 Welcome back to Move It Matters, a show designed to bring you the best physical therapy tips and exercises to decrease pain and get you back to doing what you love. I'm your host, Christine Linders, Board-Certified Orthopedic Physical Therapy Specialist. Today, we're going to learn all about breathing and how we can use breathing to improve our bodies. What helps us breathe? The diaphragm does. It's designed for breathing. And that's what most of us think of when we think of the diaphragm. But that you didn't know, it also helps with postural control during activity, decreasing reflux, improving digestive motility to prevent constipation, and preventing low back pain by activating the deep core with each breath. I'd like to welcome and introduce you to my guest today, Joan Linders, my mom and retired licensed practical nurse who will be discussing with me how she used breathing to abolish her symptoms. Welcome, Joan. Welcome, Mom. Hello, Chris. How are you doing today? So is it cold there? It is cold. It finished snowing. This time, we just got about an inch. And the other day, we got about eight, I think. So I'm tired of shoveling. My neighbors have helped me greatly. Oh, that's great. I love them. That's so kind. And I guess we're in an arctic or polar vortex, as everybody's saying. Even in Hawaii, the word I hear around here is, oh my gosh, it's freezing because it's between 68 in the morning to about 80 during the day. But it does feel cold for those of us that live in the islands. But our cold is a different version than a lot of other places. Yes, we have like 18 to 34. You look nice and bundled up. I like your scarf. And we're going to be talking about reflux, back pain, postural control, the wonderful diaphragm, and show everyone watching how to do some exercise to improve all of the above. So to start off, let's go to video number one, where Mary Massory, who's a physical therapist, a PhD in this, came on the show early in the pandemic last year to explain to us. Let's go to video number one to learn. So we know the diaphragm is a respiratory muscle. That's one thing. That's easy. Everybody knows that. I don't care what line of work you're in, you know the diaphragm is important for breathing. But the diaphragm is also really important as a barrier for reflux. So if you've gotten heartburn, and that is the layman's term for it, if you've gotten heartburn, right at that squished banana in the red portion of the diaphragm, right in the center of the diaphragm, that's your esophagus. And that's called your gastric junction. At that level, the diaphragm and the esophagus actually work together like a force couple. And maybe we can go back to my picture. So I wanted to show that video of Mary explaining her brilliance, her research, her life's work that has helped so many of us from young, young age babies and up to old, old age is that your diaphragm has this contractile tissue right in the middle of it that helps for reflux. And when you take a deep breath in, that muscular ring clamps down around the lower esophagus and stops the stomach contents from coming up. So we can use inspiration, resisted inhalation, resisted inhaling and layman's terms to strengthen that area and prevent reflux without using meds. So a lot of people are on meds. Some people are not on meds. Some people have reflux. Some people have what my mom is about to explain to you. So mom, what were the symptoms that you told me? I think it was middle of the pandemic last year. You said, oh, after I eat, I feel I don't even know some pressure or discomfort below your sternum. Tell us your story. Oh, yes. Actually, it was a surprise to me because it was as I was eating actually, and I could feel the pain right at the xiphoid. And you can explain what the xiphoid is. In case they don't know. But I thought, oh, my goodness, what is that? So of course, you put on your worry hat, you know, I marched myself to the doctor. And but you had told me about breathing. And when I went to the doctor, she said, I think you have a high adult hernia. But she said, keep doing the breathing exercise that your daughter has told you about. And so I'm much better if I ever get maybe if I'm eating something too heavy, I will make sure I'm sitting up straight and it passes. But breathing, the breathing exercise is the key. Yeah, that's wonderful. So I took Mary Mastery's class, I think two years ago, when I was trying to get some research for my book on suck it in how to activate the transverse abdominis. And halfway through the first day of the class, I said to Mary, I went up to her and I introduced myself, I said, I'm writing a book on how to activate the deep chords, you get rid of low back pain. But I have a whole new appreciation for the diaphragm. And everything that you have said is like spot on, this is her life's work, she's brilliant. And the reflux aspect of that class was mind blowing for me because I know so many people with reflux. So my late father who passed two years ago, he had a large title hernia and he would cough and cough and cough and cough after he ate. So I had him do was I had him stand up and do these breathing exercises that Joan and I are talking about and it decreased his coughing. I've also given many of my patients who have complained of reflux and you know their back hurts and their neck hurts from sitting up. And I said, well, we got to get you laying down to get your back and neck to stop hurting. So why are you sitting up? I have reflux. Great. Reflux. Great. Let's do some of these exercises to help you with this inspiratory muscle training to strengthen that barrier that Mary's talking about in your diaphragm so that you can stop this reflux from happening. So let's go to video number two where I explain a little bit and then Joan and I will show you more. Your diaphragm can help you with your reflux is that there is a tube that passes down through your diaphragm from your esophagus and there's a ring of muscle tissue that surrounds that and they call that the lower esophageal sphincter. So when you breathe that sphincter tightens around your esophagus and prevents the contents from your stomach from coming back up into your esophagus, giving you that awful burning feeling that you have after eating or before you're laying down in bed. So one of the things that has been successful in helping to exercise your diaphragm and thus that muscular tissue sphincter to prevent reflux is doing inspiratory muscle training or resisted inhalation. So I've been having people use a small coffee straw and what you need to do is put it in your mouth. This one's not open yet, but you put it in your mouth making a small hole and you breathe it. It's resisted breathing. You can also use something a little bit more expensive than the coffee straw. It's about $40 called the breather. And so what you use, it's for one person only. It has resisted inhalation and resisted exhalation, but we're going to do inhalation for this exercise. So you can turn this up from one to five. I have it on five. You put it in your mouth and you inhale. So you exhale first, everything out. Inhale, exhale, inhale. So you want to do that to help with your reflux. Try it. So it's a great video because just as I'm inhaling in the coffee straw, the motorcycle goes by, but I promise you that is not what I sound like when I take a deep breath in. So, so, Joan, if you have your straw, I have my breather. I use it to show people. I'm going to keep it in its envelope. So okay, exhale. And then if you want to do what you can, but I'm going to show everybody this is what I call the peace pipe in hospitals. It's, I forgot what they call them actually now, but I've called it the peace pipe for 25 years. So you exhale, put it in your mouth. You breathe in as much as you can. If you have asthma or COPD or any kind of obstructive or restrictive breathing, you may not be able to take as deep a breath as I or Joan or your husband or your wife or whoever else lives with you will be able to do, but just do your best. Breathe out. And I think one thing I forgot to mention, but Joan mentioned and I mentioned a little bit about my dad is posture is so important too to enable your diaphragm to descend fully and get the maximum capacity in your thorax within your ribcage in your lungs. So you'll see me. I'm breathing out. I'm bending forward to get the last bit of air out, but you don't have to do that, but it is important to sit up as straight as you can to inhale. So you inhale. It's a great commercials are a great time to do this. Joan, I don't know when you did yours, but commercials, I tell people do it during the commercials. You don't have to do 10. If you get lightheaded after three, stop. That's fine. Maybe you do three, five times a day. Maybe you stand up against the wall and you do it to facilitate improve posture. Mom, where did you do yours? Just sitting. Yeah. And it really helps. And you can even double up to the double barrel straw. If rubbing provides the more resistance like your breather there. It does. And so the thing with this that I like better than the coffee straw, especially for women is making that little as we age, you know what I mean? We lose our collagen. You want to keep all your skin looking nice. It has a nice wide mouth. So you don't have to personally a tiny. So go whoever invented this breather. Okay. So let's talk about low back pain. I mentioned how Mary Mastery's class blew my mind when I learned what you're about to learn. Let's go to video number three. My favorite thing to talk about the diaphragm and low back pain, your diaphragm intersects into your transverse abdominis on the side like a basket weave like this. So when you take a deep breath and it activates your transverse abdominis. So you can train your diaphragm to help with your low back pain. So when you suck your stomach and to activate your transverse abdominis, the fibers run this way. So you pull your belly button in and your fingers move closer together. You pull your belly button in, your fingers move closer together. If you put your hand on your diaphragm here where you're breathing, you can say it come out, but you don't want to do that. You want to take this muscand and bring it in. Pull your belly button in and let your diaphragm breathe while you keep your tummy in. Keep your tummy pulled in and relax. So a lot of people will pull both in diaphragm and transverse abdominis. You want to pull your tummy in and let your diaphragm breathe. Maybe I reversed the order of those videos when I was planning last night. I apologize. What I was showing you there is how to suck it in, how to use your transverse abdominis to stabilize your low back by pulling your belly button in without stopping the function of your diaphragm. So you're sucking your belly button in, letting your diaphragm breathe and work with itself. You can pull them both in very easily because they're attached as you're about to learn in video number four. On the inside, you see where you have half of a dome? That's half of the diaphragm that would be on the left side of your screen and then there would be another half of the dome on the right side but it's taken out for this picture. What I want you to see is that those vertical fibers are the muscle fibers of the diaphragm going up to that dome. Then look at the ones that are going horizontally. Those are the muscle fibers of the transverse abdominis which is the deepest layer of your abdominal muscles. What I want you to really notice is that junction between the two. So the diaphragm and the transversus abdominis actually intersect at the xyphoid process which is the base of your sternum and your lowest ribs which are ribs eight, nine, and ten. And they form kind of a basket weave as you can see there meaning that when one muscle contracts it stretches or stimulates the other muscle to move. So in other words you can't use your diaphragm for breathing without having it automatically activate the deepest layer of your abdominal muscles. So the diaphragm works with the abdominal muscles for breathing as well as to support the pressure in your abdominal cavity which stabilizes your spine and your pelvic floor. What a concept. You made me. No one said it better. My whole book. I love it. That was fantastic. You can see those episodes on thinktecawaii.com under Christine Liders and Movement Matters. They were last year. Mary did three. It was amazing. So don't tell me. Tell me a little bit about the back pain you've experienced in the pandemic. I think maybe from shoveling, maybe from sorting, home projects. You tell us. It was all of that. And lately it's the snow shoveling. Oh my gosh. So I have to remind myself to suck it in and sometimes I'm talking to myself when I'm out there to brace and then bitch. A lot of over the shoulder stuff. So then when I come in, I've got to relax on the sofa with a little bit of a hot pack and relax all those tight muscles again. But sucking it in is the key so that you're not hurting yourself. Excellent. Excellent. So what kind of symptoms were you having? I helped you before I came home for a pandemic visit in December with some back and hip pain. What were you experiencing? I think I actually came home too healthy with that because I was stressed out that you were in pain and I wasn't coming home normally. Yes. The back pain I experienced also when I'm getting up off the couch. My furniture gets a little older. You're sinking a little bit more. So it was that and it affected, I'm not sure if I'm on the right track, but it affected my going up and down the stairs. So you gave me some exercises to use the band around my ankles and do the exercises strengthening the leg. And at the same time I'm also, you said brace to suck it in while I'm doing the exercise and keep everything in line. So it's really, it's helped me going up the stairs. So I'm grateful for all your exercise that you showed me how to do. Great. Great. So I want to bring that up because I think it's so important to get in a regular routine and I was out there for five days in December from the 15th to the 21st. And we worked on you and we stretched your knees to your chest and we sucked it in and we did glute button muscle activation and back muscle activation. And I know it was tough for you to get into that routine. But every time you say I did my exercise and I feel better, I am so elated because I think that's the discipline and the habit and the consistency that I want everyone to take away with any of the things that I give you is even if it's two minutes, like you're sucking in and when you're shoveling and you're coming and you're laying down or stretching out those muscles or your morning routine where you said you hug your knees up to your chest and you move your feet up and down before you get out of bed, which really helps you to have more of a free day. So great job, mom. And I have a question. What do you recommend for middle-aged men? Are the exercises the same that you ladies do? If this is with breathing, it's the same. You can get a breather or you can get the coffee straw. And if it's in regards to like posture or standing up against the wall, if you've got a hiatal hernia or after eating, it's the same exercises as far as the the peace pipe and the breathing and the breathing goes. So I wanted to tell you something a little bit about this transverse abdominus and the diaphragm, that basket weave that Mary was explaining so well, when people have asthma or COPD or any other kind of respiratory dysfunction that can make it more difficult for them to breathe and you have to then walk a distance or walk down the hall to your bathroom, the diaphragm helps for postural control because every breath you take, it fires your transverse abdominus and gets that stability into your trunk. But if you can't breathe because you have asthma or some other kind of restrictive problem, the diaphragm abandons its function as a postural stabilizer and just goes to breathing. And that is why so many people start hunching or they feel like they're getting closer and closer to the floor as they're walking down the hall. That's why walkers are so useful to help with energy conservation. Just touching the walker decreases the amount of energy that you expend so your diaphragm can still help with breathing and postural control or walking sticks are great. If you don't want to use the walker, use them in your house, get the rubber things, use canes, that's the biggest thing. So I had a patient who she was walking from her car to her doctor's appointment to me and she was having back spasms. And I started working on breathing exercises with her one time because I said, you know what's happening when you walk this distance, you no longer have diaphragm for postural control. You're struggling to breathe because of your asthma. And she was because the Vague was bad the last couple weeks. I was suffering with my allergy since she was suffering with her breathing. So we worked on breathing exercises and she came back three days later. She was, you know what? The next day I thought I strained myself. I don't know why, but we had done just a few deep breathing. Now her deep breathing was not my deep breathing. It's much less of a volume because of her asthma. But she was taking deep breaths. We did three, a couple sets of three and it really did help her to expand her rib cage. So I want everyone to think about that. And I know Joan, do you know anyone who's doing activities or yourself who might get a little more hunched as you see them walking? Well, I know the walking sticks that you suggested really helped dad. Yeah. And then you suggested when I go for my walks to, you know, take them with me and, you know, takes the pressure off. And so yes, my sister-in-law, she has a balance problem. So she has to be very careful so that she's not toppling over. Maybe you teach her some breathing exercises to activate her deep core to help with her stability while she's up and about. Yeah. Okay. That's a good idea. Great idea. I talk to her every day. Okay. I love her. Maybe she'll take. So let's go to video number five where we talk a little bit about the diaphragm and some asthma exercises. You have asthma or restricted breathing for any other way. You want to start easy with some exercises. But because your diaphragm attaches on the sides to the trans or subdominous, the muscle that helps stabilize your low back during activity, you can use your diaphragm to help stabilize your posture. It works as a postural stabilizer. But when you get short of breath, because you've been walking, you lose that. And that's why people tend to hunch forward because they are getting out of breath as they're moving. And your diaphragm no longer works for postural control. It just goes to the task of breathing because you need to breathe to slowly open up your chest and open up the intercostal muscles, the ones that lie between each rib to help you get more endurance when you're walking and prevent that hunching forward or the back pain that you feel when you're walking down your driveway to the car or into the store. You can do these simple exercises. So you want to lay on your back, you can use a pillow, grab a surface. I like a physio ball. I don't have one at home. So you can use an object. This is probably a couple pounds. Put your arms around it like this on the sides. And then you raise it over your head and you breathe in as you do it. Open up those ribs and then you exhale and you bring the surface back to here. Breathe in it again, a big deep inhale. Open up those ribs and go back to start. To make it even harder and more of a challenge, you can breathe in. Open up those intercostal muscles, exhale. Let the ribs come down. Breathe in again. Reach up over your head, exhale. That's a great exercise for that. You can also lay on your side to open up each side. Lay over a pillow so it bends you a little bit. Take your arm towards the ceiling and you're going to exhale everything and take a big rapid inhale as much as you can and raise your arm up over your head to lift those ribs. And then you exhale. Do it on your own timing. If you need to catch your breath in between, don't feel like you need to do a couple in a row, catch your breath. And when you're ready, you exhale and a deep rapid inhale. It helps to open up the spaces between your ribs to help give you more capacity for breathing. When you have asthma and you're very restricted, you tend not to take a deep breath because you can't at times. So we want to stretch that out to allow you to take the biggest breath that you can. Enjoy. These exercises are great for everybody. I highly recommend you try them. They're good for shoulder pain. They're good for neck pain. They're good for poor posture. So use them, try them. That's why I do this for you so that you have some tools to do at home. So let's go to video number six, which is one of my favorite stretches for the pec muscles so that you can open up to take tension off your neck, off your shoulder, off your back. Another great way to use your chest muscles to lift up those ribs and open up the space in your rib cage and your lungs is to stand in a doorway with your arms out like the letter T. Straight arms out, put one foot in front of the other, and then you use the back foot and you push through the door and you lift your chest and you take a deep quick inhale. And then you exhale and come back. Push that back foot forward with your chest. You can hold it there and exhale. Take another quick rapid inhale. Use those pecs to pull those ribs up and improve the ability to take a deep breath in. You can also turn your head to the right and turn your chest a little to the right. Breathe in. That'll stretch your left side and then you can turn back to the left and lean a little to the left and take a deep breath in. It really opens up the chest, especially after you've been sitting or working on your phone for a long time or your laptop. Exercise. I do it every day. I should do it more. Mom, is that something that you've done? The doorway exercise is really, really stretchy. It feels so good, really. And the morning stretch because I guess I curl up in the night, but before I get up, I do, you know, the pull your, your knee to your chest and then stretch up and use your ankles. And it makes a difference that I don't get up, you know, all tight and then try to straighten up. Yeah, no, that's great. And so breathing also, like the chest stretch, not only is it helping with reflux, not only is it helping with your posture, shoulder pain, back pain, but also with constipation. I don't know who's flown on a plane for five hours or more and got off and felt like they had that rock in your stomach. And that's because your diaphragm is not descending fully while you're sitting there still to press into your abdominal contents and help you with digestion. So if anyone with constipation, doing some of this inhalation training, whether you do, or you use the breather, or you do the chest stretches, it's all going to help you with that. Now, I know we have a couple minutes left, so I want to show this one exercise that Mary showed in our shows, Mary Mastery. And mom, if you want to do it with me, you have like, you know, and you keep it in a V and you follow your hand with your eyes and you go a quick rapid inhale. And then you bring it back down. Keep no lazy elbows, Joan. Straighten that elbow. I think I did it too. Breathe in. Not only will this help you with your posture, it helps you with your shoulder pain. Sometimes you just can't get the last bit of range of motion if you've had impingement or frozen shoulder and it hurts. Work on your ribs. Do the exercise that I showed you in that video for asthma. Breathe in. You can really feel your lungs expanding. You know, it absolutely helps. Absolutely. And you discovered that I had some increasing scoliosis going on, so any kind of stretches really, really helps to open those spaces. I am so glad, yes. I am a scoliosis person as well. I taught a class with someone who calls them curvy girls. I love that because it's very lovely. And so please, everybody, do your breathing exercises for reflux, for constipation, for back pain, for shoulder pain, to help your posture, stand against the wall, to help your asthma or your COPD. For COVID survivors who are having the secondary complications of pneumonia, think about your breathing. Think about sitting up straight or leaning against the wall to allow your diaphragm to descend to give you a bigger breath than you can take when you're hunched forward because you couldn't breathe. And thank you, gentlemen. Thank you, mom. And thank Tecawai for giving us your time today and allowing us to be here for you today. Aloha, everyone.