Pain, muscle tension and the right breathing technique

Do you suffer from stiff shoulders or a stiff neck? Do you have chronic pains you can’t get rid of? Have you been diagnosed with fibromyalgia, migraines or other pain disorders? Did you know that your breathing can play a key role in how you experience your pain?

You’re not alone in suffering from pain. Norway is top in Europe when it comes to chronic pain issues. While 19% of the European population suffers from moderate or serious chronic pains, the number rises to 30% in Norway. For women, the number is even higher at 36%, and it’s 25% for men.

The causes of pain can vary greatly, but what many chronic pain patients have in common is a history of feeling like they’re not believed, not being taken seriously by the health services. This is often because the doctor can’t find an objective medical reason for the pain. Feeling like you’re not believed can make the pain even more challenging to live with. Many with chronic pains also find themselves having depressive thoughts, issues with sleep, poor digestion and low energy.

In 2019, a large study on the connection between breathing and pain, and vagus nerve stimulation and pain, was initiated at Oslo University Hospital. The study has not yet concluded, but preliminary results, as well as other research reports, prove that calm breathing exercises have a pain-relieving effect.

Some of the most common feedback I get from my clients is that they feel how their pain is releasing its hold as they practise slow breathing exercises.

Maybe it’s not so strange that there’s such a focus on breathing exercises during childbirth? Breathing more slowly and breathing in smaller amounts of air makes pain easier to handle – it’s simply much less intense.

Pain is an uncomfortable sensation associated with injury or something that is interpreted as an injury.

The feeling of pain is subjective, meaning that whatever triggers the pain can cause varying degrees of pain in different people. This can be attributed to psychological or social factors, as well as the previous experiences of the one feeling pain.

We have different mechanisms in our bodies. Some soothe pain impulses and others strengthen pain impulses in certain situations. All of these systems are affected by psychological factors, which explains why pain thresholds vary so much from person to person, and even in the same person depending on when, where and in what situation the pain occurs. The feeling of pain is therefore very complex and personal.

Acute and chronic pain differ not only in terms of how long the pain lasts, but also in how the individual experiences the pain.

Feeling acute pain is important, as it makes us able to protect ourselves against potential dangers in our surroundings. It’s also important for us to be able to know that we need to seek help and treatment. With acute pain, we often also get a feeling of anxiety or fear – for example, during a traffic accident or when bitten by a snake. This fear or anxiety can increase the pain.

Chronic pain, however, is a lasting, continuous pain that continues for more than six months. This pain is often not caused by a specific event, and can therefore feel meaningless. Therefore, chronic pain often causes other issues like depressive thoughts, poor sleep, low energy and digestive issues.

Painkillers often have little effect on chronic pain and more effect on acute pain. Slow breathing exercises have proven effects on all sequelae of chronic pain (digestive issues, depression, sleep issues and low energy).

I have used breathing techniques when I’ve been affected by pain. For years, I’ve been struggling with a painful back due to scoliosis. At times, it’s been so bad that my whole back has locked up, and I haven’t been able to put on my own shoes and socks. I remember it being painful to stand for too long, or to walk, and I always had to sit or lean on something. My neck gave me strong tension headaches.

Breathing helps in many situations – for example, at the dentist, during a CT or MRI, or in other examinations you may be worried about.

Breathing helped me through a bronchoscopy. I had a tube through my nose and down into my lungs, and I breathed my way through the discomfort. According to the nurse in the respiratory ward, they had never seen anyone get through a bronchoscopy with such calm.

After I was assaulted at my job in psychiatry, I got a bad neck injury and injuries to my face. Right away, I had to get 30 stitches without anaesthesia. All I could do was consciously use my breathing, and I felt a great lessening of the pain levels.

The doctors couldn’t understand how I remained so calm. As they were amputating parts of my nose, one of the five doctors said, “I don’t understand how you’re doing this!” What did I think? (Pardon the expression:) “Shut up! I’m breathing!”

When we experience acute pain, it’s natural for our body to start breathing quickly and superficially, because it feels like it’s in a dangerous situation. We enter the so-called fight-or-flight mode, or the sympathetic part of the autonomous nervous system. We desperately try to get away from the danger, and autonomous breathing steps in by speeding up. The problem is that when we’re in pain, this won’t work. When we breathe quickly and superficially, our blood vessels contract so the blood flow through the pained area is even worse. Instead of soothing the pain, the quickened breathing may increase the pain. Breathing consciously and slowly will therefore have an effect, even on chronic pain.

Additionally, less oxygen is released into the body’s cells, including the muscle cells, when we breathe too quickly, which causes the muscles to sour and provides a perfect breeding ground for inflammation.

If, however, we breathe more slowly and breathe in smaller amounts of air, the haemoglobin in the red blood cells will release oxygen to the muscle cells, and all other cells that have a mitochondria and therefore require oxygen. This is due to the increased CO2 levels in the blood (the BOHR effect). The body becomes less acidic, circulation increases due to the expansion of blood vessels, AND pain subsides.

When we breathe deeper and more slowly, we also avoid unnecessary tension in the chest, shoulders and collar bones. Many of those who struggle with tension headaches or pain in the shoulder and neck area find the pain more or less disappears after they develop a more optimal breathing pattern. This is because they normally breathe superficially, by tensing their chest, shoulders, neck and the muscles in their upper back. By learning to release the upper torso, they will eventually see these pains go away.

“When I sought out Anette, I suffered from a stiff neck and headaches several times a week. For years, I’ve been trying different treatments like physiotherapy, chiropractic, naprapathy, as well as strength training, without improving noticeably.
With Anette, I learned simple breathing techniques I can do when it suits me, on the bus, at work and at home. I soon saw results, and after a short while, the headaches were gone.
I have simply been given a tool to control my headaches, and handle stressful situations in my everyday life.”

– Cathrine

When we breathe more slowly, we activate the opposing power to fight-or-flight mode – rest-and-digest mode, or the parasympathetic nervous system. Some even believe it’s completely impossible for a body to heal if there is too much activity in the sympathetic nervous system. It can therefore be absolutely essential to activate this calming part of the autonomous nervous system in order to relieve pain. And a huge component of the parasympathetic system is the VAGUS NERVE.

The Swedish chief physician, Dr Johannes Lindh, believes that several diseases are directly caused by hyperventilation – that is, when we breathe in too much air. We breathe too quickly and too superficially. One of the diseases he mentions is fibromyalgia. He believes fibromyalgia is directly caused by hyperventilation. I’ve had several clients with fibromyalgia who have experienced far better pain management from practising calm breathing exercises. I’m not saying the disease itself goes away, but its symptoms become far easier to handle.

There are many reasons why we may get migraines, but if a migraine is caused by stress or muscle tension, breathing will play a key role. The same is true for tension headaches. I have had several GPs send their patients to me to learn a more functional breathing pattern in order to avoid tension in the neck, chest and shoulders. These tensions can easily spread through the head and create both tension headaches and migraines. (You can also read about jaw tension in the blog.)

Calming down your breathing pattern will, as mentioned, make blood vessels expand, circulation and lymph drainage increase, the body become less acidic, and muscle tension and pains subside. Additionally, the necessary movement of the spine and ribs will be maintained through the increased movement of the diaphragm that’s caused by a deeper breathing pattern. Depressive thoughts, digestive issues and poor sleep, which often follow chronic pain, have also seen documented effects from calm breathing exercises.

You May Need a Nerve to Treat Pain: The Neurobiological Rationale for Vagal Nerve Activation in Pain Management. (2014) – All about how the vagus nerve dampens your pain through 5 mechanisms at the same time: it soothes inflammation, lowers activity in the sympathetic nervous system (fight or flight), reduces oxidative stress, activates the pain-relieving areas of the brain, and releases pain-relieving opioids and cannabinoids in the body.

Breivik, H., Collett, B., Ventafridda, V., Cohen, R. & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10(1) 287–333. doi: 10.1016/j.ejpain.2005.06.009. https://pubmed.ncbi.nlm.nih.gov/20635134/

RR Interval Variability Is Inversely Related to Inflammatory Markers: The CARDIA Study (2007) – the first study to confirm that a weak vagus nerve increases inflammation (CRP and IL-6). – This is a massive study including 750 subjects. Even when they adjusted the statistic for other risk factors, like smoking, exercise, age, etc., a weak vagus nerve was still the main contributor to increased inflammation.

Decreased heart rate variability is associated with higher levels of inflammation in middle-aged men. (2008) – Discusses the connection between heart rate variability and inflammation (CRP and IL-6). What’s interesting about this one is, first, that it is a big study with 264 subjects, and secondly, that it uses healthy people with no cardiovascular issues. And, last but not least, the study is done on twins. Several studies have shown that inflammation causes lower heart rate variability, but this study shows that it also works in reverse: low heart rate variability causes inflammation.

Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability. (2014)

Cardiovascular and Respiratory Effect of Yogic Slow Breathing in the Yoga Beginner: What Is the Best Approach? (2013) – Describes how 5–6 breaths per minute is the best way to activate the vagus nerve, and that it’s better with the same length of inhalation and exhalation than with longer exhalations.

https://www.psychologytoday.com/us/blog/the-athletes-way/201905/longer-exhalations-are-easy-way-hack-your-vagus-neve

https://psykologisk.no/2016/04/et-liv-med-kroniske-smerter/#_ENREF_4

https://featheredpipe.com/feathered-pipe-blog/breath-affects/