Posts Tagged ‘sternocleidomastoid’

My Favorite Breathing Exercise

Thursday, March 1st, 2012

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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Assessing Faulty Breathing Patterns

Tuesday, November 22nd, 2011

I blogged quite a bit recently about the importance of breathing patterns in posture, muscle tone, optimal movement patterns, injury prevention and cardiovascular functions.  If breathing patterns aren’t optimal, it’s important to train them, or re-train them to make sure your diaphragm functions optimally for all of the reasons above.  Efficient breathing pattern means an adequate use of your diaphragm muscles (yes, you have two), and them functioning optimally is of utmost importance.

But do you know how to identify faulty breathing patterns in the first place?

There are many different ways to assess breathing patterns, some more advanced than others.  Here are simple ways to identify faulty breathing patterns:

1. Neck muscles’ hypertonicity.  When someone has faulty breathing habits, he will tend to “breathe more through his chest than through his belly”.  Breathing through your chest will make your shoulders go up and down every time you breathe and it will put a lot of stress on your neck muscles.  If you have a client who present with hypertonic neck muscles, it might be because of faulty breathing pattern.  This tension in those neck muscles can also lead to pretty severe headaches, as well.

Hypertonic sternocleidomastoid.  Could be the sign of a chest breather

2. Shoulder protraction.  As I just mentioned in the previous point, a chest breather will put a lot of strain on his neck and shoulder muscles as well.  Assessing the resting posture of the shoulders, as well as how they move when the person breathe (looking for significant up and down motion) can help identify faulty breathing patterns.  A chest breather will have his shoulders sitting higher (sort of shrugged up) and protracted because of the use of the wrong muscles to breathe.

Posture looks better on the right. But both present with protracted shoulders which could be sign of faulty breathing patterns.

3. Rib flare.  This is a really easy thing to identify: simply put the client on his back, ask him to pull his shirt up a little bit, and notice the position of his lower ribs.  If they are flaring out it is most definitely a sign of faulty breathing pattern.

  This is a rib flare.

……not to be confused with a Rick Flair.

4. Hyperextension at the thoraco-lumbar (T-L) junction.  This one goes hand-in-hand with the previous point on the rib flare.  If there is indeed a rib flare, chances are that there will also be a hyperextension at the T-L junction.  This can be caused by a faulty breathing pattern, as well as a lack of appropriate thoracic spine mobility.  People often compensate for a lack of t-spine extension with hyperextension at the T-L segment.

This is some of the stuff that I got from Dr. Jeff Cubos’ presentation in Muscle Imbalances Revealed – Upper Body.  That is a resource with great information, and if you’re interested in learning more about breathing patterns, how to assess for them and how to re-train them properly. You can get it by clicking on the link below:

Muscle Imbalances Revealed – Upper Body

4 Things You Should Know About the Neck

Thursday, January 13th, 2011

The neck is a very particular area on the human body. In athletic development, we pay little to no attention to neck training. Some sports like football and wrestling will sometimes devote time to neck training, but that is pretty much it. And the way they do it is usually not only far from optimal, it’s just flat out dangerous. But I digress, as this could be an entirely different blog post. The truth is, even if we don’t train it specifically, the neck muscles still receive stimuli from conventional strength training.  At the same time, I feel strength coaches and trainers alike (me included) do not know nearly enough about how the neck works, how we should deal with it and when we should refer out.  Because let’s face it: the neck is a very sensitive area (with the numerous muscles and nerves that pass through it) that should be handled with care at all time.

I watched Charlie Weingroff‘s Training = Rehab DVD set over the last week, and I must say before anything else that it is an incredible resource for any physical therapist, strength coach or trainer out there.  Throughout his presentation, Charlie highlights the importance of taking the neck into consideration in training, as well as in rehab, no matter what you are addressing.

Here are a couple of things you should know when dealing with the neck.  But before I go any further, the most important thing to remember about the neck is that if you’re a coach or trainer and are dealing with a neck dysfunction or neck pain in a client, REFER OUT! We are not qualified for this type of work by any means, we shouldn’t deal with that.

1. The neck muscles, especially the deep neck flexors are a very important, yet totally forgotten, part of the core. The deep neck flexors are part of the inner core, with the diaphragm, the pelvic floor, the TVA and the multifidus.

Deep Neck Flexors

Inner Core

If you’re not familiar with the inner core, make sure you check out my blog post I wrote a while ago (The Inner Core).  The inner core muscles are very important spine stabilizers, and so are the deep neck flexors.  A tucked chin or neutral cervical position will always make your spine more stable because it prevents unwanted cervical movement during heavy lifting.  Also, the neutral cervical position that the deep neck flexors are able to maintain are going to have a big impact further down the spine; which leads me to my next point.

2. The position of the cervical spine can influence what happens at the lumbar spine. When you create extension at the cervical spine, you have more chances to create extension at the lumbar spine, which we try to avoid when we use heavy loads because of all the shear forces that are going to be applied to the spine.  When deadlifting for example, starting with the neck extended (when your eyes are looking straight ahead) will put a lot more stress on the cervical spine, and on top of that, it will increase the extension shear forces on the lumbar spine.

Cervical Hyperextension = Big No No

This happens for 2 reasons; for one, as I mentioned earlier, the deep neck flexors are part of the inner core, and the inner core needs to be activated to optimally stabilize the spine.  If you’re looking up, the deep flexors are not activated and the inner core will not stabilize as efficiently.  Second, the cervical and lumbar segments of the spine are both inwardly curved (“lordotic”), which causes them to react similarly; if one goes into extension, more often than not, the other one will try to get into extension as well.

3. Coaching and cueing neck position during training is very important.  If you’ve read the 2 last points, this might seem pretty obvious, but we want to keep a tucked and neutral chin during everything we do in training.

This might seem a little retarded, but it really is the optimal neck position to lift with!

When you start noticing the position of your neck and the ones of your athletes during a training session, you’ll realize that the neck tends to go in a less than desirable position (read: too much extension) with many, and I mean MANY exercises: lunges, squats, deadlifts, seated rowing, chin ups, push ups and almost every core exercise possible!  You will honestly be shocked at how much people go into an extended neck position on so many exercises, and most of the time they don’t even notice it.  Notice how much more difficult a simple plank is when you force your chin to stay tucked back.

4. The tucked chin position facilitates efficient breathing.  Being aware of the importance of efficient breathing has been a topic that has grown in importance among the strength and conditioning community lately.  Breathing through your belly instead of through your chest improves diaphragm function and puts less stress on the already overactive neck muscles scalenes and sternocleidomastoid.  Many coaches try to cue breathing through different techniques and exercises to reinforce good breathing patterns.  But the truth is that when you get in a tucked chin position, with your neck packed back, you don’t even need to cue anything; it just happens.  If you’re not convinced, try it yourself: stand up, get our head in a forward position (chin protruded), put one hand on your chest, one hand on your belly and try to take a deep breath.  Now do the exact same thing, but with your chin in a tucked back position (as in the picture above) and take a deep breath.  You’ll notice that, when in a tucked back position, without even thinking about it you’ll breathe through your belly much more easily.  So instead of cueing breathing techniques, why not just cue good neck position?

For more info, make sure to check out Charlie Weingroff’s Training = Rehab DVD set.

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