Diaphragmatic Breathing Exercises

Original Editor - Ahmed Essam Top Contributors - Ahmed Essam, Stella Constantinides, Kim Jackson, Lilian Ashraf, Hing Long Yip, Khloud Shreif, Oyemi Sillo and Lucinda hampton

Introduction

Diaphragmatic breathing is a type of breathing exercise that helps strengthen your diaphragm, an important muscle that helps you breathe as it represents 80% of breathing. This breathing exercise is also sometimes called belly breathing or abdominal breathing.

. Two phases of breathing

When the diaphragm is functioning effectively in its role as the primary muscle of inspiration, ventilation is efficient and the oxygen consumption of the muscles of ventilation is low during relaxed (tidal) breathing. When a patient relies substantially on the accessory muscles of inspiration, the mechanical work of breathing (oxygen consumption ) increases and the efficiency of ventilation decreases.

Controlled breathing techniques, which emphasise diaphragmatic breathing are designed to improve the efficiency of ventilation, decrease the work of breathing, increase the excursion of the diaphragm, and improve gas exchange and oxygenation. Also breathing from the diaphragm generate intra-abdominal pressure for control of posture and you can accomplish slow respiration.

Aims

• To mobilize secretions and teach breathing control.
• To teach effective coughing and remove secretions.
• To teach relaxation.
• To teach postural awareness.
• To mobilize thorax and shoulder girdle.[2]

Physiological Effect

1. It improves your core muscle stability.
2. It slows your rate of breathing so that it expends less energy.
3. It helps you relax, lowering the harmful effects of the stress hormone cortisol on your body.
4. Increased efficiency of venous return
5. Improve respiratory capacity.
6. It helps lower your blood pressure
7. It helps you cope with the symptoms of post-traumatic stress disorder (PTSD).
8. It improves your body’s ability to tolerate intense exercise.
9. It lowers your chances of injuring or wearing out your muscles.

Supine position

1. Lie on your back on a flat surface (or in bed) with your knees bent. You can use a pillow under your head and your knees for support if that's more comfortable.
2. Place one hand on your upper chest and the other on your belly, just below your rib cage.
3. Breathe in slowly through your nose, letting the air in deeply, towards your lower belly. The hand on your chest should remain still, while the one on your belly should rise.
4. Tighten your abdominal muscles and let them fall inward as you exhale through pursed lips. The hand on your belly should move down to its original position.

You can also practice this sitting in a chair, with your knees bent and your shoulders, head, and neck relaxed. Practice for five to 10 minutes, several times a day if possible.[3]

Sitting position

1. Sit up straight in a chair lengthen the distance between your navel and sternum.
2. Keep your shoulders relax.
3. Keep the pelvis in neutral position (Sit on your sitting bones).
4. Place your hands at either side of your lower ribs.

Breath in slowly through your nose. As you inhale feel your ribs expanding outwards and upwards. During inhalation is generated expansion of the trunk in three directions front , sides and back. Breath out from your nose. As you exhale feel your lower ribs moving inwards.

Precautions

• Never allow a patient to force expiration. Expiration should be relaxed or lightly controlled. Forced expiration only increases turbulence in the airways, leading to bronchospasm and increased airway restriction.
• Do not allow a patient to take a highly prolonged expiration. This causes the patient to gasp with the next inspiration. The patient's breathing pattern then becomes irregular and insufficient.
• Do not allow the patient to initiate inspiration with accessory muscles and upper chest.
• Allow the patient to perform deep breathing for only three or four inspirations and expirations at a time to avoid hyperventilation.

Indication

1. Post -operative pain
2. Airway obstruction (COPD, asthma)
3. Atelectasis
4. Restriction of breathing due to musculoskeletal abnormality or obesity
5. Central nervous system deficit
6. Neurological patient with muscle weakness.
7. Surgical procedure such as thoracic or abdominal surgeries.