Monday, May 5, 2003 - Physiology
Breathing (Part 4 of 6)

- By: Ross McKinnon, PT

The tests and exercises described should be performed with the help of a physiotherapist to achieve maximal benefit.

 

When you ski hard do you concentrate on breathing?  Does your pattern of breathing change with different techniques, changes in pace or changes in terrain?  Coordinating core stability and correct breathing will allow better oxygen utilization when skiing.  For example, if we go to lift something quite heavy we will typically perform a Valsalva maneuver (holding our breath through diaphragm and abdominal muscle tension).  This is quite effective for short periods of time.  Now imagine that you are one skating on an uphill – you wouldn’t want that same Valsalva maneuver to take over as you would quickly go anaerobic.  Instead we need the abdominal and inner unit muscles to stabilize the core while the diaphragm moves freely to allow for proper breathing.  Athletes that suffer from side “stitches” most likely have poor diaphragmatic and core stability control.  In summary, the inner unit muscles should provide the stability and control of the spine allowing independent movement of the diaphragm and ribcage which is needed for efficient breathing. 

 

The diaphragm is a dome shaped slow twitch skeletal muscle which forms the bottom of the thorax.  The diaphragm has a central tendon which is attached to the ribs and vertebrae of the spine.  The lungs are roughly divided into the superior, the middle and the lower lobe.  As air is drawn into the lungs an increased volume is required.  The dome of the diaphragm flattens and is lowered roughly 2cm.  At the same time the ribs will expand outward and upward to increase the lung volume.

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There are three common breathing patterns:

1)       Upper lung breathing –the neck muscles are overused to assist the diaphragm with respiration which leads to muscle imbalance around the neck and shoulders.  This would be uncommon in a trained athlete.

2)       Abdominal breathing – the abdominal muscles bulge outward with inspiration.  The abdominal muscles are required for posture and stability.  This breathing pattern is usually due to posture (increased lumbar and thoracic flexion), a tight ribcage and/or thoracic spine.  This is often mistakenly called diaphragmatic breathing.  This type of breathing is commonly used in relaxation techniques but is detrimental in sport as the abdominal muscles cannot provide stability and power if they are moving during breathing.

3)       Rib cage breathing – this is the ideal.  This pattern allows the abdominal muscles to provide a stability role allowing for the diaphragm to maximally expand the lower lobes.  The ribs should expand out to the side and slightly elevate during a breath in.  Remember that the diaphragm can only lower 2-3cm.  To further increase lung volume the ribs must move upward and outward.  Improving rib expansion will allow more oxygen to enter the lungs (especially the lower lobes where the most oxygen exchange takes place).  Posture is extremely important for correct breathing as an overly flexed or bent posture makes it very difficult for the diaphragm to work correctly.  Imagine the diaphragm as a piston in the ribcage; the straighter the shaft the more efficient the piston.

 

Assessment

Assessing breathing will determine both the pattern and if there are any muscle imbalances contributing to poor inspiration.

 

Breathing pattern – Check for the type of breathing patterns previously mentioned above while the athlete is relaxed in standing.  With the athlete standing, have the athlete flex the spine and instruct them to take a normal breath in.  Do the same with a corrected upright posture.  There should be a noticeable improvement in the ability for the ribcage to expand during the upright stance.  This is especially important in athletes with a pronounced swayback posture.  It is very important that during relaxed breathing that the time of inspiration and expiration are equally.  At rest the expiration should require no muscle use.  If the expiration is significantly shorter then the oblique stomach muscles may be overused.

 


Rectus abdominus – Instruct the athlete to prop themselves up on their elbow or hands and try to expand the ribcage maximally with a deep breath.  A restriction may indicate short abdominal muscles.  Check that the right and left sides can expand equally and maximally (this test was covered in Part 1)

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Cat stretch position – On all fours lift the spine to the ceiling, maintain that position and sit down towards the heels without moving the arms.  In that position try to expand the ribcage maximally with a deep breath.  Check that the right and left sides can expand equally and maximally.  A restriction may indicate short latisimus dorsi and/or back muscles.
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Pattern of breathing during exercise -
 experienced runners have a rhythmic pattern of breathing, timing their inspiration and expiration to a certain number of strides.  Check yourself the next time you are skiing or roller skiing.  Do you breathe in or out during the push phase of double poling?  During diagonal stride, do you breathe in on one side of the kick phase and out on the other?  If so is the inspiration always on one side?  What about offset or one skating.  Can you breathe out while poling on one side of the one-skate and then breathe in while you pole on the other?   Can you only breathe out and pole?  I am not sure if there is any right or wrong pattern at this point but this is something to be aware of as the more efficient, controlled and coordinated your oxygen intake is the longer you can stay aerobic.  The most important part of breathing and increasing efficiency is focusing on rib expansion with a stable core.  Like any technique these must be practiced!  Bike riding is a great place to learn to stabilize the core and expand the ribcage while breathing in.  Just remember to keep the spine relatively straight as this will allow better expansion.

 

Breathing Exercises

•Use the rectus abdominus or cat stretch position from above if any restrictions were found.  Use correct breathing into the ribcage to facilitate improved expansion of the ribcage.  Hold 30 seconds and repeat 3 times.  Use any of the other stretches from Part III focusing on improving ribcage expansion during the stretch.

•Theraband Breathing – loop theraband around your ribcage crossing the band in the front.  Hold your elbows at your side with tension on the band.  Using the resistance of the tubing around your chest, practice rib cage breathing.  The theraband is commonly used by physiotherapists and can be purchased at most physiotherapy clinics.  Buy a blue or green color (the bands are color coded for resistance).

•With all strength and stability exercises (including ski specific and weight training) focus on stabilizing the core and breathing into the ribcage.  Do not use a Valsalva maneuver i.e. breath holding especially with heavy load exercises.

•Focus on different breath patterns as mentioned above during ski and ski specific technique sessions as different zones of intensity.

 

Breathing patterns combined with core stability is a large interest to me.  If anyone has any comments I would love to hear from you.  Contact me by email.


Ross McKinnon is a former ski racer now working as a physiotherapist at Rutland Physical Therapy in Kelowna, BC. His interests include improving an athlete's performance through the use of specific exercise. For further questions he can be contacted at or at . Ross provides individual evaluations to help improve performance and prevent injury.

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