I’ve blogged about the importance of breathing patterns many times in the past, and for a good reason.  Breathing patterns and the muscles responsible for breathing affect so many things in our bodies, yet we too often ignore their importance.  In the presence of a faulty breathing pattern, accessory muscles will compensate for the diaphragm not doing its job properly.  We then see hypertonic neck muscles (scalenes, sternocleidomastoids, upper trap, etc) which can also lead to neck pain and headaches, referred pain in the shoulder, etc.  But this is only the superficial stuff.

If the diaphragm isn’t working properly, chances are that it’s also not positioned optimally.  We could debate which one causes the other (dysfunction causing faulty positioning or faulty positioning causing dysfunction), but it would be a case of the chicken or the egg.

The thing to keep in mind is that when the diaphragm isn’t positioned properly there are also surrounding structures that are affected.  The lower ribs flare out, the T-L (thoraco-lumbar) junction is stuck in extension, and the whole rib cage is positioned differently.  This in turn will affect the positioning of the scapula because it sits on the rib cage, and therefore the positioning of the whole shoulder girdle will be changed.

Faulty breathing patterns can also affect structures lower down the kinetic chain.  Because of the attachment of the diaphragm and its fascial connection through the psoas, that goes through the hips, the positioning of the hips can be affected.  And if the hips are positioned differently, everything below (femur, tibia, foot) might be in compensated positions.

Not the best picture, but you can still see the convergence of the psoas and diaphragm

Before this turns into an anatomy course, I’ll stop here!  The goal was just to make you understand how powerful breathing patterns can be and how it can affect the whole body.  That is why school of thoughts such as the Postural Restoration Institute put such an important focus on breathing patterns and diaphragm function to treat all sorts of problems (overuse injuries, low back pain, shoulder pain, flat feet, etc, etc).  All of their corrective work involve very specific breathing patterns.  They have a bunch of different exercises incorporating breathing patterns to get you back into a “neutral alignment” as they would put it.

I have learned a great deal from PRI and started including a lot of their stuff with my athletes, which has worked almost like magic in many cases.  Here is one of my favorite exercises that I stole from them to teach proper breathing patterns:

The position: Lying on your back with your feet up on the wall and your knees and hips at 90° angle, squeeze a foam roller or a small medicine ball between your knees.  Dig your heels into the wall and posteriorly tilt your pelvis just enough to get tail bone slightly off the floor.  Get your right arm straight up and reach with the palm of your hand towards the ceiling.

Execution: Take a deep breath trough your nose, Blow out through your mouth as hard as possible trying to inflate the balloon as much as possible.  Blow all your air out in the balloon.  When you have no more air in your lungs, pause for about 4 seconds while pushing your tongue against the roof of your mouth (your teeth should not be clenched).  Then, breathe back in through your nose, and repeat the sequence. You can do anywhere from 5 to 10 breaths, but start on the lower end, and make sure you control everything.

Cues: Make sure that the tail bone remains slightly off the ground the whole time and the heels keep digging in the wall.  When reaching up with your right arm, you only want to reach as high as your arm will go, meaning you don’t want to lift your upper back off the ground to reach higher.  The pause with the tongue against the roof of your mouth is probably the most important step.  Do not repeat on the opposite side.

We only do it on one side because the diaphragm on the right side and on the left side are shaped and positioned differently; we want to facilitate the air going into the right side to re-position you in a more neutral position.  This is again part of the PRI philosophy that the human body is assymetrical for a host of different reasons; we have a heart on the left side above the diaphragm, we have a liver on the right side under the diaphragm, the left side of our brain manages motor control, etc.  I’m not going to get too deep in the PRI philosophy as it could be the subject of an entire different blog post, but hopefully you get the concept a little bit.

Don’t overlook breathing patterns and make sure that it’s part of your assessment protocol with everything else you assess for.

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Core training is most often referred to as exercises that work your rectus abdominis.  Sometimes the concept of core training will go as far as including the external and internal obliques and the lumbar erectors, but it rarely goes past that stage.  The term “core” in itself is very loosely used to describe either abs training or stability training, or sometimes both.  But the reality is that your core can include every muscle that runs across your hips, spine (including the cervical spine) and shoulders.

And this is only the back view…

So we definitely need to broaden our horizons when we think about core training and realize it’s much more than just the muscles around our belly.  Here are some of the most overlooked aspects of core training:

• Cervical spine alignment (packing the neck)
• Inner core activation (pelvic floor, diaphragm, transverse abdominis and multifidus)
• Breathing patterns

These are 3 things that go hand in hand with each other, as well as with traditional core training and in my opinion they’re probably the 3 most overlooked aspects of core training among athletes and regular gym-goers.

The trend since Stuart McGill’s work came out is to use neutral spine whenever we train the core and lift weights.  The goal is to reinforce this pattern as much as possible.  But we often forget that the neck is part of the spine and that should also be trained to be neutral.  There is a much deeper core activation when the neck is packed in a neutral position and it provides for greater stability.  The cervical spine often gets into hyperextension when training, especially with posterior chain exercises.  The tendency is to keep the eyes up while the angle of the spine gets closer to parallel.

Notice how hyperextended the cervical spine is.

This position puts a lot of strain on the inter-vertebral discs of the cervical spine on top of having sub-optimal spine stability all the way down to the lumbar spine (each segment of the spine interacts with each other).  Keeping the neck in a neutral/packed position will facilitate a proper breathing pattern (Try and take a deep breath- without thinking about it- first, in a relaxed position with your neck not in a neutral position, and then try it again in a packed neck position.  Notice how the breath with the packed neck position is much more of a belly breath, compared to more of a chest breath without your neck packed).  And that in turn will facilitate activation of the inner core muscles.

Why is this the first image that pops up when I google “packed neck position”??
…but I have to say that his form is pretty impressive

The bottom line is that everything in your core is interrelated together and when everything is indeed coordinated, you gain amazing stability that you wouldn’t have otherwise.   That’s why it’s so important to train your inner core, your breathing patterns and your packed neck position.  From an injury prevention and a strength gain standpoint it can make all the difference.

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Core Training. One of the most important component of a training program.  We all include in our program exercises like planks, rollouts, knee tucks, rotation/anti-rotation exercises to work the core in all possible ways. 

But what happens when you perform these exercises with high loads or you go to failure on them?

You overload the rectus abdominis, external obliques and in some cases the lumbar erectors. 

But isn’t that the whole purpose of core training?

The answer is, in part.  The rectus abdominis, external and internal obliques as well as the lumbar erectors are part of what we call the outer core.  The thing is there is also an inner core.  The inner core is a term I learned from Dr. Perry Nickelston and it is used to describe the core muscle group formed by the diaphragm, the pelvic floor, the multifidus and the transverse abdominis (TVA).

The inner core is responsible for the muscle activation that support respiration and segmental stability at the lumbar spine.  When these muscles are not properly activated, more stress is applied to the outer core muscles to stabilize the spine and this can further lead to back pain.

So how do we train the inner core?

First of all, the inner core needs some low load exercises to activate properly without having the stronger, more dominant outer core muscles compensating if the load is too heavy.  The inner core is also easily activated by squeezing something between your knees or by reaching overhead with your arms.  With that in mind, I am currently using a variation of the dead bug series that combine both activation patterns of the inner core muscles. 

When performing this exercise, you should focus on keeping your belly thight the whole time, crushing the ball with both knees and you should avoid arching with you lower back as you reach overhead (you want to keep a slight natural arch in your back though).

I’ve had great results from implementing this movement in my own training program.  I still need to play around a little more with these inner core activation exercises, as I’m just starting to understand their true function.  I do believe that inner core training is a good complement to any core training program.

Dr. Nickelston also wrote a very interesting blog post on Carson Boddicker’s website about the inner core where he demonstrates 2 simple progressions of exercises that  work on activating the inner core.  You should definitely check it out HERE.