This week, I visited my physical therapist for a procedure called fascial counterstrain, a manual technique designed to provide pain relief by relaxing the fascia (the connective tissue that covers our nerves, arteries, veins and internal organs) and restoring proper functioning to the body. (Interesting Fact – I saw the same therapist who treated entrepreneur, #1 NY Times bestselling author, and philanthropist, Tony Robbins.)
I’ve been told I have moderate to severe inflammation in my body, which is not atypical for someone with chronic pain. Inflammation—caused by illness, injury, stress, obesity, and other health conditions—results in pain, stiffness, and tissue damage or death. My therapist believes inflammation reduced the blood flow to my extremities, resulting in decreased nerve fiber density as my tissues were deprived of oxygen. While this theory has not yet been proven, I witness the effects of poor circulation when I sit or stand still for a period of time. My feet often turn purple, my legs burn, and my hands become freezing cold.
One of the things that came up in conversation was natural ways to reduce inflammation. This information is helpful for anyone—not only those living with chronic pain or illness—but it is especially important for those of us with systemic inflammation that affects our mood, sleep, digestion, and other aspects of our well-being.
In addition to moving our bodies and following an anti-inflammatory diet that includes Omega-3 fatty acids, fiber, and antioxidants (and avoids sugar, saturated fat, and highly processed foods), he suggested implementing techniques to help lower stress. Stress—whether caused by illness, injury, relationship issues, work, major life events, or unresolved emotions—fuels the pain cycle (see diagram below). It triggers a cascade of pro-inflammatory cytokines, including interleukin (IL)-1β, interleukin (IL)- 6, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, which have been shown to affect neurotransmission, brain structure and function,
Most of us are familiar with deep breathing as a way to reduce anxiety and return the body to a baseline state, but what you may not know is that it has a slew of other health benefits. Slow, deep breathing stimulates the vagus nerve, a bundle of nerves that exit the brain stem and are the main component of the parasympathetic nervous system, the system responsible for relaxing your body after periods of stress or danger. The vagus nerve also plays a role in digestion, heart rate regulation, and and the reduction of inflammation in the body.
Stimulation of the vagus nerve (through deep breathing and other practices) calms our autonomic nervous system and halts the secretion of stress hormones (e.g. cortisol and adrenaline) that can fuel the chronic pain cycle (see diagram below). While your body is complex and requires a multidisciplinary approach to healing, the exercises shared in today’s post can help you moderate and reduce your symptoms, improve your ability to function, and enhance your overall well-being.
Any breathing practice that alters the depth or rate by which you would normally inhale or exhale has physiological effects on the body, including a change in heart rate, blood flow, digestion, mood, and even pain perception.
Without going too deep into how this happens, when we breathe in our diaphragm (the dome-shaped muscle below the lungs that helps with respiration) moves down. This opens up the chest cavity, allowing the heart to expand slightly and blood volume to flow at a slower rate. The brain registers this change and sends a message back to the heart to speed up our heart rate.
When we exhale, the diaphragm moves up, providing less space for the heart and causing blood volume to flow at a slightly faster rate. The brain registers this information (via the SA node, the “natural pacemaker” of the heart) and send a message back to the heart to slow down.
Inhalation, therefore, speeds up our heart rate, while exhalation slows it down. This natural variability in heart rate, controlled largely by the autonomic nervous system, can be measured by something called heart rate variability. Heart rate variability is a good predictor of cardiovascular health and adaptability. It gives us insight into how our bodies respond to the environment, emotions, and stress.
In a healthy individual, heart rate variability is generally higher (see the charts below for average rates by age and gender), indicating an ability to adapt to stressful stimuli. When their body encounters stress, their sympathetic nervous system (i.e. the fight or flight response) kicks in, but only for a short time—until the threat passes. The parasympathic nervous system (i.e. the rest and digest response) soon takes over, reducing heart rate and blood pressure, decreasing respiration, redirecting blood flow back to organs that were considered “nonessential for survival” during the stress response, and inhibiting production of pro-inflammatory cytokines.
In someone who is chronically stressed, has experienced trauma, and/or struggles with anxiety or fear (including fear of pain itself, as is common with “pain catastrophizers”), their body can get “stuck” in fight or flight mode (also called fight flight freeze). They live in a constant state of high alert that, over time, drastically impairs their physical and mental health (here’s a good article that goes into more detail). As a result, their sympathetic and parasympathetic nervous systems are “out of balance,” resulting in a low heart rate variability.
Heart rate variability, which can be assessed through a device such as an Oura ring or Apple Watch, is one way we can measure the effects of stress on our body. Other symptoms of chronic stress include low energy, unfocused thinking, feelings of anxiety, changes in appetite, irritability, and increased pain. Awareness of these symptoms and how we respond to them is key to our well-being.
Side Note: During sympathetic activation—when the body perceives a danger or threat—distal blood flow (i.e. blood flow to the areas furthest from the core) decreases. This is observed as poor capillary refill (i.e. the time it takes for blood to return to an area when pressure is applied), changes in color and temperature (i.e. a purplish or bluish appearance of the skin, or skin that is cold to touch), pulses (i.e. an absent or diminished pulse at the ankle or wrist), and swelling. These symptoms are common in people with peripheral neuropathy and other chronic health conditions, but can potentially be improved with exercise, an anti-inflammatory diet, and practices such as deep breathing that usher the body back into a relaxed, parasympathetic state.
Mean Heart Rate Variability (HRV) Scores Based on Age and Center from ⒸElite HRV 2023
In 2020, shortly after my chronic pain started and in the midst of the coronavirus pandemic, my average heart rate variability was 22, which is incredibly low. Over time, as I have modulated my body’s stress response through controlled breathing, music, meditation, and other strategies I’ll discuss in future posts, it has increased to 31. While this is still far from where I want to be, it is progress and I have hopes it will continue in a positive direction.
By slowing our heart rate through deep breathing, meditation, and other relaxation strategies, we can calm our body’s flight or flight response, reduce inflammation, restore blood flow, and return our sympathetic and parasympathetic nervous systems to back to their proper balance. In addition to reducing stress, deep breathing has been show to positively impact metabolism, sleep, lymphatic drainage (which removes toxins from the body), and cognition.
Even things we are genetically predisposed to can be altered through intentional practices. Migraines, autoimmune conditions, and stress-induced disorders may run in your family, but you can still take proactive measures to reduce stress, strengthen your immune system, and improve your overall health. If, like me, you’ve noticed stress makes your symptoms worse, practices like deep breathing can help.
Here are three different breathing practices to try:
1. Diaphragmatic Breathing – Diaphragmatic breathing involves taking slow, intentional deep breaths (using your diaphragm) while paying conscious attention to how the air feels as it moves in and out of your body. Begin by placing one hand on your abdomen at the waistline and the other hand on the center of your chest. Notice the rate and depth of your breathing.
Next, slowly inhale through your nose and exhale through your mouth for at least a count of 3-4 seconds. The best and fastest way to decrease stress is to emphasize and extend the exhalation.
Since exhalation is what slows your heart rate, increasing the length of the exhalation (to a count of 6-8) will activate your parasympathetic, relaxed state. Here’s a handout that goes into more depth.
This breathing exercise is ideal for when you’re feeling stressed, anxious, or fearful and want to calm your body’s fight or flight response. Practice it for 5-10 minutes a few times a day. For more information, you can download this PDF that outlines the benefits of diaphragmatic breathing and different techniques to try. You can also click here to schedule a call with me to find out which technique works best for you.
2. Box Breathing – This technique is used by Navy Seals to relieve stress and improve focus. It works well in high-stress situations when we need to calm our autonomic nervous system while maintaining concentration. Box breathing got its name from the notion of dividing our breathing into four steps as if you were breathing along the edges of a box.
With box breathing (also called square breathing), you breathe in for four seconds, hold for four seconds, breathe out for four seconds, and then hold for four seconds. (Here’s a handout on this practice and a YouTube video you can use to follow along.) Ideally, do this for 2-5 minutes at a time.
What separates this breathing exercise from others is the hold between inhalations and exhalations, which increases carbon dioxide in your blood. Doing so increases the cardioinhibitory response, which further lowers your heart rate and puts you in a more relaxed state. For more information on how this breathing technique can help, click here.
3. Breath Prayer – Breath prayer combines the science of deep breathing with the spiritual discipline of prayer to reduce stress, foster gratitude, and grow closer to the Lord. Breath prayer reminds us that every breath is a gift from God, and that His Spirit is nearer to us than our own breath.
In solitude and silence, close your eyes and slowly inhale while whispering or thinking a word/phrase, such as a Name or Attribute of God (e.g. Jehovah Rapha/The God Who Heals, Jehovah Shalom/The Lord is Peace). Then, slowly exhale, completing the phrase (aloud, or in your mind). For example:
Prince of Peace, You provide rest for my soul (based on Matthew 11:28-30).
Lord, my Fortress and Protector. You keep me safe (based on Psalm 18:2).
Jehovah Jireh, my Provider. I trust You to supply all my needs (Philippians 4:19).
There are some additional examples on this printable handout or you can search online for examples of breath prayers. The song below, Peace by Bethel Music, may also provide some inspiration.
One variation of Breath Prayer is to breathe in the Spirit of God, Peace of God, Love of God, etc. and breathe out what we want to get rid of—the ways we try to control, reliance on ourselves, anxiety, fear, or feelings of unworthiness. We push these things away with our breath as we meditate on the character of God and His promises. When I do this, I open my hands in a posture of receptivity and ask God to remove anything that is not in alignment with His will for me.
An act as basic as our breathing can be a powerful reminder that God literally breathed life into us and He now lives within us in the form of Holy Sprit. As we fill our lungs with the breath that flows from the Author of Life Himself, we can be still and know He is sovereign over all things (Psalm 46:10). We can let go of trying to control, cast all our anxiety on him, and breathe in His peace. In His Presence, deeper healing and transformation happen.
By changing your breathing, you can literally change your health. In the short term, you may feel more relaxed, notice an increase in your heart-rate variability, and experience decreased pain intensity. Long-term changes include reduced blood pressure, autonomic nervous system arousal, anxiety, and stress, along with improved focus, emotional regulation, and quality of life.
In the words of Dr. Joe Tata on The Healing Pain Podcast, “Many people with pain don’t want to focus on their body because they see their body as a place that’s unsafe. However, bringing them to the breath, or an awareness of the breath, introduces them to (a) bodily sensation that they can begin to approach—and they have some control over—and they realize when they approach it in a (nonjudgmental) way… it has an impact on their pain or their emotional regulation. Then, they have a bit of empowerment…and they feel like, “Okay, I can do something for myself. I can do something to impact this pain.”
Deep breathing in and of itself will not get rid of stress or pain, but it can help you reduce them and experience peace that moves you in the direction of healing.
Call to Action: Deep breathing is a simple, cost-free way to dramatically improve your physical, emotional, and spiritual health. Give one of the above practices a try and leave a comment below to share your experience.
3 thoughts on “The Science Behind Deep Breathing – Why it Works to Reduce Stress and Pain”
Jen, thank you for this post! I have done deep breathing for my anxiety for the past couple of years but never thought about it for my inflammation/pain. Reading this truly helped me and inspired me to keep fighting (or breathing) through it. And thanks for reminding me that I’m not alone! Love you, girl!
well done! Informative and helpful.