Introduction
In this article, I will make the case that patterns of unhealthy breathing are among the most vital target areas for progressive reduction of the symptoms of Parkinson’s Disease. Breathing dysfunctions are prevalent in people with PD, such as chronic mouth breathing, but, in particular, shallow breathing from the chest and neck, with very little movement of the diaphragm, which has become spasmodic, rigid and stiff. These breathing patterns often precede diagnosis by years or may even be life-long habits, and therefore could have a more causal role, rather than just being an effect of developing the disease. Conversely, if a chemical cure was invented tomorrow, which alleviated the main symptoms, it is very unlikely to fix the unhealthy breathing habits, and so associated chronic health issues are likely to re-emerge. The positive message is that this can be worked on and repaired over time even with PD, and that long term strategies to improve the situation could help reduce symptoms and disease progression, and improve quality of life.
Breathing and Parkinson’s Disease
I know I am far from being alone in having issues with breathing correctly, and observing other people with Idiopathic Parkinson's Disease, one cannot help but note the similar defaulting to mouth breathing instead of through the nose, and the shallow, rapid and tight breathing from the chest or neck, instead of from the diaphragm/belly. People with PD have even reported to me that they feel like they can't breathe at all when very symptomatic or highly stressed, because the whole body is then so tight and stiff. I have experienced this feeling of not being able to expand the chest or the abdomen far enough to get air in my lung when I was very poorly and ended up being hospitalized last year,
MY HOSPITALIZATION WITH PARKINSON'S DISEASE,
so I know how frightening this can be.
Furthermore, shallow breathing may have more impact on people with PD than most, since PD symptoms already correlate with a lack of oxygen to the brain,
LACK OF OXYGEN TO THE BRAIN IN PARKINSON'S DISEASE,
and hence low oxygenation levels through poor breathing are likely to make the neurological situation worse.
Furthermore, these unhealthy breathing patterns are still apparent in many people with PD even when the medications are working well and the other main motor symptoms are alleviated. Speaking with many people with PD about this, the realization usually occurs that poor breathing habits were already ingrained years before diagnosis, and often are life-long patterns. It seems therefore that issues with breathing may be more causal of other symptoms, or at least an exacerbating factor of PD, rather than just an effect of the disease.
Lessons from Dystonia
Involuntary muscle contractions, known as dystonia, are part and parcel of many forms of Idiopathic PD. Dr Joaquin Farias, a leading expert in dystonia and movement disorders, who helps people to reduce symptoms and recover through movement therapies,
Dystonia Recovery Program, Neuroplasticity Training for Dystonia: A full body recovery experience,
teaches that re-training breathing is one of the top priority areas in any progressive symptom reduction plan. Dr Farias views PD as a form of generalized dystonia. However, Dr Farias also coaches that breathing techniques which force the diaphragm to move will actually make the situation worse for people with dystonia and PD, causing the diaphragm muscle to go into even greater spasm. This matches my own experience, since I have always found deep breathing exercises from other modalities to be more triggering of my symptoms, and hence detrimental, rather than being helpful/relaxing. Indeed, he teaches that deep breathing does not mean forced breathing, or even taking in lots of air, but breathing small amounts with controlled finesse of the diaphragm. He talks about small breaths going "all the way down", and demonstrates how to breathe from the diaphragm without the neck or ribs engaging at all. Apparently, forms of cervical (neck) dystonia can be completely recovered from through breathing exercises alone, but this has to be done ever so gently over a very long time.
Dr Farias’s success with clients at least shows that unhealthy breathing habits can be changed over time even with movement disorders, and doing so can greatly benefit quality of life. I personally know it is possible to fix breathing issues, even with Parkinson’s Disease, as some time ago I sorted out my lifelong mouth breathing habits, and now naturally default to nose breathing,
BREATHING THROUGH THE NOSE AND PARKINSON'S DISEASE,
but taking Dr Farias' course revealed to me just how far I still am from healthy breathing, how restricted it remains, and how much spasm/hypertension/tightness my diaphragm and abdominal area are still in.
Lessons from Fascia Decompression
Another seminal source of information which affirmed for myself the critical role of breathing in health and disease, especially the [lack of] movement of the diaphragm, was the book
Fascia Decompression - the Missing Link in Self-Care
by Deanna Hansen. Deanna writes
“It is through proper mechanics of the body that we maintain the optimal tissue temperature. The diaphragm muscle is situated in the core of the body, acting as the ceiling to the abdominal organs and the floor to the heart and lungs. When we inhale, the muscle moves down in the core and the belly extends; when we exhale, the muscle moves up and the belly squeezes small. Breathing with the diaphragm muscle is like turning on the furnace in the body. This muscle’s action regulates the core temperature with its continual movement up and down through proper inhalation and exhalation. Correct posture is required to support the diaphragm’s shape and action. When we collapse into the core from unconscious posture, the diaphragm doesn’t have the opportunity to move in the way in which it is designed."
"When the diaphragm can’t function, the muscles of the upper chest kick in to pull in the breath, but this is limiting to the health of the fascia [connective tissue] as the overall temperature of the body becomes cooler. If breathing with the diaphragm is like turning on the furnace, breathing with the chest muscles is like putting a space heater in a room. Only that room will be heated, not the whole building. Not only does the lack of movement from the diaphragm affect tissue temperature, but tissue compression from incorrect posture also causes cooling. Tissue needs space in order for fluids to travel freely. Compressed tissue is dense and creates roadblocks, or tree trunks of restriction. For tissue to be healthy and clean, it needs to have room for blood and oxygen to reach each and every cell, and to clean them of debris. We need to de-compress tissue manually in order to remove the roadblocks, and heat the tissue with the full conscious breath."
“Correct posture is required to support the diaphragm’s shape and action. When we collapse into the core from unconscious posture, the diaphragm doesn’t have the opportunity to move in the way in which it is designed.”
Postural collapse is another key feature of PD. The links that Deanna makes with the movement of the diaphragm and fascia [connective tissue] health made me sit up and pay close attention to her work, as I had already come to the conclusion that problems with the fascia, just as much as with muscles, are a key reason for the pain, stiffness and rigidity experienced by people with PD,
FASCIA (CONNECTIVE TISSUE) AND PARKINSON'S DISEASE.
and that fixing these fascial issues will be key to progressive symptom reduction. Deanna’s work thus points us to the conclusion that correcting diaphragm dysfunction and unhealthy breathing patterns will, in turn, be vital for mending the fascia.
Connection Between Diaphragm Dysfunction and Chronic Health Issues
In the course of my research, I found a very important scientific review article which links poor diaphragm mobility to a host of health issues, all of which are common as symptoms or complicating factors in Parkinson’s Disease:
Symptomatology Correlations Between the Diaphragm and Irritable Bowel Syndrome.
“The text reviews the diaphragm's functions, anatomy, and neurological links in correlation with the presence of chronic symptoms associated to IBS, like chronic low back pain, chronic pelvic pain, chronic headache, and temporomandibular joint dysfunction, vagus nerve inflammation, and depression and anxiety. The interplay between an individual's breath dynamic and intestinal behaviour is still an unaddressed point… and the paucity of scientific studies should recommend further research to better understand the importance of breathing in this syndrome.”
This article explains the direct links between diaphragm dysfunction and: issues with the pelvic floor, jaw and tongue; lower back pain; headaches; gastroesophageal reflux (GERD); perceived pain; emotional state and body image; pain and inflammation; the nervous system.
Connection with the Nervous System
Important nerves both innervate and pass through the diaphragm, including the vagus nerve. The link to Parkinson’s Disease and the vagus nerve has come to the fore in recent years. Indeed, my own perspective is that Idiopathic PD occurs when the Nervous System gets stuck in a “death feigning” or immobilizing response to perceived threats, resulting in inhibition of the ventral (super-diaphragmatic) part of the vagus nerve, and giving control over to dorsal (sub-diaphragmatic) part of the nerve responsible for immobilized defensive states, see
THE DORSAL VAGUS NERVE AND PARKINSON'S DISEASE.
The labelling of the branches of the vagus nerve as “super-” and “sub-diaphragmatic” takes on added meaning here, since the diaphragm not only provides the dividing line between them, but any dysregulation of the diaphragm will have an affect on the proper function of the vagus nerve and the communication between the branches.
Indeed, according to a premise in the above cited review article, if the diaphragm is limited in its movement, it becomes stiff, dry, tight and frozen. Then, instead of gliding past or stroking the various nerves which pass through it, as it contracts and releases, the diaphragm squeezes or elongates or compresses these nerves over its limited range of motion. This then causes dysfunctions in the nerve systems - and some very vital nerves pass through holes in the diaphragm, including the vagus.
“… reduced vagal tone may be induced by mechanical stress caused by a dysfunction of the diaphragm, resulting in a compression of the nerve, which induces abnormal vagal function. There is a close relationship between the vagus nerve and the perception of pain. We know that a compression of the vagus nerve can alter its function and, just like a dysfunction of a peripheral nerve, mimicking an entrapment syndrome. We can assume that abnormal tension of the diaphragm in the region of the oesophagal hiatus could cause a compression of the vagus nerve, reducing its anti-pain and anti-inflammatory activity."
Another important nerve the article mentions is the phrenic nerve, which also passes through the diaphragm, but which innervates (flexes and senses) the diaphragm itself. I had never heard of this nerve before, so made some based on
Anatomy, Thorax, Phrenic Nerves.
"The phrenic nerve originates from the... C3 through C5 nerve roots [in the neck] and consists of motor, sensory, and sympathetic nerve fibers. It provides complete motor innervation to the diaphragm and sensation to the central tendon aspect of the diaphragm."
"The left phrenic nerve innervates the left diaphragmatic dome, and the right phrenic nerve innervates the right diaphragmatic dome. The motor innervation activation will cause the diaphragm to contract with inspiration, resulting in a flattened diaphragm. During exhalation, the diaphragm relaxes and returns to the dual dome shape."
"The phrenic nerves provide motor innervation to the diaphragm and work in conjunction with secondary respiratory muscles (trapezius, pectoralis major, pectoralis minor, sternocleidomastoid, and intercostals) to allow respiration."
"The phrenic nerve supplies sensory innervation to the diaphragm. Pain arising from the diaphragm is often referred to the tip of the shoulder. For example, a patient with a subphrenic abscess or a ruptured spleen may complain of pain in the left shoulder. The hiccup reflex is due to irritation of the phrenic nerve."
These links between the phrenic nerve and referred pains in the shoulder, and referred pain in the neck and shoulder arising from problems with the diaphragm more generally, is pertinent to PD, in which neck and shoulder pain abound. This is true for myself personally, where my worst pain arises in the right neck and shoulder. Interestingly, two of my most painful spots occur on my right shoulder tip and also beneath my right clavicle, precisely where the anatomy diagrams show the right phrenic nerve passes under.
Many people also have problems in the cervical [neck] vertebrae, especially the C3-C5 region where the phrenic nerves originate, including pain, soreness and a lot of clicking and grinding. It may be worth considering if the origin of these pains is due to diaphragm dysfunction rather than problems with the shoulder itself.
The article also mentions
“… during respiration, the muscles of the abdominal wall and the diaphragm muscle are controlled in an electric combination that allows a perfect synergic contraction during inspiration and expiration. A dysfunction of the diaphragm muscle may alter this functional synergy and cause an alteration in the motor scheme”,
and the anatomy video included below also discusses how a weak or paralysed diaphragm, e.g. due to phrenic nerve damage, can actually move up instead of down on one side when inhaling.
What Can We Do About It?
While there may be no quick fixes for this, in my experience, it is possible to progressively improve matters, through daily diaphragm breathing exercises of the right kind. Due to faster disease progression and the myriad of other health issues associated with poor diaphragmatic breathing, I would recommend anyone with PD, but especially those newly diagnosed, to seek out gentle breathing techniques which they can personally work with, following Dr Farias’s advice to avoid methods which try to force the diaphragm to move before it is ready, and commit to setting aside a little time each day to do the exercises. Two modalities I’ve found personally beneficial are Dr Farias’s own program of breathing exercises, which are tailored specifically for people with dystonia and PD, and a self-care technique called Block Therapy, developed by Deanna Hanson, which isn’t specific to PD, but is designed to gently restore diaphragm function. Both of these only require a few minutes a day, every day, for improvements to slowly but surely accrue. However, note that these are generally part of paid-for online subscription courses, although Deanna has free resources explaining how to do the diaphragmatic breathing exercise part of Block Therapy.
Another modality that I am currently considering, as it may be helpful since it is also based on very gentle breathing exercises, is the Buteyko Method.