In this day and age, we live exceptionally busy lives and often find ourselves racing the clock and ending up completely exhausted, only to do it all again tomorrow! In March 2015, I was diagnosed with Graves’ Disease – a condition in which the thyroid gland works overtime. Due to the nature of the condition and the detrimental role of stress, part of my recovery has been taking a good look at where I can add more ‘down-time’ to my daily routine. As a ‘Type A’ personality, this has been extremely hard for me and something I will need to continually work on but this has encouraged me to delve into the importance of something we so often take for granted – breathing. 

As Physiotherapists, we are educated in all aspects of the human musculo-skeletal system, including the respiratory system, by which our breathing is regulated. Breathing is something we do 17,000-30,000 times per day, usually completely subconsciously, but I am now starting to see the positive effects that mindful breathing can have. Lets take a few steps back and touch on the anatomy of the respiratory system. Inspiration (breathing in) is caused by a combination of the downward movement of the respiratory diaphragm and a contraction of the intercostal muscles between the ribs. This allows for a larger space in the chest cavity and creates a vacuum which draws air into the lungs. The air starts at the nose/mouth and then moves through the trachea (windpipe), into a series of passageways and ends up in tiny air sacks known as the alveoli. It is at the alveoli that the exchange of oxygen and carbon dioxide takes place. Expiration (breathing out) is caused by an upward movement of the respiratory diaphragm, a falling of the ribs and a subsequent increase in pressure to force the air out of the lungs and escape through the nose/mouth. As mentioned above, we breathe between 17,000-30,000 times per day, on average 12-20 times per minute (although this can vary depending on age, level of physical exertion and any conditions that may affect the respiratory process). 
When we are stressed or experiencing anxiety we tend to breathe shallowly and at a quicker rate than normal. A condition called hyperventilation can result if this pattern of breathing is continued over an extended period of time. Hyperventilation causes an upset in the balance between the amount of air inhaled and exhaled. When you exhale more air than you inhale, the levels of carbon dioxide fall and this can cause symptoms such as weakness, dizziness and confusion. In contrary to hyperventilation and something of interest to me personally is a term known as ‘diaphragmatic breathing’, also known as ‘belly-breathing’. This type of breathing is best done sitting in a comfortable seat or lying on your back with the head supported. Place one hand over the sternum (breastbone) and other other hand just above the belly button. Open the mouth and let out a small exhale to create the vacuum mentioned above which will help to draw the air in with the inhale. Take a long, slow inhale through the nose (I aim for 4-5 seconds) and notice that the stomach expands and raises up against your bottom hand. I then hold the breath for a further 4-5 seconds (but this is up to personal preference as some will find that this can cause dizziness) and then exhale slowly through the mouth and notice that the stomach falls beneath the hand. I must admit that it has taken a long time to implement the concept of diaphragmatic breathing into my daily routine (I recall learning about this back at university circa 2008) but I think it is better late than never! 
The term ‘mindfulness’ has become a real buzz word in the wellness world of late and for very good cause. According to the Oxford Dictionary, mindfulness is defined as “the quality or state of being conscious or aware of something”. Diaphragmatic breathing requires a focused attention/mindfulness and this is further optimised by counting the seconds with every inhale, hold and exhale. From my own personal experience, this practice of mindful diaphragmatic breathing temporarily prevents my ever-wandering mind from running off and thinking about my to-do-list. Around the time of my Graves’ Disease diagnosis, I started to dabble in the occasional guided meditation. A friend had suggested the Headspace iPhone app some time ago (https://www.headspace.com) but this was something I had previously deemed unimportant in my busy life. I finally download the app and committed to the 10 day challenge (a 10 minute guided meditation each day for 10 days). Admittedly, there were days where I had the best intention to meditate but decided that a training run was more important! However, I got through the 10 days, albeit non-consecutive, and did notice an increased sense of calm at the end of the challenge. Since this time, I have tried my best to implement 10 minutes of meditation into each day and I have probably been 50-70% ‘successful’ at putting this into practice. I have found guided meditations incredibly helpful but more often than not, I jump on YouTube and search ‘relaxing music for meditation’ or words to those effect, find a comfortable seat, put a few drops of my favourite essential oil on a hanky and settle in for 10 minutes of uninterrupted ‘me-time’. 

I recently attended a day course at the Kadampa Meditation Centre Australia (which was a wonderful introduction to meditation and something I would highly recommend to others starting out) and the instructor taught us to visualise inhaling a white light and exhaling black smoke – a technique that I have found quite useful as a visual learner. So next time you are feeling overwhelmed, stressed, anxious or just in need of some personal space, I would highly recommend utilising the above mentioned techniques (belly-breathing, guided meditation or self-guided meditation) and discovering the benefits for yourself.

-Ali Wilson
Physiotherapy Yoga