How to improve posture and relieve pain with your breath

By Dana Santas, CNN

In the first article of our series, we established why breathing is your superpower, impacting virtually all aspects of your health and wellness. In this second installment, we take a closer look at how breathing can improve your posture, enhance your mobility, and relieve common aches and pains. I also share the same positional breathing exercises used by Yankees All-Star outfielder Aaron Judge and other professional athletes.

You might be wondering how exercises I use with pro athletes relate to you. In my extensive study of breathing biomechanics with the Postural Restoration Institute, I subscribed to its philosophy that “we’re all athletes in some form.” We all put physical demands on our bodies in the context of our own lives. How you breathe impacts your ability to meet those demands.

Why posture = breathing

At some point in your childhood, a well-meaning teacher or relative probably directed you to “sit up straight.” And, if your posture was deemed “bad,” you were likely given the standard cue to force your shoulders back to open your chest.

If you tried conforming with that cue, you likely found it impossible to sustain. That’s because you can’t fix something that’s inherently fluid by treating it like it’s static.

Posture is a living, breathing element of our being. In fact, our posture and our breathing are so intrinsically related I’d argue they are one and the same.

To be clear, I’m not saying that the metabolic process of respiration, which we covered in the last article, is what holds you upright. I’m saying that breathing, the movement pattern that fuels respiration, fundamentally impacts the position of your skeleton.

From a biomechanics perspective, it’s the axial skeleton, comprised of the head, spine and rib cage, that holds a human erect in what we call “posture.” Your rib cage takes up nearly 50% of your axial skeleton. Yet the common perception of bad posture remains focused on shoulders slouching forward, which leads to that well-intentioned but not-so-helpful, shoulders-back cue.

The fact is, no matter what you do with your shoulders, how you breathe is the biggest dictator of rib cage position and your overall posture.

Did you know that your diaphragm, your primary breathing muscle, attaches to both your rib cage and your spine, giving it a secondary function as a postural stabilizer? Your ribs also attach to your spine, and your spine to your head, further connecting all of these postural elements to your breathing. Therefore, as your breathing pattern impacts your rib cage position, your spine and head move in response. And because your shoulder blades are designed to glide over your rib cage, your shoulder position and function are also impacted.

Multiple studies confirm that both head and shoulder blade position are adversely affected by poor breathing mechanics. Research comparing the impact of mouth versus nasal breathing on developing school-age children showed that mouth breathing creates structural changes that contribute to forward head posture and scapular winging, or shoulder blades sticking out.

No wonder, when I asked Postural Restoration Institute founder and physical therapist Ron Hruska if he could only provide one cue to help people breathe better for better posture, he said “to breathe through your nose.”

The impact of faulty breathing

Do you feel like you have poor posture? How about shoulder or neck tension? Difficulty twisting? Back pain?

If you answered yes to any of these questions, a less-than-optimal breathing pattern is likely contributing to your issue (if not the cause).

Take a few breaths now to check in with how you breathe.

When you inhale, do your shoulders rise, neck muscles tense, rib cage lift or chest puff out? Do you feel any stress in your jaw or face?

You shouldn’t feel tension or effort coming from your shoulders, neck, chest or face when you inhale. Your diaphragm — your primary breathing muscle — should initiate inhales for you in an almost effortless manner.

With functional inhales, the diaphragm contracts, flattening and lowering as your ribs move out more horizontally than vertically, creating space for your lungs to expand. This action also decreases the pressure in your thorax (space inside your rib cage), which creates the force that pulls air into your lungs — without requiring extra upper-body effort and upward movement.

When you are not using your diaphragm optimally to inhale, you don’t benefit from the decreased pressure, so you need to recruit upper-body muscles to lift your rib cage vertically to pull air in. That’s why you might have felt tension in one or more areas when you checked in with your breathing.

This upper-chest-oriented breathing pattern works as an adaptation to keep us alive when diaphragm use is restricted, but it’s only meant to be a short-term compensation strategy.

Because you take up to 24,000 breaths daily, if you are using the wrong muscles to breathe, you are unknowingly contracting them all day long, creating chronic tension that can’t be stretched out.

That’s the bad news. But the good news is that most tension, pain and immobility caused by bad breathing can be relieved simply by learning to breathe better.

Improvements you can feel and see immediately

Remember Aaron Judge’s comments in the first article about noticing “a change and feeling of relief instantly”?

His experience isn’t isolated.

Just ask Scott Weberg, Toronto Blue Jays major-league strength and conditioning coach, who shared this: “When I was first introduced to the concept of breathing to change posture and movement, a lot of the information out there geared towards sports was overly complex and hard to apply in the weight room, but you used understandable terms and practical exercises the players could easily do and see results.”

When I’m introducing a Major League Baseball team to how breathing can change their posture and movement, I bring the pitchers up to the front of the room and do quick measurements of their shoulder range of motion so everyone can see, then take them through a set of the breathing bridge, a positional breathing exercise you’ll learn below. Then I remeasure shoulder mobility, which almost always shows immediate, visible gains in range — sometimes as much as 30%!

Weberg said: “Of course, when you see a significant change of motion in the shoulder or hips with just a few breaths, it’s easy to think it’s a gimmick. You wonder, ‘How repeatable is this?’ But then you come to realize that it doesn’t just apply to restoring motion in specific exercises but everything.”

Ready to start learning to breathe better to improve your own posture, movement and pain right away? Read on.

How to breathe better

To acquaint you with the function of your diaphragm, place your hands on your lower ribs.

Your diaphragm is a skeletal muscle housed in the lower portion of your rib cage, attaching to your lower ribs. For the diaphragm to contract when you inhale and relax when you exhale, your lower ribs need to move in synch.

Run your fingers over the inside edges of the triangular split in your rib cage below your sternum, or breastbone. That split is called your infrasternal angle.

When you inhale, that angle should widen as your lower ribs expand out, enabling your diaphragm to flatten and descend. When you exhale, your ribs should move in toward each other, narrowing the angle as your diaphragm relaxes and domes inside your rib cage.

Now that you understand the importance of rib movement, try a couple breaths focusing on rib movement. Watch the video at the top of this article for me to guide you.

Remember, you should breathe in through your nose, as Hruska cued earlier. In addition to helping prevent forward-head posture, inhaling through your nose expresses nitric oxide, a natural vasodilator that increases oxygenation.

It’s also important to extend exhales a couple of seconds longer than inhales. As you begin taking longer exhales, it may feel challenging. You need to activate core muscles to move your lower ribs in, back and down. But as you do, you should feel relaxation in your upper neck, shoulders, chest and face — all of the muscles you want to relax and stop acting as compensatory breathing muscles. Longer exhales create the space necessary for your diaphragm to dome and relax up inside your rib cage, priming it to initiate the next inhale so your body won’t need to call upon those chronically overworked upper-body muscles.

You can work on longer, deeper breaths with extended exhales using my “5-7-3” pattern: five-count inhale, seven-count exhale and three-count pause. Watch this video for guidance. I call this the 5-7-3 foundational breathing pattern, as it’s the one I use with all my clients when training deeper, more functional breathing. Once they master this, we move on to the positional breathing exercises below.

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Positional breathing exercises that really help

Important note: Consult your physician before starting any new exercise program.

Breathing bridge

I use this positional breathing exercise with all athletes to train their breathing and set their posture. It strengthens your diaphragm, core and glutes while releasing your hip flexors to establish optimal rib cage and pelvis position for better overall body alignment.

Begin on your back with your knees bent and feet on the floor, hip-distance apart.

Hold a foam yoga block or rolled towel between your knees to keep them from splaying out.

Place your hands on your lower ribs to guide and monitor their movement in and out with each breath.

Exhale fully, drawing your lower ribs in toward each other, feeling your core turn on and your rib cage move down. At the end of that exhale, without inhaling, tuck your tailbone, flattening your low back, and lift your hips 3 or 4 inches off the floor.

Maintaining the bridge posture, take five long, deep breaths, focused on proper rib movement, particularly on exhales.

Hold this position using the strength of your core and glutes to avoid letting your low-back arch.

Avoid upward movement of your rib cage while breathing; you shouldn’t feel any stress or tension in your jaw, neck or shoulders.

Practice two sets for a total of 10 breaths.

Double bent-knee twist

This exercise uses your breathing and corresponding rib movement to support healthy rotation from the middle of your back where your ribs attach to your spine. It helps mobilize your rib cage and release low-back tension.

Lie on your right side with your knees bent at 90 degrees and aligned out in front of your hips.

Use a pad or pillow under your head to keep your neck neutral.

Place a yoga block or pillow between your knees.

Make sure your shoulders, hips and knees are all stacked.

Reach both arms straight out in front of you in line with your shoulders. Place your palms together, hands resting on the floor.

Inhale as you open your left arm and shoulder to the left, while keeping your lower body in place on the right; knees and hips remain stacked.

Rotate from the middle of your back — not your low back.

Place your right hand on the outside of your left leg to help hold it in place.

Exhale and focus on drawing your lower ribs inward on the right side of your rib cage to help rotate your rib cage and thoracic spine further into the twist.

Take four more breaths, holding the position and continuing to focus on rib movement on exhales to guide the rotation. Then release back to the start.

Gently flip over and repeat from the left side.

Wall angels

This positional breathing drill strengthens your back muscles to counteract the overactive compensatory breathing muscles in the front of your body that pull you into a slouching posture.

Stand with your back against a wall, keeping your feet hip-distance apart, about 6 to 8 inches from the wall.

Bend your knees slightly, leveraging your legs and core to push your entire back into the wall with your lower back as flat as possible.

Rest the back of your head against the wall, directing your gaze forward.

Raise your arms to shoulder height, bending your elbows to 90 degrees with your shoulders, elbows and back of your hands against the wall.

Inhale as you slide your hands and elbows up the wall until you feel like it is difficult to maintain the wall touch points of your back, head, shoulders, elbows and hands.

Exhale to slide your arms back to 90 degrees.

With every exhale, concentrate on moving your lower ribs in, back and down while also pulling the base of your shoulder blades down.

Continue breathing with the movements through six long, deep breaths.

Even if this exercise feels difficult and awkward, do your best and you should notice an increased freedom of shoulder and neck movement as well as rib cage mobility.

By practicing these exercises daily, you’ll not only experience some immediate relief but, after about two weeks, you should notice lasting, positive changes in your overall posture, mobility and any chronic pain related to faulty breathing.

Tune in for the next installment in our breathing series, where I’ll share breathing-based techniques to help you sleep better.