Everyone Touts the Benefits of Belly Breathing – But Here’s What They Miss

We breathe – we do it for a living. It’s the first thing we do and the last thing we’ll ever do. How do we learn to breathe? Who is the teacher? How do we know if we are breathing correctly? What is incorrect breathing? Which healthcare or movement specialists learn how breathing should happen efficiently in their training?  Are they the same specialists that are actually teaching the subject?

Today, we can google search for belly breathing and go to the most reputable sources of healthcare education and find lots of information about “belly breathing” or “diaphragmatic breathing”, nearly all of which is contradictory, misleading, or confusing. Below are the first few results I found when I searched “[insert institution name] diaphragmatic breathing” on Google. Phrases in italics in the examples below are all inaccurate statements about the mechanics of breathing:

From the Mayo Clinic: 

“Next time you can observe a baby or child, notice how their bellies move when they breathe, not their chest. Adults, especially those in pain or under stress tend to use the secondary breathing muscles that include neck, shoulder, and upper chest muscles.”

“Ready to get started? Here are some tips:

• Begin in a reclined, comfortable position
• Shoulders down, head supported if possible
• Exhale first and then breathe in through your nose allowing your stomach to rise as air enters
• Do not over-breathe. Usually a pace of breathing in to the count of 3, pause, then exhale to the count of 3 is a good place to start.
• Relax during each exhale.”

From the Cleveland Clinic:

“How do I do diaphragmatic breathing exercises?

When you first learn the diaphragmatic breathing technique, it may be easier for you to follow the instructions lying down.

1. Lie on your back on a flat surface or in bed, with your knees bent and your head supported. You can use a pillow under your knees to support your legs.
2. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
3. Breathe in slowly through your nose so that your stomach moves out, causing your hand to rise. The hand on your chest should remain as still as possible.
4. Tighten your stomach muscles, so that your stomach moves in, causing your hand to lower as you exhale through pursed lips (see “Pursed Lip Breathing Technique“). The hand on your upper chest should remain as still as possible.”

From the University of Michigan:

“Focusing one’s breath is an effective way to encourage the body to relax. When practicing diaphragmatic breathing, the stomach, rather than the chest, moves with each breath, expanding while inhaling and contracting while exhaling.  Deliberately paying attention to each breath serves to distract and quiet the mind.” 

From the Harvard Medical School:

“Breathe in slowly through your nose, letting the air in deeply, towards your lower belly. The hand on your chest should remain still, while the one on your belly should rise.”

From the American Lung Association:

“To practice belly breathing, sit down in a comfortable chair, sit up straight and put your hands on your belly or if it’s more comfortable you can lay down.

Close your mouth and take a slow, deep breath in through your nose.
When you breathe in, you want your belly to fill with air and get bigger like a balloon.
Blow all of the air out slowly and gently through pursed lips as if you were blowing bubbles.”

Finally, when I performed a Google search for “proper diaphragmatic breathing”, this is what was suggested:

In all of the examples above, the instructions given for proper diaphragm breathing are to expand your belly and not your chest.  Since the lungs are what fill with air when you breathe-in, it should be the chest that expands as air enters. Also, since most activities in life require our abdominal muscles to support our core, expanding the belly causes the abdominals required for support to loosen or let go in order to take a breath when following these instructions. Let me dispel the paradox of how to support the diaphragm and use it properly as the primary muscle of respiration.

The Mechanics of Breathing

Let’s start simple and then move to complex. 

Breathing happens in the chest cavity into our two lungs which are surrounded by our ribs, sternum and thoracic spine.  Air moves in and out through our nose (and mouth) and travels through our airway. The airway includes all of the tubes that air flows through from our nose and mouth, throat, trachea (windpipe), bronchus and bronchioles (tubes in our lungs), until it reaches the lung tissue, where air exchanges in our blood to take it where it is needed. 

The primary muscle of breathing is the diaphragm. It’s responsible for all of our restful breathing and is assisted by the “accessory muscles of respiration” when the demand for airflow increases beyond just rest. These accessory muscles include the scalenes, upper traps, pectoralis major and minor, serratus anterior, erector spinae, quadratus lumborum, and in some cases, psoas major and the hamstrings. 

The more the demand for air increases, the more we use accessory muscles to assist us. This means that accessory muscles are “helpers” and should never be put in a position to be primary muscles of respiration (more on this later).

So, as we breathe-in, the diaphragm muscle is expected to be in its tallest position so that when the muscle contracts and pulls down, it creates a vacuum or suction effect that draws air into the lungs through the nose (and mouth), much like a pump. This implies that the chest, which houses the lungs, will expand in an outward (preferably not upward – more later) direction. In order for this to happen properly, the muscles between the ribs (intercostal muscles) must not cause any increase in resistance unless forced to do so. This means that we mostly want relaxation in our intercostal muscles between the ribs. Since air follows the path of least resistance, it will enter the space that has least pressure first and the greatest pressure with greatest effort last. In summary, the taller and more relaxed the diaphragm is when inhalation starts, the more air it can pull into the chest and the chest is the area that houses the lungs thus it should be the region that expands when air enters.  

When we exhale, much of our breath will leave our lungs without effort since all of the tissues and ribs are already stretched out and expanded with air. The tension of these tissues and the weight of our chest will allow air to leave on its own. 

Try it: Inhale and feel the chest expand like a balloon. Now stop holding the breath in and just let go. Experience that the air leaves your lungs automatically like taking your pinched fingers off of the neck of a full balloon. 

This is when the diaphragm relaxes back to a neutral position. As we try to move the rest of the air out, we will use additional muscles of exhalation which includes the abdominals and the intercostals (between the ribs) to squeeze more air out of the chest.  

Try it: Exhale as above, but then continue to blow more air out through a small circular shape in your lips (like when blowing out a candle or at a pinwheel). Feel as you blow out that your abdominals tighten and your ribs squeeze down together. It is at this moment that your diaphragm is able to get as tall as your body will allow and prepare it for the next inhale.

There is an important distinction between primary respiration and accessory respiration.  Primary respiration is the most energy efficient way to get air. The better our primary respiration, the less our body has to expend additional energy to breathe. When we sleep, we should only use primary respiration muscles. 

Popular Misconceptions About Belly Breathing

Misconception: The chest should not expand but the abdomen should.

The chest SHOULD expand with inhalation. It should expand outward NOT upward. Outward chest movement fills the lungs with expansive motion that allows trunk rotation, and an alternating arm swing while walking. Upward chest and shoulder expansion however IS accessory breathing, meaning it is a compensation for the primary breathing muscles and can cause neck and shoulder overuse syndromes. 

Misconception: Belly breathing is perfect breathing because babies do it and they are born without bad habits.

Belly breathing is observed in infants and is proper breathing during this phase of life when the infant does not have the ability to walk. As soon as that baby learns to be upright and walking, they will need to integrate their abdominal wall to allow them to balance and still have sufficient airflow. IF, during ambulation, the abdomen expands while they are breathing, the abdominal muscles will not be able to support the ribs and diaphragm on the side that the body is moving toward and cause an increased amount of back support for upright walking and standing. This often happens in adults that do not use their abdominal muscles for upright activity like standing and walking. The first steps of a baby around 10-12 months of age are never very coordinated and often you can see the abdominal muscles struggle and the back muscles be tense.

Misconception: Intercostals (muscles between the ribs) are for inhalation.

Most of the intercostals generally are not used for inhalation and definitely not for primary inhalation. In fact, they serve a greater role in exhalation – especially “forced exhalation” such as coughing. A large portion of our primary exhale happens with very little muscular action. This is because of gravity pushing down on our body as well as the tension that builds up in our ribs, muscles, fascia, and skin during inhalation. It is like letting the air out of the balloon. Forced exhales like coughing and clearing our throats will engage the neck and shoulder muscles as accessory muscles. 

Misconception: Lower ribs should expand while the abdominal muscles relax and “let go” to belly breathe.

When the lower ribs expand, the diaphragm has to move down and become flat. Flat diaphragms are not good pumps.  We need our diaphragm to be a great pump. To accomplish this, we need our lower ribs to not get too wide and our abdominal muscles to support the lower ribs’ position WHILE the diaphragm relaxes upward. This happens as air leaves the lungs and the chest and ribs get smaller. As we breathe back in, if the abdominals relax as the air comes in, the lower ribs will widen and the body has to lean backward into low back muscles.  This will cause our pelvis to tip forward, and our ribs to elevate. This can cause a lot of back and hip flexor tension. This also prevents normal centering on each foot during walking and running.

The Consequences of Improper Breathing

Belly breathing is observed in infants and is proper breathing during this phase of life when the infant does not have the ability to walk.  Once humans learn to walk, they need to be able to hold their trunk upright and rotate toward the ground they are standing on with each step.  Belly breathing causes humans to extend and rotate away from the ground they are trying to push with their foot resulting in back tension and muscle imbalances. During walking and running, the body has to move from side to side, toward the foot that is on the ground.  This means on the standing side, the ribs SHOULD come down, in, and back even more than with standing.  This means that the lower ribs should NOT expand on that side if you expect to stay properly balanced and oriented on that foot.  Those of us who struggle with keeping our lower ribs tucked in, will have to compensate for our lack of centering with additional hip (glutes) and low back (lats, QL, erectors) and hip flexor muscles, resulting in overuse syndromes.

The Link Between Belly Breathing and Postural Problems

Posture has more to do with our ability to center ourselves and decrease the effort required to be upright than it does with looking straight, or lined up. To center ourselves, there is a spot under ourselves in the middle called our center of gravity.  In our body, we have another center called the center of mass.  These centers change depending on if we are on one foot or two. They even change and affect us when we are sitting.  The body wants to do the least amount of work possible to line up our centers.  

You can try this by standing on both feet and then picking one foot up. When we are standing on both feet, the center of gravity is directly between both feet and the body should look like half of it is to the right and the other half is to the left of that center line. There is also the half of the body that is in front of that line and the other half that is behind that line (but that is harder to see in the mirror and you may have to ask someone to take a profile photo of you). 

Now, pick up one foot while noticing what your head and body do. Did you move toward the foot that was on the ground?  Did you try to put half of yourself outside of that foot?  If not, can you feel more muscles in your standing hip, or your lifted sides low back?  Did your back and/or neck muscles get tighter?

The muscles that get tighter are the ones taking responsibility for your posture, but may in fact not be the correct postural muscles. In addition to that, your ability to even move your center requires you to be able to tuck your ribcage down and get air out of the lower ribs on the side you are moving toward. What if it is hard for you to get air into the chest on the side you are moving from? (Perhaps because you have been working on “belly breathing” like so many healthcare providers suggest but teach incorrectly.) What if your body is not great at that yet and it forces you to use these additional muscles to hold you up? We see a lot of overuse muscular syndromes and even spinal compression and degenerative syndromes show up in clients that lack the ability to properly support their diaphragm with their abdominal muscles for breathing.  

Our body needs access to efficient positional changes on any side (left, right, as well as forward and backward).  Without this access, posture strategies decline and holding “posture” becomes too much effort to sustain.  Do you find it hard to hold on to “good” posture? You might be beginning to understand why! If you want to address these issues, a physical therapist trained in Postural Restoration can help you retrain your breathing strategies and address other movement patterns that may be contributing to poor posture.

How to Breathe Properly

There’s a lot to unpack about proper breathing technique. The biggest factor in proper breathing is dependent on the activity that one is engaged in with respect to the oxygen demand of the brain and the tissues. Sleep requires a different definition of “proper breathing” than running, swimming, or even speaking.

Proper breathing can be generally summarized by first optimizing the respiratory diaphragm’s ability to ascend. This increases the volume of air that the diaphragm can bring in without accessory muscles engaging when it descends. However, in order to optimize this end result, there needs to be space in the chest cavity for the increased volume of air to go. This means that chest expansion is necessary for the diaphragm to glean the outcome of proper diaphragmatic breathing (which includes keeping the abdominals appropriately engaged to support the diaphragm’s optimal rib position). This also gets more complex when we start moving our body in an upright activity.

While upright, our body needs to balance our center of mass with muscles that hold us up, as well as balance our breathing. This means that when we go to our left foot, our left ribs should stay smaller and more air has to go to the front and side of the right rib cage (and some to the back of the left rib cage – if it can). This means that we have even less room for great breathing when we move our body than when we stand still. In addition, as our activity level becomes more involved, we have even less room but our increased activity level demands more air. This is why we can easily get winded with running if we do not practice sport-specific breathing exercises.

While laying down, the body does not have to recruit muscles to prevent falling and the overall oxygen demand is less since we are at rest. During sleep, the diaphragm alone should be capable of providing airflow exchange so that all of the other muscles can rest and recover. Imagine if your diaphragm was not positioned well enough to accomplish this for sleep and you needed accessory muscles in your neck, jaw, chest, and back to make up the difference all night. Can you see why you may wake up with back, neck, and jaw tension?

The Benefits of Proper Breathing

Proper breathing increases the body’s ability to manage the airflow and oxygen requirements for all activity in life. When the body senses a challenge to breathing, it will neurologically detect and physically change your body posture to make sure that you get enough air (oxygen), even at the expense of muscles, tendons, and joints. Dr. Bahar Esmaili is quoted as saying “Patients compromise by financing their airway with poor posture.” in an article she wrote for DentalSleepPractice.com.

Proper breathing decreases the taxing demands of the accessory muscles that all have different primary functions for physical activity. Overuse of these muscles to get air is fatiguing considering that we take 22,000 – 25,000 breaths per day, on average.

Proper breathing, when the diaphragm works like a pump, also aids in gut motility and digestion, as well as moving cerebro-spinal fluid between the spine and skull, which nourishes the brain and nervous system.

Breathing is one of the most neurologically protected activities we do. Proper breathing is the best natural anxiolytic and antidepressant. It is the first thing you ever did, and the last thing that you will ever do.

We breathe for a living – literally.

Is Belly Breathing Bad?

The short answer is no, the long answer is more complicated. Our bodies have multiple strategies for acquiring oxygen, and the optimal approach depends on the situation. Healthcare often teaches that “belly breathing” is synonymous with “diaphragmatic breathing,” suggesting this is the proper way to use the diaphragm. However, this is an oversimplification.

For the diaphragm to effectively pump air, the abdominal muscles – especially the deeper oblique and transverse layers of the core – need to be engaged. This prevents the ribs from rising as the diaphragm descends during inhalation. If we simply “belly breathe” by letting the abdomen expand, the abdominal obliques disengage, allowing the ribs to move up. This actually flattens the diaphragm, reducing its power as an air pump. It also promotes excessive back extension, which can increase low back tension.
During activities like standing, walking, and various athletic movements, the body needs to be able to move the torso forward and turn toward the foot we’re standing on. If the ribs rise excessively during inhalation, it can throw the body’s center of gravity off, reducing balance and efficiency. Keeping the abdominal muscles engaged to hold the ribs down allows the diaphragm to be optimally positioned to draw air in.

While babies often “belly breathe,” their abdominal muscles are not yet developed for the balance and coordination required for upright activities. Individuals who benefit from belly breathing, like opera singers or wind musicians, use it to increase their total air capacity for specialized performance needs – not as their sole breathing strategy.

In summary, while “belly breathing” may have its uses, the ideal breathing pattern involves engaged abdominal muscles to support the diaphragm’s function as an air pump. This allows for more efficient, balanced movement and respiration, especially for standing, walking, and athletic activity.

Conclusion

Breathing properly can be complicated, and while there is no one way it is learned or taught, there is a lot of mis-information out there about how to breathe. Much of the information is based on observations of “normal” breathing. When abnormal breathing becomes the “norm,” then we start to get confused about what we are supposed to be doing.

When we look at the system as a pump that moves air. We can see where the air is supposed to go and with which muscle groups. This is the defining difference between good breathing habits and bad. It is also at the root of understanding if there are inefficient breathing patterns that are affecting your joints, muscles, sleep, teeth, and even anxiety.

Have you noticed your neck muscles getting tight, or your shoulders rising when you take in a relaxed breath? Or maybe you have been practicing letting your belly expand with your breathing. If so, you should give us a call to have your breathing strategies checked.

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If you found this information useful, you can learn more about patterned human asymmetry and breathing on our Postural Restoration Physical Therapy page. If you need breathing help, or wonder how breathing patterns are affecting you, contact us.