Breathing and Soft Tissue

SET TALK
By Don McCann, MA, LMT, LMHC
MA3267 MH705 MM3717

Just moments ago I overheard a phone conversation where a mother was talking to a daughter who was stressed out and not feeling well. The advice she gave her was “just breathe, relax and things will be better.” This is the simplest and best advice that the mother could give her daughter on this occasion.

Breathing is the charge and discharge of our life energy. Whether you believe energy is breathed in like the yoga concept of Prana, or that energy is from the burning of fuel in our bodies, breathing is an absolute necessity. We all seem to agree that the exhalation releases used up gasses and waste products from the energetic process of the body, and inhalation fills the body with oxygen and renewed energy.

As massage therapists we work with our clients’ breathing all the time. We all know how difficult it is to do a massage when a client is not breathing and relaxing. However, since we communicate both verbally and non-verbally with our clients, we need to be conscious of our own breathing as well – if we stop breathing, often our clients will not breathe either.

Some of our clients will have difficulty being able to maintain steady relaxed breathing. This is indicative of any number of potential problems. Beyond our non-verbal communications to our clients about breathing, we need to be sure that we have the tools to assist the expansion of their breathing process when we observe shortened or restrictive breathing.

Let us first examine some of the problems associated with our client’s restricted breathing. Clients who are under crisis stresses in their lives, whether they be from job, family, relationship, illness, loss, or even natural disasters, will tighten up the musculature of the chest and abdomen and restrict their breathing. In cases like these, just encouraging them to breathe or become aware of their limited breathing is usually not very effective, and consequently, the stress does not release and discharge from their bodies. When this happens they can’t relax even under normal situations. Often they will experience spasming in the muscles of the chest which can be misunderstood as a heart attack, and sometimes they can actually precipitate a heart attack. These clients need help in releasing this build up of physical stress, and a massage therapist who understands the breath mechanism with the contractions in the soft tissue involved is probably the best professional for them to see.

Surgery, especially those that cut into the tissue and bone in the thoracic region, often result in a tightening and restriction of the breathing process that can go on for years. When either the abdomen or thoracic area is surgically cut, the fascia and scar tissue become adhered and tightened creating a splinting in the area to reduce movement of the damaged tissues during the healing process. After the healing has taken place, the tightened fascia with its adhesions and scar tissue in the soft tissue now acts like a band continuing to restrict the breathing process even though here is no longer a need for splinting. Patients who undergo open heart surgery often experience an extended period of time of feeling a marked decrease in their life force and energy. Many doctors say this is normal for open heart surgery patients. However, my focus with these clients is to open the breathing process, and in a very short period of time they report feeling re-energized with a sense of vitality and even exuberance returning in their lives. This is in sharp contrast to the ongoing limitations experienced by those who do not have this soft tissue treatment.

Injuries to the ribs often receive minimal medical attention even though they are quite painful and sometimes have long lasting effects. Rib injuries, breaks, or sprains can cause considerable pain over a fairly extensive period of time. If you have ever had a client with a broken rib, you are aware that they can have difficulty lying a certain position or moving their whole body and torso in certain movements even a year after the injury. Provided the rib doesn’t puncture the body cavity, the normal medical treatment is usually just immobilizing the area to restrict movement. Unfortunately, this also immobilizes and restricts the breathing process. The body will splint and eventually the fascia will adhere and shorten so that movement becomes nearly impossible past a certain point. This point of restriction is usually far short of deep, free, easy breathing. The other complication with rib injuries is that they are allowed to heal in whatever distortion the break has created without being set or straightened. This is often true with a rib sprain where a rib can be pulled dramatically out of place and never be brought back into its normal alignment. Often just the misalignment after a break or sprain will also add to a continued restriction of the breathing process.

Clients will also see massage therapists for a number of pain producing conditions in the thoracic region. These include thoracic outlet syndrome, costochondritis, muscle pulls and strains, and in chiropractic terms ribs and rib heads being out of alignment. These all produce pain and involve the ribs, the vertebrae and/or the sternum. They also make breathing deeply a painful process resulting in restricted breathing for our clients. In addition, they also often produce nerve entrapments creating additional pain, restriction, and immobility. Again, they have come to massage therapy for relief, and it is our challenge to be able to assist them in their recovery.

It is impossible for me not to include some of the psychological aspects of breathing when discussing the breathing process for clients. If you observe a person who is depressed you will note they will do very little breathing, and are very restrictive in their breathing process to the point that both shoulders are internally rotated and the chest is compressed. One of the aspects of depression is lack of energy. The physical manifestation of depression is restricted breathing which makes recovery and transition to normalcy extremely difficult. There are no pills that open the breathing process.

Anxiety attacks usually have some form of hyperventilation associated with them. You would think that when someone is hyperventilating the breathing process is open and full. However, if you observe someone who has anxiety attacks you will note that when they are not hyperventilating they are extremely restricted in their breathing, partially from fear of hyperventilating and partially from the stress that builds up and triggers the anxiety attacks. When observing the physical manifestation of anxiety in the body we see contraction in the soft tissue that contains energy and restricts breathing. Many clients who have had anxiety problems show marked and almost immediate relief when the tension that restricts the breathing process is released. Pills that suppress the anxiety do little if anything to open and normalize the breathing process.

Loss and mourning are something every healthy person will have to deal with. These emotions are often intense, overwhelming, and scary. Unfortunately, we live in a culture that gives people very little time to mourn. Usually, after two to three days everybody is pushing them to get back into their normal life routines forcing them to bury these intense emotions during the time when they are normally still in shock. People who are experiencing these emotions will tighten and restrict their breathing as they try to regain control over the intensity of the emotions and return to normal function in their day to day lives. As we all know from experience, if we cut off the energetic charge of breathing then the energy for emotions and the intensity of emotions is reduced, and it is easier to keep them at bay or under control. When these emotions have been held and shut down by restricting the breathing process over a period of time it becomes more and more difficult to breathe deeply due to the adhesion of the soft tissue that becomes chronically tightened to hold back the intensity and expression of these emotions.

Now let’s look at the areas that we need to treat to expand our clients breathing process using our massage techniques. Those of you who are familiar with the Three-Step Approach will know how to treat and expand these tissues while staying within the sensation threshold of your clients. I begin by treating the muscles associated with the thorax. I have found that working from the sternum outward produces the best results in facilitating the ability of the thorax to expand. It is very important to release the pectoralis muscles, especially when the shoulders are rotated internally, so they are usually the first muscles I will treat. I follow this with the attachments of the pectoralis at the sternum and the shoulder along with the fascial connections directly under the clavicle. I then address the serratus anterior and subscapularis which will further expand the thoracic area and allow the shoulder to move out of internal rotation and back into balance. Then I’ll move to the other side and work in the same sequence.

I will then address the diaphragmatic arch working through the rectus abdominis and obliques, and release the restrictions and tensions found in the diaphragm. By working the anterior muscles of the breathing process first, I am also releasing the body into structural balance. Then, when I apply normal massage techniques on the posterior muscles paying special attention to the trapezius, rhomboids, and latissimus dorsi, the client’s ability to breathe will increase substantially. In future sessions I will work deeper and more specifically working with adhesions, scar tissue, and shortened fibers that would not have responded well in the initial treatment.

By taking your time and working in this supportive manner, you will see almost miraculous changes in the ability of your clients to breathe and experience their lives. They will be able to relax, have more energy, and be free of the acute and chronic painful symptoms they have been experiencing. They will also be in a healthier psychological state of being. Specific psychological problems will often improve substantially due to the body’s increased ability to charge and discharge energetically and emotionally.