Diaphragm, Ribcage, Abdomen and Other Matters in Pranayama
Vijai P. Sharma, Ph.D
The purpose of this article is to explore the mechanisms, effects and the rationale of the ancient pranayama techniques in the context of contemporary knowledge of anatomy and physiology with major focus on the respiratory system and to some extent, the cardiovascular system. However, this should not preclude us from a passing reference to the psycho-emotional, mental or spiritual aspects of pranayama techniques.
We will discuss the varying and often contradictory views of diaphragmatic, thoracic and abdominal breathing and make an attempt to arrive at a broad consensus. Furthermore, we will attempt to create a framework in which yoga therapists could design various modifications and adaptations to serve the specific needs of an individual.
There is not just one way to perform a pranayama technique. When you use different methods to perform the same pranayama technique, their physiological-mechanical effects can be different.
Consider the following two examples:
Example 1: While inhaling in Bhastrika-renowned pranayama teacher Sri Ram Deva Ji Maharaj (SRDM)--presses his hands and wrist against his knees and actively lifts his ribcage and brings the chest out to fill the air into the lungs. More prominent stretch in this action is a vertical stretch of chest and abdomen as differed from that of back to front or side to side. ribcage and chest muscles important for inhalation. In this vertical stretch of the chest and abdominal cavities, diaphragm contracts forcefully downward creating negative pressure in the chest allowing the air to rush into the lungs. Furthermore, as the diaphragm is attached to the lower ribs, the upward (and to some extent outward) movement of the lower ribs provides room for diaphragmatic function. Let's call this method as, "thoracic breathing," which is lower thoracic but to some extent involves upper thoracic breathing too.
Another method of performing Bhastrika is "abdominal pumping," which may involve little or no movement of upper chest or lifting of the shoulders. According to this method, when you inhale, you actively expand the abdomen. When you exhale, you actively contract the abdomen towards the back. The difference between the two methods is that in abdominal pumping, you more actively engage abdominal muscles and in thoracic breathing, you more actively engage the chest and shoulder muscles. Both methods execute Bhastrika. As long as your inhalation and exhalation both are active and equal you are performing Bhastrika. Therefore, an individual practitioner knowing the benefits and risks of each method may choose one over the other as they suit his or her specific needs.
Example 2: While exhaling in Kapalabhati, SRDM focuses on forceful and vigorous sniffing action to perform Kapalabhati. He explains that through the rapid and powerful sniffing action, abdominal contraction occurs automatically. Let's call this method as, "The sniffing method." But you can choose another method to accomplish the same purpose, that is, the method of abdominal pumping. Hoffman who describes the abdominal pumping action for performing Kapalabhati recommends strong and rapid contraction in the muscles in the front wall of the abdomen just below the ribs. The contraction of lower belly muscles and pulling the abdomen towards the back would effecting a powerful exhalation. Both methods execute Kapalabhati. As long as your exhalation is active and forceful, and inhalation passive, you are performing Kapalabhati. The difference between the two methods is that in the first method your intention and focus is on actively sniffing which automatically recruit the chest and the diaphragm, while in the second method, the intention and focus is on the muscles of the lower abdomen and thus pushing the diaphragm up towards the bottom of the lungs. One is "top down" and the other "bottom up." Both methods engage the diaphragm and help to produce a burst of exhalation with passive inhalation. The sniffing method engages the chest and diaphragm from above and might even cleanse the nasal passages and upper lung congestion more effectively. The abdominal pumping method actively engages the lower belly muscles. Watch for the effect of each method on yourself. For example, if the sniffing method agitates you or makes you somewhat restless, switch to the other method. Or, you might want to make use of both methods to get the best of both worlds!
"Those who intend to gain control over breath
Gati is "path" or "speed." Prana, among other meanings, can mean "inhalation" or "thoracic breathing" and apana can mean "exhalation" or "abdominal breathing."
According to my interpretation rather than the literal translation of the above verse from Gita, there is not just one method for breathing. Practitioners may do thoracic breathing or abdominal breathing. They can initiate and end both inhalation and exhalation in the abdomen or in the chest. A breath cycle could be initiated with exhalation or inhalation. Or, while inhaling, let your breath move downward into the belly, the seat of apana and while exhaling let the breath move upward to the seat of prana. In some yoga circles in the west the former technique is referred to as, "top down" and the latter as, "bottom up."
The Matter of Diaphragmatic Breathing
Much controversy and confusion exists regarding what exactly "diaphragmatic breathing (DB)" is and whether abdominal excursion or chest expansion should be emphasized (or minimized) in DB. The controversy and confusion is not limited to yoga practitioners, it is equally rampant among health professionals. Some say DB can increase the tendency for hyperventilation and hyperinflation of lungs, at least in case of people suffering from chronic hyperventilation or lung impairment and discourage the use of DB in pulmonary rehabilitation. , Unfortunately, many studies are based on varying and often conflicting or questionable techniques for DB training. Just as in the medical professional world and so in the Yoga world, many different techniques for DB prevail. The fact is that emphasis on chest or abdomen during breathing can serve different purposes and both can be helpful or harmful depending on the person and his or her condition.
Some controversies stem from our partial understanding of breathing and particularly of DB. This situation reminds me of the parable of "The Elephant and Blind Men" cited in an ancient Indian philosophical system called, "Syadavad" translated as "Perhapsism." PERHAPS, they all are correct in describing a specific aspect, pattern or technique of breathing! Just as those blind men in the parable were correct in describing the part of the elephant on which they had their hands. Their description was accurate but limited to the part of the elephant they were groping. But, they argued vehemently with one another believing what they "grasped' was all that there was to the elephant. The diaphragm is much like that proverbial elephant. We focus on one aspect of DB and believe that others with a different aspect of the reality of DB have got it all wrong.
Kaminoff, founder of E-sutra and Breathing Project and his colleagues based on their review of the breathing-related resource material identified the following four common confusions about breathing: 1) context dropping 2) false dichotomy between diaphragmatic breathing and non-diaphragmatic breathing 3) confusion between the respiratory shape changes and regional ventilation and 4) more oxygen is always a good thing. Very true! For example, you can't determine the appropriateness of a specific method of breathing without considering the context such as the intention of the individual, the position of the body and the pull of gravity. Abdominal breathing is not necessarily DB in every case. Sometimes what seems abdominal breathing may actually involve little or no diaphragmatic breathing. In contrast, chest and ribcage movement may involve strong diaphragmatic movement.
Here is a simple working definition of DB offered by cardio-pulmonary physical therapist Cahalin and his colleagues: "(DB is) breathing predominantly with the diaphragm while minimizing the action of accessory muscles that may assist with inspiration." But, it still begs the question what exactly is "DB and the action of which other muscles is more minimal or less?"
To the best of my knowledge, Coulter : is the first anatomist who has attempted to synthesize conflicting views of DB by defining two types of DB: "Thoraco / diaphragmatic breathing" and "Abdomino/ diaphragmatic breathing."
During breathing, if the respiratory musculature movement primarily occurs in the abdominal and midsection area, it is thoraco-diaphragmatic breathing. When the movement primarily occurs in the abdominal area it is abdomino-diaphragmatic breathing. There is yet another term used by Coulter, "Thoracic breathing." In thoracic breathing, primary movement of inhalation occurs in the upper chest. However, he identifies two types of thoracic breathing: "Empowered thoracic breathing" and "constricted thoracic breathing." In the former, the abdomen is relaxed but taut and the diaphragm resists being pulled up towards the chest. In the latter, front wall of the abdomen is held rigidly and the diaphragm is almost immobile. Note that I am giving an over simplified version of the three kinds of breathing. Coulter explains the three types of breathing in detail with the aid of diagrams, yoga poses and other experiential tips so the readers can practice and empirically appreciate the differences.
We all know that the trunk is not divided into airtight compartments (Pun intended!). The diaphragm with its attachments to the ribs, lumbar and sternum, the ribcage along with the intercostals and the abdominal muscles (external and internal obliques and transversus abdominis)-all these guys have a "hand" in respiration. Some have a bigger hand and others a smaller hand. Of course, diaphragm is the work horse of the breathing. Kaminoff gives the analogy of diaphragm as the engine of the car and the other accessory muscles of breathing as the steering structure. I often give a chariot analogy in my yoga classes. According to my chariot analogy, ribcage is the chariot, lungs are the passengers and the diaphragm is the horse. Abdominal muscles are king's servants that go up and down with the chariot and also push and pull to help the chariot go up and down.
To emphasize that the movements of the muscles of respiration or of the spine do not occur in isolation, I have slightly modified Coulter's terminology and broken it down into four segments of breathing. The fourth segment I have added is to basically cover the entire field and make explicit what is implicit. Here are the four segments of breathing with slight modification of Coulter's terminology:
1. "Predominantly Thoraco / diaphragmatic breathing;"
Such a segmental breathing breakdown may can help in integrating different views related to DB. It can also assist pranayama practitioners in making purposeful and informed choices regarding the relatively more active and purposeful engagement of the diaphragm vis a vis the engagement of the accessory breathing muscles. In other words, you can more purposefully manipulate the breathing muscles to achieve specific desired effect. To use the elephant's analogy, do you want the elephant to raise its "trunk," lift its leg or wag its tail?
To practice a specific breathing technique, bring your intention and awareness to that specific region of the trunk. With such mental and physical focus you might more actively engage specific muscles during inhalation and exhalation. With such a focus, the relative strength and the extent of diaphragmatic movement and accessory breathing muscles would vary according to your choice of the specific segmental breathing. Below are three examples to illustrate this point.
Example 1) You want to take a yogic "long breath" (also known as "full breath" or dirgha shvasa). Start exhaling and systematically engage all the four segments of the trunk from pelvis to the clavicles and while inhaling, proceed in the reverse order. Note that diaphragmatic movement occurs through the entire breathing process but you deliberately and methodically engage the four segments as you inhale and exhale.
The above three examples illustrate varying degrees of diaphragmatic movement along with engagement of different regions of the trunk. Furthermore, you can manipulate the degree of diaphragmatic movement through your attention and deliberate recruitment of specific muscles. Your attention and intention, skills and experience in manipulation of breathing skills and the ability to mentally and physically relax can influence diaphragmatic movement. Diaphragmatic movement may be automatic and unconscious, but for the most part you can influence, manipulate, direct and train your diaphragm. You with your background in yoga might say, "Duh! Everybody knows that." Know that there is a great controversy in the medical field whether breathing retraining is possible for an individual who has a breathing disorder. Not sure about medical experts' opinion with regard to a healthy person's ability to retrain their breathing. Well into the first half of the 20th century, it was believed that breathing is governed by the automatic nervous system (ANS) and therefore totally "automatic," that is, not subjected to our voluntary and conscious control. Now, it is well known at least in the yoga community that breathing is at the crossroad of automatic (not conscious) and voluntary, conscious process. You can choose to delegate it to the ANS or consciously regulate it yourself to the desirable speed, depth, volume and the extent of the diaphragmatic movement.
I totally endorse Kaminoff's recommendation for "freeing the breath" and getting out of its way. But some people with medical disorders and/or exceptionally high stress level may not be able to free their breath without good deal of training. They have to learn how to train and direct their breath at will before they can learn to free it. They have to remove all encumbrances to the flow of breath. Observe a person in deep trance or deep relaxation and you may witness a wonderfully free and deep diaphragmatic breathing. Such deep diaphragmatic breathing occurs automatically if you can stand out of its way. But, a majority of people have gotten out of the habit of natural breathing. They can breathe naturally only during deep relaxation, hypnosis-induced trance or a totally stress-free and worry-free state of the mind.
For DB training and breath control, we need a closer understanding of the diaphragm itself and its dynamic relationship with the chest and the abdomen. Much controversy has resulted from the description of diaphragm as a "dome." We tend to view the diaphragm as one large dome and therefore conceptualize that the pushing or releasing of the diaphragm is solely done in the center, meaning the front of the abdomen. But, that doesn't take into account the side rib action of the diaphragm, that is, the powerful diaphragmatic action in the lower left ribs and lower right ribs. Describing the central action of the diaphragm, Hillsman chest physician says, "There is a central tendinous portion of the diaphragm, that is, muscles fibers arch upward and inward to end in tendinous fibers which form the central tendon. This is the insertion point of the diaphragm. It does not "contract," but moves generally downward pulled by the muscular diaphragm. This of course causes the abdominal contents to compress, and thus cause the abdomen to bulge outward." Let's call it the "central portion."
It might be helpful to view diaphragm as having three parts, the two domes, "left dome" and "right dome" and the "central portion." Utilizing our 2-dome and central portion analogy, we can define exhalation as a process in which the three parts act in a concerted manner to push up at the lungs to push the air out. Likewise, we can define inhalation, as a process in which the three parts of the diaphragm move downwards and create space in the chest. This process creates negative pressure in the chest cavity allowing the air to rush into the lungs.
The 2-dome and central portion conceptualization of the diaphragm is not inconsistent with the true anatomic structure. The diaphragm is attached to the sternum (more specifically the sternal ligaments) in the front (what we called, "the central portion"), lumbar vertebrae at the back (lumbocostal arches and the two crurae) and the lower 6 ribs on both sides (what we called the "costal portions" of the diaphragm). Anatomically speaking, it is the costal portions of the diaphragm that I refer to as, "the left dome" and "the right dome." With practice and trained attention, you can feel the movement of the central dome in the front of your abdomen and that of the side domes in the lower side ribs.
You see how the parable of the "Elephant and Blind Men" applies to the DB debate? We tend to pay exclusive attention to either the front abdominal excursion caused by the action of the central portion of the diaphragm, the movement of the side ribs caused by the action of the costal portions of the diaphragm or the movement of the abdominal contents. The controversy regarding diaphragmatic movement remains unresolved because of "either this or that" positions we hold. Let's turn to infants' breathing as they have a thing or two to teach adults regarding DB. Observe an infant's breathing during sleep and you can see a powerful movement in the lower ribs as well as the front of the abdomen because the ribs of an infant are very soft and pliable. Ribs become harder and less pliable due to calcification as we grow into adulthood. Furthermore, adults who suffer from chronically high level of stress, tend to demonstrate a breathing pattern characterized by suppressed side-ribs movement and an equally unimpressive front abdominal movement.
Beware that deliberately excessive expansion of the abdomen during inhalation can compromise the side-rib action of the diaphragm. This can occur with people who have a structural-mechanical breathing-related problem, wrong conception of DB, or received incorrect DB training. Deane Hillsman, chest physician and inventor of "Breathing Trainer" calls such non-functional abdominal expansion "belly puffing," not true diaphragmatic breathing. One can do belly puffing during inhalation even while lying down by simply puffing out the soft abdominal tissues with little or no engagement of the diaphragm. In fact some belly puffers puff out their belly with expiration and pull it in with inspiration. In such paradoxical diaphragm movement, the abdominal movement is totally out of phase with the diaphragmatic movement and provides no indication of diaphragmatic movement.
Most yoga practitioners are aware that if you keep abdomen slightly firm during inhalation, you can feel the diaphragmatic movement more strongly in the lower side ribs. But, if you have an excessively rigid diaphragm or weak or tight ribcage muscles, you may not be able to feel any significant movement in the lower side ribs even if you keep the abdomen slightly firm.
Here is an experiential exercise if your diaphragm and ribcage muscles are in healthy condition: While inhaling, keep abdomen slightly firm. As the abdomen is pulled inward at the end exhalation, don't let it return outward all the way during inhalation. No need to tighten up the abdomen, just a slight inward pull will do it. Maintain that gentle abdominal pull while inhaling and exhaling to experience the side-ribs movement of the diaphragm.
When you maintain such gentle pull, the lower abdominal contents resist the downward movement of the diaphragm. This allows more prominent action for the costal portions of the diaphragm and you can feel it more tangibly in your side ribs. The base of the ribcage spreads out and upwards to the sides. This is called, "bucket handle action," because it is like you are lifting the bucket handle up and out. Hillsman say, "Lateral Bucket Handle movement is very important in moving the diaphragm and thus increasing the working volume in the chest. I believe it is important to concentrate on the Bucket Handle movement, and then let the increased inspiratory abdominal protrusion flow from same." In other words, instead of concentrating on the movement of the abdomen, concentrate on the movement of the lower ribs and the rest will take care of itself.
I pointed out elsewhere that in the bucket handle analogy the bucket (i.e. your belly) has not one handle but 6 handles on each side of the bucket. Incidentally, the anterior up and down movement of the ribcage is called "pump handle" movement powered by the accessory muscles of respiration. Remember how in the good old days we drew water from the ground by pulling the pump handle up and down? Similar up and down action occurs in the upper chest and neck. The pump handle action more prominently engages the accessory muscles of respiration rather than the diaphragm. Accessory breathing muscles are generally used in emergency breathing or any situation that is perceived as stressful by the individual. In normal circumstances, we should not be using them in any prominent fashion. Pump handle movement is felt more prominently in the upper chest. Upper ribs don't fan out like the lower ribs, which even contain the "floating ribs." Therefore, one is more likely to experience the up and down movement of the ribs. The bucket handle action at the base of the ribcage (where the costal portion of the diaphragm is attached) allows the air to rush into the lungs more effectively than could the upper chest and neck muscles movement. Furthermore, during upper chest breathing, especially the constricted upper chest movement might make you feel anxious and agitated.
Another important but relatively unknown aspect of breathing is the three dimensional movement of the diaphragm. Here is a brief description of the three dimensional diaphragmatic movement: "During inhalation, the dome shaped diaphragm lowers and flattens. The base of the ribcage spreads out to the sides and the back and the front as well. At the same time, the intercostals contract, lifting the ribs, which stand at right angles to the spine, increasing the entire volume of the chest cavity in all three dimensions." A more visual description of the three-dimensional diaphragmatic action is available in the DVD designed by the author for people with COPD. Kaminoff has explained the 3-dimensional action of the diaphragm in more detailed and precise anatomical terms.
So, where should we direct our attention during breathing exercises? My teacher Gary Kraftsow points out that different breathing techniques have more to do with directing your awareness and controlling the muscles of respiration, and less with actual movement of the air. In that context, he identifies "five types of inhalation" and "three types of exhalation."
In order to experience the five types of inhalation, Kraftsow suggests that practitioners direct their awareness and effort for muscular control to the following five sites (slightly paraphrased by the author): 1) chest (expansion) 2) belly (abdominal excursion) 3) from chest to belly 4) from belly to chest and 5) solar plexus (radiation to and from). In aside, to relate to Patanjali's Yoga Sutra, we can conceptualize the five "sites" as the five pranayama "deshas (regions/sites)."
Here are the three types of exhalation as identified by Kraftsow: 1) Relax and exhale without contraction 2) Exhale with contraction from navel to sternum and 3) Exhale with contraction from perineum to sternum.
Pranayama Techniques for Diaphragmatic Exercises
Pranayama techniques such as Bhastrika and Kapalabhati can be utilized for the depth, breadth and the range of diaphragmatic movements as practiced in various yoga traditions. Pranayama techniques should be performed at least periodically. They engage and challenge inspiratory and expiratory muscles in a far more actively than is possible with regular breathing. For example, Bhastrika, if not performed too rapidly, can assist in contracting and releasing the diaphragm in a powerful way. Likewise, Kapalabhati demands forced expiration as differed from regular expiration. Expiratory muscles, notably, the internal and external obliques and transverses abdominis become active in such forced expiration as demanded by Kapalabhati. Furthermore, different variations of the same pranayama technique can exercise diaphragm differently.
Incidentally, Bhastrika literally means "Bellows," in which you focus on active and forceful inhalation and exhalation. In Kapalabhati, you focus only on active and forceful exhalation and let the inhalation occur passively.
Let us first discuss five methods of Bhastrika which exercise diaphragm in slightly different ways:
1. "One Stroke" Method: While exhaling, push the entire abdomen in and up and all the way back towards the back as single stroke from pelvis to solar plexus. While inhaling release the entire abdomen in one stroke action. Thus the abdomen pushes back during exhalation and bubbles out/ balloons during inhalation. Let's call it "One Stroke" method. With this method, you can choose to do Bhastrika with moderate to fast speed.
In my experience, it is better to start with exhalation and then inhale-exhale-inhale-exhale and so on. It feels to me that by first exhaling, you "hook" the diaphragm and then it is easier to "pull down" the diaphragm in order to inhale.
Here are variations of Kapalabhati which exercise diaphragm in slightly different ways. Kapalabhati exhalation methods are somewhat similar to the exhalation methods of Bhastrika but still needs to be stated separately in their own right. Furthermore, since inhalation in Kapalabhati is passive, it may influence the exhalation process to some extent. Since Kapalabhati is a burst of exhalations with passive inhalations, it begins to draw upon the expiratory reserve volume of the lungs. It is my understanding, that during exhalation in Kapalabhati the diaphragm "domes" go up even higher pushing the lungs than they would in Bhastrika. Thus Kapalabhati is more likely to empty the old and stale air out and provide greater flexibility for the diaphragm than Bhastrika. If you have time to practice only one technique, chose Kapalabhati.
Here are three variations of Kapalabhati to engage the diaphragm slightly differently:
1. "One Stroke" Method: While exhaling, push in and up the entire abdomen all the way back towards the back as single stroke action from pelvis to solar plexus and release it for inhalation.
I have been experimenting with all such methods. In my opinion, SRDM's method involves greater work of breathing, and is more prone to cause hyperventilation. Sniffing method and abdominal methods feel easier. If we can utilize your lab at the Northeaster University, we might be able to determine which method demands lesser effort, facilitates diaphragmatic motion and is more effective in getting the air in and out of the lungs. Such analyses can of help in resolving the controversies about DB. Wish if someone would insert a micro camera inside to take pictures of the chest wall and abdominal wall motions and the coordination between the two.
Perhaps you are saying, "Oh well. I know diaphragm is three dimensional and it's attached to the side ribs and front and back. I have heard about bucket handle, pump handle, chest cavity and abdominal cavity, but how do I feel these things?" Let me offer a few experiential tips. These tips will also help in identifying breathing irregularities and the normal breathing patterns. Please read the experiential tips in their entirety before starting with your Pranayama Practice!
Experiential Tips for Identifying Breathing Irregularities
1. Use the "two hand technique" In order to feel the muscular movements related to breathing, use the popular "two-hand" technique, that is, one hand on the chest and the other on your abdomen. In order to feel the movements of your breathing muscles more strongly, experiment as to where exactly should you place your hand. For example, with regard to the hand on the chest, should you place it right above the sternum, in the middle of the breast region or above the breast region? Experiment with different hand positions on the torso to feel the movement of the breathing muscles.
Experiential Tips for Identifying Normal Breathing Patterns
Postures (asanas) first
Start the self-observation session with a few vertical stretches, forward bends, backbends, lateral bends and twists so the spine and the muscles of respiration are activated and flexed. Observe the flow of the breath when your spine moves in different directions, that is, the vertical stretches, bends and twists. Some yoga poses are more effective than others to activate the breathing muscles. Likewise there are breath-assisted poses such as the Cobra pose or Locust pose with free hands in which you can more easily feel the movement of the midsection or even diaphragm. Some poses are particularly helpful in order to augment inhalation or exhalation. The space does not allow us to get into those details. However, refer to the literature to identify those poses. After performing the asanas, settle down in a steady and comfortable sitting position with head, neck and trunk straight. Good posture helps to experience the breath more easily.
*Note that I have artificially separated the up and down, side to side and front to back movements of the ribcage and the diaphragm so we can isolate and focus on one dimension at a time. Needless to say that the movements of the ribcage and the diaphragm occur in the three dimensions simultaneously.
Observe the vertical movements of the torso in the sitting position
For majority of beginners, it is easier to feel the movement of the trunk vertically (up and down-north and south) rather than laterally (side to side-east and west) or sagittally (back to front or front to back). Start with the vertical (up and down) movement of the trunk. Here is a description given by Kraftsow that might be of some help in experiencing the vertical movement during inhalation:
While inhaling "…the intercostals (muscles between the ribs) contract; the rib cage elevates; the diaphragm contracts downward. …(slightly paraphrased by author) chest expands, thoracic curve flattens as the vertebral bodies stretch and the spine elongates,"
With persistent practice and keen body awareness, some practitioners are able to feel actual movement (contraction and release) of the diaphragm. But even as beginners, you can feel the movement of the trunk and other breathing muscles. For example, while inhaling, you may be able to feel the movement of the ribcage lifting up and/or abdominal contents moving down along with the contraction of the diaphragm. Be cognizant of the fact that there are several kinds of sensory and motor feedbacks that are competing with one another during breathing. When the ribcage feels lifting up, the diaphragm is actually contracted in the downward direction. The more obvious perception of the ribcage movement and/or abdominal organs tend to dominate the perception of the subtle and deeper movements of the diaphragm. But with steady attention and stillness, over time, one may be able to differentiate between the various movements.
Utilize the pranayama techniques: Kapalabhati and Bhastrika when done correctly can also assist in differentiating between the movements of the ribcage and that of the diaphragm.
Observe the movements of the lower side ribs (lateral DB) in the sitting position
In the sitting position, place hands on your lower side ribs. Inhale slowly, gently allowing the lower ribs to expand. Notice the hands being pushed outward horizontally. Exhale slowly. Feel the sides contracting and the hands being pulled in. Note that while inhaling, lower ribs push hands outwards. While exhaling, hands push the lower ribs in. If the rib action feels strenuous, you are working too hard. Go easy and try to notice even the subtle movement occurring in the lower ribs as you breathe in and out.
Lewis describes a fascinating little trick to experience as well as activate the side rib-breathing by pulling the skin on the lower side of your ribcage. With your thumb and index finger, grab the skin and the fascia from the lower ribs of one side at a time. Simply pull the skin away from the ribs and inhale. You can feel that the diaphragm and the ribs seem to fill the space you just created. Then you can try the other side of the ribcage.
When you first time actively sue the side rib breathing by any method you use, muscles in the side ribs are likely to hurt. Start with just a couple minutes of side rib breathing and gradually increase the time. If you feel short of breath, anxious or agitated during or after the side rib breathing practice, you might be doing upper chest breathing or keeping your diaphragm too rigid while trying to do side rib breathing. Observe, engage the side ribs and relax.
Observe the back to front breathing (Sagittal DB)
In the sitting position:
With the head, neck and trunk straight and relaxed, you may notice that as you inhale, the lumbar curve slightly deepens as being pulled by the crurae (literally the "legs" of the diaphragm attached to the lumbar) and the abdomen expands. When you exhale, the abdomen retracts towards the back and the lumbar curve slightly flattens. Feel the movement in the back and the front of the torso.
In the supine position, use the "Book Technique"
In the lying position, place a flat book on your belly between the navel and the breastbone tip and watch the book going up and down as you breathe. When you breathe in, the book comes up and when you breathe out, the book should go down. But, do NOT try to raise or lower the book. Do not try to push or pull the tummy by using force because then you will simply be doing "belly puffing' and not diaphragmatic breathing. Instead of a book, you may use a bag of sand, rice or potatoes on your belly that can be placed between the navel and the sternum.
Let your belly relax. The weight of the book or the bag will exert pressure to activate and strengthen the diaphragm. Start with lightweights. When your diaphragm and the tummy muscles get used to that particular weight, gradually increase the weight. You may continue with this exercise for a few minutes, which might prove to be relaxing. But, make sure the weight on the tummy is not too heavy. If you experience discomfort in breathing, use lighter weight.
Some people find this exercise so relaxing they like to do it for 10-15 minutes at a time.
In the prone position, use a yoga pose
Cobra pose (Bhujangasana) and/or crocodile pose (Makrasana) are excellent tools to feel the vertical, front and side movements of the diaphragm and other respiratory muscles. Experiment with these postures in two ways: 1) Keeping the buttocks and hips fixed and leaving the chest free and 2) Keeping the upper chest fixed and hips and buttocks free. Take several deep breaths in each position.
Feeling the movements of the diaphragm on the body of another person
According to Cahalin et al , who adapted Cherniack and Cherniack method for examination of diaphragmatic excursion, you can feel the movement of the diaphragm at three spots on a person in the supine position (paraphrased by author):
1. Feeling the upper abdominal and upper chest wall movement: Place thumb tips on both sides of the breast bone tip, the point of the sternum where the ribs from both sides join it. The rest of the thumbs are on the breast bone connecting rib on each side (costal margins) and the fingers are fanned out and up on the front of the chest wall. Ask the person to take deep and full breaths. During deep inhalation, you should feel your hands moving laterally and slightly upward. To provide another marker, ask the person to take several deep and full breaths. Towards the end of the exhalation, your thumb tips should be drawn towards each other and during inhalation, your thumb tips should start moving away from each other. Ask the person to breathe normally and check if the diaphragmatic movement is still occurring, which would not be as pronounced as before.
Measure it! According to Cahalin et al, a very practical and reliable method to evaluate the "diaphragmatic excursion as well as competency in DB" is the measurement of the chest and abdomen at three different points. The 3-point tape measure method was developed by Cahalin and Massery to provide them information about the bucket handle movement. Here are those three points for tape measurement: 1) Upper chest wall level at the second rib (the first rib is at the pit of the throat) 2) Middle chest wall exactly at the breast bone point (Xiphoid process) and 3) abdominal wall, the mid point between the breast bone tip and the navel. Take a soft measuring tape that can be wrapped around the trunk. Ask the person to take deep and full breaths. Compare the measurement at the three points during inhalation and exhalation. During inhalation, there should be chest and abdominal expansion, so the size of the chest and abdomen during inhalation should be larger than it would be at the end-exhalation.
According to Cahalin, "the bucket handle motion is most likely to be measured at the mid-point between the Xiphoid process and the umbilicus." So, if you want to take just one measurement rather than all three, place the tape between the breastbone tip and the navel and measure the difference in the size at the end of exhalation and the end of inhalation between the breastbone tip and the navel. However, to be absolutely sure that you are capturing true diaphragmatic bucket handle movement and not some element of belly puffing artifact, Hillsman recommends one should also take the measurement at the breastbone tip (the Xiphoid tip) level.
Experience Almost Non-diaphragmatic Breathing
Soft abdominal breathing requires minimal diaphragmatic movement. Deliberate soft abdominal breathing as in the "Relaxation Pose" (Shavasana) has a "grounding" effect and can be very relaxing for the mind and the body. Soft abdominal breathing is gentle and can only occur when the diaphragm is supple and the mind and body are relaxed. In order to experience this, lie still in the relaxation pose and continue relaxing the entire body. When mind wanders, bring it back to the body and scan the body for any tension. Continue deepening the relaxation of all the muscles in the body. Now bring passive and gentle focus on your breath. Breath should be getting soft, smooth and subtle at this point. Let it become even softer, smoother and more subtle. The pause between exhalation and next inhalation might become longer and longer. The diaphragm has to do very little work at this point which deepens the relaxation further. The whole process takes time. For a person with average relaxation skills, it takes at least 10 to 15 minutes in the relaxation pose to be able to reach the state when soft abdominal breathing can occur. But, it's worth the time. During soft abdominal breathing, your diaphragm is not working that hard. It is good to let the diaphragm also have the opportunity to "rest" since it works hard all the time. It has tremendous benefits for the mind and the body. Perhaps, that is why Swami Rama used to say Shavasana is the best form of pranayama.
Be aware that the terms used in contemporaneous yoga literature as "non diaphragmatic" or "sub-diaphragmatic" are misleading because diaphragmatic movement does occur with the act of breathing. Nevertheless, in certain medical conditions the diaphragm and/or ribcage muscles may be extremely rigid and almost immobile.
Copyright 2006, Mind Publications