~Simple Step Exercise: Breathing to Control Pain

Pause for a minute and pay attention to your breathing. What is going on right now? This is such a routine body activity that we rarely think about the quality of our breathing.  Breathing allows for oxygen to go in and carbon dioxide waste to be eliminated from the body.  This is a necessary function. Without breathing, we would quickly die.  Fortunately, the body is very good at doing this on a basic level most of the time.  This does not mean, however, that our breathing is always optimal for our health.  For example, people in pain are not good breathers. Their breathing is often shallow, fast, and involves a lot of upper body movement.  

What if there was something you could do that would improve your pain levels, blood pressure, heart rate, immune system, sleep,and energy levels as well as improve your body's reaction to stress? How much would you pay for something like this?  

Well, breathing a specific way is a simple method to get all of these benefits.   Did I mention it also happens to be FREE and you can do it anywhere?  How is that for a drug-free treatment for pain?

Go back to paying attention to your breathing while just sitting around at rest. (It is normal for your breathing to be faster with more movement when you are more active, such as climbing up stairs.)  You may notice some or all of the following signs of poor breathing habits that are especially common in people with pain:

• shallow, fast, or uneven inhalation or exhalation
• more than 12 breaths per minute
• forced breathing
• upper chest movement
• little to no movement of chest or belly

To tap in to the relaxation response you want your breathing to have these qualities:

• deep, slow, even inhalation and exhalation
• less than 12 breaths per minute, even better at around 4 breaths per minute
• relaxed breathing
• relaxed lower rib cage and belly movement with little upper chest and no shoulder movement

To watch an example of one of the best breathers on the planet, check out a sleeping baby.  They breathe effortlessly and with their little bellies rising up and down- almost like they were born to it.  In fact, we are all born to breathe this way but somehow we tend to lose this ability along the way to being a grown-up.  Well, now is the time to start practicing the relaxed breathing that is your birthright. Along the way you just may have less pain, sleep better, and feel more relaxed.

HOW RELAXED BREATHING WORKS

The diaphragm is a dome shaped muscle that sits at the bottom of the rib cage.  Check out this video of the diaphragm in action.  It is the main muscle involved in breathing.  All breathing involves the use of the diaphragm,  but there are also "helper" muscles in the rib cage and the upper shoulders that help us when we need to breathe faster or more forcefully.  When these "helper" muscles are used, the brain tends to think the body is under some type of stress and gears up the other systems including the heart, blood circulation to be able to react to the stress.  This is a totally appropriate "fight or flight" reaction if you have to run really fast to get out of the way of traffic or a hungry tiger.  This is not the way you should be breathing at rest.  When you learn to return to a slower, deeper type of breathing, the brain gets the signal that "everything is ok, nothing to worry about here".  You activate the body's relaxation response and get all the benefits of doing so (improved blood pressure, heart rate, pain, etc..).

HOW TO BREATHE FOR RELAXATION AND PAIN CONTROL  

Here is a basic way to learn to perform relaxed diaphragmatic breathing or belly breathing:

• start at first in a quiet area away from distractions
• lie down on your back in a comfortable position
• place one hand gently on your belly and the other on your upper chest
• start to pay attention to your breathing
• try to slow your breathing down gradually to a goal of around 4 seconds in and 4 seconds out
• Monitor your hands.  You should have little to no movement at the upper chest hand and a lot of movement at the belly hand
• breathe slowly and deeply but DO NOT force
• the belly should gently expand like a balloon filling with air and then deflate without force
• continue to breathe this way as long as you can
• once you get the hang of breathing this way lying down, try it sitting or standing

The most common errors I see when people are learning to breathe this way are:

• Trying to breathe deeply and slowly by FORCING the air in and out.  Diaphragmatic breathing should be very relaxed and quiet.  If you sound like a blowhard, you are probably trying too much.  
• Using the upper chest to assist in deep breathing.  Again, this is trying too hard and it activates the "fight or flight" system instead of the relaxation response.  Gently pay attention to your upper and lower hands.  Bring you attention to allowing the lower belly hand move in and out.  Relax the upper chest to the point you get little movement at the top hand.  
• Using the abdominal muscles to force the belly movement.  Do not use your abdominal muscles to squeeeeeeeeze the air out of your belly, just relax and let your belly deflate gently without effort
• Trying to force the timing of the inhalation and exhalation.  The 4 second in-out tempo is just a guide.  Let your breathing slow down as you pay attention to your hand movement.  It will naturally reach a slower pace. 

Diaphragmatic breathing is easy to learn with a little practice.  Be patient with yourself.  Remember, most of the errors happen when you try too hard and force the breathing.  Just relax,  you will get better with time.  It is easy to incorporate diaphragmatic breathing into your day.  Once you get the hang of it, do little mini breathing breaks throughout the day.  It is especially useful if you are feeling increased pain or stress.  Take a few minutes to practice your breathing and it should help.  

Do not let the "simplicity" of this exercise fool you. I often have patients question how something as simple as breathing can help.  Like most of the important things in life, diaphragmatic breathing is very effective and makes profound changes to your body via the relaxation response. Patients are very surprised to find that this little exercise has a big impact on their lives.  They find that they are able to control their pain levels and headaches when using this technique during the day. It is also good to get into the habit of doing it before bed.  Most everyone who tries this reports they sleep more deeply and wake up more refreshed with less pain.  The hardest part of this little breathing exercise is REMEMBERING to do it.  Sometimes it helps to set an alarm on your phone or computer to remind yourself to take breathing breaks.  

Start practicing diaphragmatic breathing today.  It is simple, free, and you just might find yourself feeling better!

 

*Go Red For Women Day and FREE WV Health Screening

Friday February 3rd 2012 is Go Red for Women Day.  The American Heart Association created this initiative to help raise awareness of cardiovascular disease and empower women to take charge of their health.  Heart health is a big deal and 500,000 women loose their lives to this disease each year.  Know your risk and take steps today to lead a healthy life. Check out the American Heart Association to learn more about this important health issue. 

Some of the things you can to do reduce your risk of heart disease include:

• Do not smoke or stop smoking
• Get  at least 2 1/2 hours of moderate exercise a week
• Do muscle strengthening exercises 2 days a week
• Eat a diet high in fruits and veggies
• Keep your BMI below 25 (calculate yours here)
• Keep you waist size less than 35 inches
• Maintain an optimal blood pressure of 120/80 mm Hg

For those of you who live in West Virginia, the WVU Heart Institute will be having a free health screening day on February 3rd to measure some of the risk factors associated with heart disease.  Check out the details here.  

Help celebrate Go Red For Women by learning more about heart disease.  Start tomorrow by wearing red and taking steps to improve your health and that of women around you.  

~Research: Wii Fit (TM) Video Games Shown to Improve Health and Fitness

A lot of people have video games at home and use them to have fun and relax.  Most people also know that they should be exercising for the health benefits but often don't feel they have the time. Wouldn't it be great to combine the two? A recent study in the Journal of Strength and Conditioning Research found that you may be able to have your fun and exercise too.  

The study looked at two games that come with Wii Fit^TM videogame system, Step and Hula. Both "games" were shown to provide enough exercise to improve health and fitness according to the researchers. They looked at a variety of different measurements associated with the benefits of exercise including oxygen consumption, rate of perceived exertion (RPE), and calorie expenditure. At the beginner levels of the games there weren't significant levels of oxygen consumption or perceived exercise intensity (how hard you feel you are working). However in the intermediate to advanced levels, these exercises produce the energy expenditure equivalent to a brisk walking pace of 3.5 mile-per-hour. Of the two games, Hula was the best aerobic activity, and burned the most calories. 

While the study involved only a small number of healthy women, it does suggest some overall benefits of short periods of exercise using the Wii Fit^TM games. The exercises were performed in three short bouts of 10 minutes.  Ten minutes of exercise is usually a "doable" amount of activity for someone who is unfit or dealing with pain.  For example, one of the things that has been shown to significantly help people with fibromyalgia is aerobic exercise.  Due to the pain involved in doing too much exercise, most people with this condition do not like to exercise.  It must also be done on a consistent basis.  Commonly they will overdo an exercise program, increase their pain, and decide never to do it again.  The exercises could be done in a slowly progressive manner to prevent the painful aftermath and then built up slowly over time.  This would be easier for someone with pain to do so that they get the benefits without the drawbacks.

 A good way for someone in pain to use these games is to start with the beginner levels for 2 minutes.  Then progress as tolerated up to 10 minutes.  When this gets easy, start at the intermediate level for 2 minutes and progress up in time as tolerated.  Repeat with the advanced stages.  You could also do multiple short bouts of exercise at the same time with rest periods in between or do several short periods of exercise multiple times a day.  The convenience of having this type of game at home makes it easy to do.   If you have an increase in pain that lasts more than a day after exercising, this is your body telling you it is not ready for that much exercise yet.  Do not give up, just dial the intensity or frequency down and then slowly work your way back up again as you can tolerate. 

The Hula and Step programs on the Wii Fit^TM are fun and can be done in the comfort of your own home. This means even if it is raining or snowing outside, you can still get the aerobic benefits of that brisk walk mentioned above.   If progressed slowly and consistently, they can potentially improve fitness, burn calories, and help people with pain increase their activity levels.  As with all exercise, it is good to check with your health care practitioner to determine if you are safe to begin this or any exercise program.  Once you get the go-ahead, start stepping or hula-ing your way to a better you.  

~West Virginia Rated # 1 in Lack of Sleep

West Virginia has made number one on a top 10 list again, and not for a good reason.  Two different reports place our state at the top of a list of both states and cities lacking in good sleep.  The Center for Disease Control (CDC) compiled a report that was based on people reporting if they had slept well in the past 30 days.  West Virginia claimed the top spot at 19.3% of those saying they had poor sleep.  The next highest rated state was Tennessee at 14.8%.  Apparently North Dakota contains the best snoozers at the lowest rate of 7.4%.  Surprisingly even people in DC and California are good sleepers at 8.5% and 8.0% respectively.   The factors most commonly found in people reporting the poorest quality sleep were:

•  age 25-34
•  female
• unemployed
• below high school education
• divorced, widowed , or separated.

As far as cities go, Charleston, WV ranked number one as a top 10 town for insomniacs as reported in Newsweeks's The Daily Beast.  The list was complied from the number of people who take pain relievers for a sleep disorders. Cities in Illinois, Ohio, Kentucky, Tennessee, and Virginia also top the list.  

So what is the big deal about sleep quality?  It is known to be related to health risk factors for heart attacks, strokes, cancer, high blood pressure, diabetes, and obesity.  Pain significantly affects getting good, restful, recuperative sleep.  Common causes of sleep loss include headaches, temporomandibular pain (tmj-jaw), fibromyalgia, and back and neck pain.  Seek medical help if you have difficulty sleeping multiple nights in a week or routinely wake and are unable to return to sleep.  Unrelenting pain that wakes you and won't allow you to return to sleep can be a serious problem and needs to be checked out by your physician.  

Some easy steps to try on your own for improved sleep include:

• reduce or eliminate caffeine
• practice deep breathing daily, especially prior to bedtime
• sleep in a comfortably cool room
• sleep in a completely dark room (this includes covering the light from your alarm clock)
• get regular, moderate exercise (but not right before bed)

~ Herbal Helper for IBS and IC

Did you ever wonder why peppermint seems to be around a lot at Christmas?  Maybe Santa  is on to something.  Since he has to fly around the world in one night he can't afford to make frequ  ent pit stops due to abdominal cramping or pee breaks. I bet he spends the night with a peppermint stick.  

 

Peppermint is a great help to sufferers of Irritable Bowel Syndrome (IBS) and Interstitial Cystitis (IC).  These conditions often cause cramping and spasms of the muscle in the bowel and bladder system.  Recently peppermint capsules have been found to help IBS sufferers by acting on pain sensors in the GI system.  Peppermint also acts as a muscle relaxant, especially in the gut.  This, along with mint's breath freshening properties, is why some restaurant meals end with the staff giving you a hard mint.  

 

Unike typical tea, such as black and green tea made from the   Camellia sinensis plant, peppermint is a herbal "tea" or tisane.  Most IC sufferers cannot tolerate typical black and green tea but often can drink herbal teas without trouble. 

Peppermint tea is easy to make.  Most grocery tea sections carry it in the herbal teas.  It is also very easy to grow.  Here is a page on how to grow mint if you enjoy the idea of cultivating your own.  If you grow mint, you can either use the fresh leaves, or freeze or dry the leaves for later use.  The tea is then made by steeping the leaves for a couple of minutes in boiling water.  Then sweeten it (or not) to taste and enjoy either hot or chilled with ice. 

Wether you grow your own or buy the prepared tea bags or hard mints,  it is nice to have a non-prescription tummy-tamer when you have an IBS or IC flare.  Brew a cup or pop a mint in your mouth and enjoy it's belly relaxing properties.