While many people experience a pivot from an expected vaginal delivery to an emergency Cesarean Section (C-Section) birth. There are also many people who have a planned or scheduled C-Section.
If this is the case, Physiotherapist can help prepare you in advance for the birth as well as the first few days. While many people try and soften the process by titling it a “C-Section birth” and a view point that it is as valid of a birthing process as a vaginal birth (which it IS!). A C-Section is still a surgical procedure that has different considerations when it comes to recovery than a vaginal birth.
It is possible to have have pelvic floor issues post c-section even when / if a person has not laboured, had to push, or delivered vaginally.
These pelvic floor issues post C-Section may be:
Pain / discomfort with urination
Stress or urge urinary incontinence
Pelvic floor pain or discomfort
Bowel issues / constipation
Pelvic organ prolapse (POP)
In the early days post C-Section your pelvic floor focussed physio can provide you with a plan in how to set your home environment up to best help your own recovery as you care for a newborn.
Once your C-Section incision is healed, your pelvic floor focussed physio can assess and gently treat your scar / incision or the surrounding area. Your Physio can also assess your pelvic floor. You should be provided with some education and a plan of how you can self treat at home and how to fit it into your new life!
If you have not had your scar massaged or worked on by a physio and you are further down the road of your recovery, if is never too late. People are often surprised by how much C-Section scar work as part of physio treatment can help with low back issues and pelvic floor tension / issues as well as in the local area.
If you are interested in a pre-hab or prenatal physiotherapy session for a schedule C-section we are here for you. We are able to see you in person in our North Oakville Physio clinic. We are also able to “see” you virtually via Telehealth if you are residing or have a permanent address in Ontario.
Hi all! Welcome back to why our breathing pattern is important!
In Part 1 we talked about the muscles involved in breathing and how to test if your breathing pattern is “optimal.”
Today we will delve a bit into the why this matters!
Role of breathing in ribcage expansion and joint mobility
If you remember… when we inhale, our intercostal and diaphragm muscles contract to spread out and elevate our ribcage to make room for the lunges to expand as they fill with air.
But stiffness in our joints between the spine and ribs can affect how well this expansion happens.
Alternatively, if our breathing pattern is not optimal, or not all of the muscles are engaging, we may get more expansion on one side than the other. The side that gets less expansion gradually gets stiffer.
As the ribcage attaches to the thoracic (upper and mid back) spine, its mobility also affects how our torso moves (e.g. turning our body to look over our shoulder).
As you can see, spine and ribcage mobility can both affect and be affected by our breathing!
Role of breathing in posture
In Part 1 we briefly talked about “accessory breathing muscles”, or muscles that are not active during regular breathing. Instead, they are activated during heavy exercise, a stressful situation, or an asthma attack, i.e.when breathing becomes hard work and more energy is needed!
These muscles also become active depending on our stress levels, our posture, or even when the major breathing muscles are not being optimally used.
When these accessory muscles are habitually used, our breathing pattern changes so that we become more “apical” breathers. This means that most of the movement happening is through our chest and shoulders.
However, most of the movement should be happening from the expansion of the ribcage!
These accessory muscles then become overactive and tight, while our diaphragm is underused, and our ribcage becomes stiffer.
This leads to, and is reinforced by, a more slouched posture:
Head and neck positioned more forward
Greater curve (or “hump”) in the upper and mid back
More rounded shoulders and tighter pec muscles
Role of breathing in stress and anxiety
A lot of people carry stress in their neck and shoulders. This is also reinforced by a lot of us sitting in front of a computer all day. As we sit for prolonged periods of time, we naturally crane the neck forward toward the screen, round the shoulders and upper back, and slouch through the lower back.
Our stress and anxiety can affect how much muscle tension we carry. Have you ever noticed that when you are cold, you hike your shoulders up and tighten the neck?
What about when you are stressed, anxious, or even just overly focused on your work? Do you hike up your shoulders, or clench your jaw?
Interestingly, our respiratory rate (our breathing) can influence our nervous system and therefore, our muscle tension.
For example, if we are in a more stressed state (fight, flight, or freeze response), if we consciously slow down our breathing and lengthen our exhales, we can switch over to a more relaxed state (rest and digest state).
There are known as the sympathetic and parasympathetic nervous system… When we are in an amped up state (sympathetic response), we carry more tension. When we are in a relaxed state (parasympathetic response), our muscles are also more relaxed.
You can try this as a stress management technique!
Every time you find yourself stressed or anxious, take a moment to close your eyes, consciously relax your shoulders, or anywhere else you feel you are tense.
Then, take five deep breaths, making the exhale twice as long as the inhale.
e.g. Breathe in to the count of three. Exhale to the count of six.
Another breathing technique for when feeling anxious isalternate nose breathing:
Exhale through the nostrils
Then, close the right nostril with your right thumb and inhale slowly through the left nostril
Then, close the left nostril with the right ring and pinky fingers, and slowly exhale through the right nostril
Still covering the left nostril, slowly inhale through the right nostril
Then, close the right nostril again with your thumb and slowly exhale through the left nostril
Repeat either nine rounds, or for about 5 minutes
End on a left nostril exhale
Role of breathing in low back pain
If your ribcage and spine are stiff, you may experience some upper and/or mid back pain.
That stiffness may be also contribute to low back pain…
Let’s take the psoas muscle as an example. The psoas flexes your hip, but can also function as either a spine stabilizer or a spine mover. In others words, it affects our back stability and mobility.
That’s because the psoas attaches to both the lumbar spine and to our hip bone. However, it also attaches to the diaphragm through the fascia! Therefore, it has the potential to be affected by our breathing.
If we are chest or belly breathers, our ribcage and low back do not expand much with our breath. This is the path of least resistance for the breath.
If our psoas is tight, it reinforces a suboptimal breathing pattern because we are going to continue breathing through that path of least resistance into either the chest or the belly.
But when we focus our breathing into our sides and back, we can help relax some tight muscles, like the psoas, that can be contributing to low back pain and/or tightness.
Here is an exercise you can try to do this:
Start by lying on your side. Curl into the fetal position so that we are opening up the back and blocking the abdominals. You can even hug a pillow to brace the abdominals.
Now, take a few regular (or slightly deeper) slow breaths. Every time you inhale, think about forcing that breath into the back (upper and/or lower), feeling it slightly expand out.
Then, as you exhale, feel the the expansion come back in.
You can even place your top hand on your lower ribcage, pushing the hand away on inhale, and pushing the hand down into the ribcage on exhale.
Role of breathing in core strength
The diaphragm attaches to the ribs, sternum, and lumbar spine. As such, it is both a respiratory muscle and a postural stabilizer.
Imagine the core units surrounding the abdominal cavity as a container:
Transversus abdominus muscle at the front and sides
Back stabilizer muscles like the multifidus and erector spinae at the back
The diaphragm at the top
The pelvic floor muscles at the bottom
As you can see, the diaphragm is part of our core unit! Therefore, how well it is functioning can impact the rest of our core muscles.
Our breathing pattern is foundational. In fact, more and more research is showing that the first step to core strength, stability, and overall function is diaphragmatic breathing.
More than that, we want that diaphragmatic breathing to expand our ribcage from all sides, rather than just focusing on pushing out the belly with the inhale. In others words, we want a 360 degree expansion with each inhale!
Role of breathing in diastasis recti
If you remember from Part 1, as you inhale, the diaphragm contracts and moves down to allow for the lungs to fill with air.
This causes the pressure to go into the abdominal cavity (see the cylinder diagram above!).
Pressure will follow the path of least resistance, which means it will usually go to the belly and distend some of that front fascia (i.e. the abdominal diastasis).
If we carry a lot of tension in our abs and tend to brace there, breathing into the fascia is a good thing. We can help relax and stretch that fascia.
But if we have some weakness there (e.g. postpartum), then belly breathing reinforces stiffness/tightness in the back and weakness in the abdominals because the breath is constantly following the path of least resistance, and pushing into the weak abdominals.
This can then reinforce the diastasis recti, rather than help heal it.
Therefore, focusing the breath into tighter areas, like the back, is preferable.
Role of breathing in pelvic floor
As shown in the cylinder diagram above, our pelvic floor muscles form the base of our core. This means that your pelvic floor is also a spine stabilizer. (In fact, sometimes pelvic pain can refer to the back!)
When we are belly breathers, we often breathe through the upper abdominals. However, women postpartum often have more weakness in the lower abdominals, which means that’s where the path of least resistance will be.
This puts more pressure down into the lower abdomen and pelvic floor.
As a result, women who close their diastasis recti more quickly postpartum often have a greater risk of prolapse!
To prevent the pressure system from placing too much strain on the pelvic floor, we want to reduce the upper abdominal tension, strengthen the lower abdominals, and overall encourage a breathing pattern that expands on all sides (front, sides, and back)! And eventually, even breathing down into the pelvic floor!
If you are having back pain, or recovering from a diastasis recti, and would like to learn more about what you can do (including the role of breathing for core strength and general mobility), let us know! We offer both in-person and Telehealth Physiotherapy services 😊
Breathing… it’s essential for life! It’s also something so basic we never give it a thought.
That’s because breathing (AKA respiration) is an automatic function, subconsciously controlled by the respiratory center at the base of the brain.
While we can control our breathing rate and even hold our breath voluntarily, we do not need to think about it all the time. Breathing continues whether we are awake, asleep, or even unconscious!
There are several respiratory (or breathing) muscles involved in the process:
this is our most important respiratory muscle!
It is a dome-shaped muscle that separates our chest cavity (where the heart and lungs reside) from our abdominal cavity (where the rest of our internal organs are).
What’s more, the diaphragm has multiple attachments: the sternum, ribcage, and spine
Intercostal (rib) muscles
These muscles lie between your ribs, attaching them to one another.
There are three layers: external, internal, and innermost.
Cervical (neck) muscles
these are referred to as the “accessory” muscles of respiration, and include the scalenes, sternocleidomastoid (SCM), levator scapulae, and the upper fibers of trapezius (“traps”).
include the rectus abdominus (our “six-pack” muscle), the internal and external obliques, and the transversus abdominus (the “inner core”)
Other accessory muscles that are in the chest and back area include: pectoralis major and minor (“pecs”), latissimus dorsi (“lats”), and the superior serratus posterior.
What are “accessory” muscles of inspiration?
Accessory muscles (found in the neck, chest, and back) are typically needed during heavy exercise, a stressful situation, during an asthma attack, or in someone suffering from COPD. In other words, when breathing becomes hard work and more energy is needed!
However, when these accessory muscles are habitually used, our breathing pattern changes and that can have wide-ranging effects…
So how does breathing work?
As you breathe in (or inhale), the diaphragm contracts and moves down in order to increase the space in the chest cavity. That’s because your lungs are filling with air and need additional space to expand.
The intercostal muscles also help to spread out the ribs (by pulling them upward and outward) and allow for the chest cavity expansion.
Interestingly, exhalation is a “passive” process, meaning that no muscle work is required.
As we naturally breathe out (or exhale), there is an elastic recoil from the lung tissue, which pushes the air out of the airway.
However, if we are engaged in vigorous exercise, or if we forcefully exhale, that will require muscle work. Specifically, the abdominal muscles help out the most. They contract to raise the abdominal pressure so that they can push the relaxed diaphragm up into the lungs, and in this way, push the air out.
The “correct” breathing pattern
Normally, as we inhale and the diaphragm and intercostal muscles contract, the ribcage expands from all sides. While the chest rises a bit, the lower part of the ribcage (upper part of the abdomen) should rise even more.
As we exhale, the chest and upper abdomen fall back in.
You can test this yourself! 😊
Place one hand on your chest and the other hand below the chest (upper abdomen). Take several regular (or slightly deeper) breaths, pressing the hands into the chest and upper abdomen. On the inhale, you should feel the bottom hand rise a bit more than the top hand.
To test overall ribcage explosion, place your hands on your sides, high enough that you are pressing into your lower ribs. The thumbs will be feeling more the back portion while the rest of the fingers more of the front portion. Press into your ribs as you take several regular (or slightly deeper) breaths. You should feel equal expansion on both sides as you inhale. Note if there is movement on the front, side, and back of where you are pressing!
Why does this matter?
Aside from bringing oxygen into our body and expelling carbon dioxide, our breathing has an impact on many other areas of our body and health…
Stay tuned for Part 2 to learn how breathing can impact our ribcage and joint mobility, our posture, our core strength, our pelvic floor function, and even our stress levels!
There are many styles of yoga, some more modern than others, and some which are combinations or derivatives of more traditional styles.
For our purposes here, we will describe the five main styles you are likely to encounter in a yoga studio near you!
This way, when you sign up for a class, you will have a better idea of what to expect and if it’s for you! 😊
1. Hatha Yoga
Hatha is referred to as “physical-based” yoga because it is more grounded in physical practice (as opposed to other types of yoga that are grounded in more abstract concepts such as spirituality, self-discipline, or even energizing techniques).
It is also a more generalized style of yoga which makes it great for beginners:
Provides an introduction to the most basic asanas (yoga postures, or poses)
Practised at a slower pace
Provides some focus on meditation, breathwork, and relaxation
In fact, most Western classes are hatha-based.
Therefore, best for beginners and those who prefer a more relaxing practice!
2. Vinyasa Yoga
Translated from Sanskrit, Vinyasa means “to place in a special way”, as in the arrangement of steps, or the flow from one asana to the next. This flow sequence is coordinated by the breath, from an inhale to an exhale.
Vinyasa Flow practice is more intensive than Hatha:
More challenging poses, focusing on strengthening all parts of the body
Poses and sequences are variable, depending on the creativity of the teacher
Classes can have different themes, and so, no Vinyasa class is the same!
Therefore, great for those seeking a challenge, faster-pace, more variability, and wish to focus on strength!
3. Bikram Yoga
Developed by Bikram Choudhury in the 1970s, Bikram Yoga is a very specific practice that takes its poses from traditional hatha techniques:
Always 90 minute sessions
Always the same sequence of 26 poses
Always two breathing exercises
In a heated room of about 40C (or 105F)
In a carpeted room, with mirrors, and brighter lights
Bikram Yoga is meant to be more intensive:
Focuses on strength, flexibility, and aerobic practice
Does not usually adjust for the practitioner
So, are Bikram and Hot Yoga the same thing?
Short answer, not quite.
Hot Yoga, is a derivative of Bikram Yoga, and as the name implies, it is also practised in a heated room:
Poses and sequences vary from the original Bikram Yoga to avoid trademark disputes and the controversies surrounding the founder
In a heated room of about 26-37C (or 80-100F)
Often in a dim, candlelit room with music playing
Adjusts for the practitioner’s needs
The heated room has several benefits:
Sweating a lot more, which is suggested to be good for both detoxification and calorie loss
Increased heart rate increases the aerobic challenge
The warmth loosens up the muscles and tissues, and is more comfortable for joint pain
For either one, make sure you bring water and a towel!!!
Therefore, best for those who like the heat and prefer to break a sweat during their workout!
Focuses on winding down after a long day, relaxing the mind, and calming the nervous system
Minimal number of poses during a class, usually 5-6
Poses can be modified to be easier and more relaxing
Supports such as blankets, bolsters, and yoga blocks are used so you can relax further
Resting in each position comfortably for approximately 5-10 minutes
No yoga experience needed
Therefore, great for anyone who is looking to reduce anxiety and improve their sleep quality, or for anyone recovering from an injury or illness!
5. Yin Yoga
Yin Yoga was established in the late 1980s, based on the ancient Taoist concepts of “yin” and “yang”. The idea being that we often need to complement the Yang in our lives with a bit more Yin.
Yang represents more the masculine, active, fast-paced, and energetic aspects of our lives. On the other hand, Yin represents more feminine, passive, slow-paced, and calm energy.
There is a misconception that Yin and Restorative Yoga are the same thing. While both:
focus on passive positions (rather than the “Yang” poses of the more active Yoga styles)
appropriate for any level of experience
calm the mind and nervous system
cultivate an aspect of meditation by increasing inner awareness and focusing on the breath
Yin Yoga specifically:
Works to release the deep connective tissues with challenging and slightly uncomfortable prolonged stretch positions (whereas Restorative poses are entirely about comfort and relaxation)
Increases and maintains flexibility by helping release the fascia
Lubricates the joints by improving circulation
The poses work into the meridians (or energy flows) of the body as per traditional Chinese Medicine
May or may not use supports during class, depending on the teacher
Therefore, great for anyone looking to improve flexibility, or balance out an already strong Yang practice, such as Vinyasa!
Bonus: Prenatal Yoga
Prenatal Yoga is adapted for pregnancy to avoid poses that would otherwise stress the joints. As long as your doctor has cleared you for physical activity during pregnancy, Prenatal Yoga is a great activity for expectant moms:
Usually focuses on pelvic floor and breathing exercises, meant to prepare for labour and delivery
The focus is more on stability rather than flexibility, as pregnancy hormones already loosen your ligaments, which can sometimes lead to joint pain
Gentle and relaxing, it may also help lower your blood pressure and stress, as well as help stabilize emotional ups and downs
Ask your yoga teacher for modifications as you go through the changes of the different trimesters and your center of gravity continues to shift.
For example, you may need to take more breaks as you feel more tired during the first trimester. Focusing on Cat-Cow rather than Downward Facing Dog may be helpful when experiencing morning sickness.
As you get your energy back in the second trimester, it might be best to focus on strengthening.
Relaxation and breathing techniques might be more beneficial as you near the end of your pregnancy.
If you are struggling with your Yoga practice, or recovering from an injury that is affecting your ability to engage in Yoga, we offer one-on-one Therapeutic Yoga sessions!Contact us for more information to find out how both our Physiotherapists and/or our Yoga Therapist can help!