people with a diastasis.

Reference: Pelvic Floor & Diastasis Course. December 2023. Dr. Sarah Duvall, PT, DPT.

3. Four Exercises to Help with Abdominal Distension. Also relevant if you have an Anterior Pelvic Tilt.

Do your abs look distended as the day progresses or after a challenging workout? Click on this video for 4 more exercises you can do. These are super helpful if you have an anterior pelvic tilt (APT). Note that lower belly pooching is more likely to occur if you have an APT.

1. Gather your low abs and hold 10s. Seated in a chair. 5x.
2. Side & Back Expansion. Standing. 5/side
3. Deep Squat Breathing, 5 breaths
4. Quadruped Pelvic Reposition. Feet against wall. 5 Breaths.

Reference: Dr. Sarah Duvall, PT, DPT.

4. 90-90 Decompression: do this when you are anxious, stressed, tight, tense or injured.

Do this when you have back pain. Do this when you feel stressed and tight/tense.

• Lie on your back, 90-90 (feet elevated on chair). Head on the ground. Relax.
• Pull down (gently) with your heels to facilitate lower ab engagement.
• Breathe naturally in and out of your nose (which will activate your parasympathetic nervous system… which feels like a warm hug from Grandma).
• Place your hands below the ribs, inhale and feel the ribs expand 360 degrees circumferentially as your lungs fill up with air and feel your hands rise. The floor will give you the tactile cue: you’ll feel your ribs pushing into the floor (it might feel tight).
• Then exhale and feel your lower ribs move down and the waist cinch in. Feel your hands lower back down. You will feel the TVA cinching in like a corset being tightened. The full exhale sets the stage for a proper inhalation
• Inhale for 4 counts, feeling the expansion. When you inhale, you should feel a nice stretch in your intercostal muscles. Then exhale for 4 counts and you’ll feel the ribs move down and the TVA cinch in. Repeat for 4-5 breath cycles

TIP: How to improve your nasal exhalations: When you nasal exhale: imagine you have a glass in front of you and you want to fog it up with your breath, but do it with your mouth closed. This causes a small constriction to your throat. Maintain this feeling for the nasal inhale. When you breathe like this, it kind of sounds like the ocean or a soft snoring sound. Breathe like this when you are training.

5. BALLOON DRILL: to help you fully exhale

If you have a hard time fully exhaling, do this to improve your exhalation.

• Crook seated position with your mid to low back against the wall. Knees close to chest. Feet hip width apart. Feel your sit bones on the floor grounding you (so make sure you are not too far from wall or too close). You can put yoga block or pilates ball between knees to activate your pelvic floor and facilitate TVA engagement.
  Reach with your right arm.
  Hold a balloon with left hand and exhale ALL air out through your mouth. Feel yourself peel of the wall and flex more, and feel the side abs and TVA engage. Don’t let the air out of the balloon. Pause before you inhale for 4s. Then repeat this one more time before you let the air out of the balloon. Do 3-5 sets of 2 exhalations.
• You can also do it with a straw but a balloon is way more effective.
• Notice how pausing before you inhale again maximizes the amount of expansion you will get in your rib cage.
• The full exhale sets the stage for a proper inhalation
• Don’t shrug your shoulders

6. RIB CAGE MOBILITY ROUTINE

If the rib cage lacks mobility, then the diaphragm and intercostal muscles won’t be able to work properly to expand the rib cage when you inhale. This will cause the pecs and lats to become tight. Hence a rounded shoulders appearance.

Here are 2 exercises that will help open up the ribcage. Nasal inhale for 4 counts and nasal exhale for 4 counts (do this 4 times) ... just follow along with me in this video.

• External Intercostal stretch: (external intercostals = primary muscles of respiration). This is a rib opener. Pull on a doorway frame (watch the video): when you inhale, feel the ribcage expanding, feel the intercostals stretching. You’ll also feel a lat stretch. Do both sides.
• Upper Rib Cage Expansion Drill: crook lying position. Push forearms into floor and pack shoulder blades down (do not extend the spine!). Rest head against wall. Dig your feet into the ground and fake pulling your heels towards your bum. Gently nasal inhale for 4 counts (but don't rib flare!) and feel the rib cage expand circumferentially (feel your pecs & biceps stretch!). Fully exhale for 4 counts and you’ll feel the TVA engage. Do 4 full breath cycles. This drill will improve upper rib expansion.