Understanding Breathing Pattern Disorders and Their Impact on Pain and Fatigue

Breathing is something most people take for granted. Yet, when the way we breathe changes in subtle but persistent ways, it can cause a range of problems that go beyond just feeling short of breath. Breathing pattern disorders (BPD) affect nearly 1 in 10 people and often contribute to chronic pain, fatigue, and anxiety. Understanding how dysfunctional breathing impacts the body can open new paths to relief and better health.

Diaphragmatic breathing practice to improve breathing patterns

What Are Breathing Pattern Disorders?

Breathing pattern disorders happen when the usual rhythm and depth of breathing change in a habitual way. These changes are not caused by obvious lung or heart disease but still produce symptoms that feel worse than any underlying physical problem. People with BPD often breathe too quickly, hold their breath, or rely heavily on their upper chest muscles instead of their diaphragm.

This altered breathing pattern can lead to symptoms such as:

• Chronic fatigue

• Muscle tension and pain, especially in the neck, shoulders, and back

• Dizziness or lightheadedness

• Anxiety and panic attacks

• Difficulty concentrating

  
  

BPD is more common in people with chronic pain conditions, asthma, anxiety disorders, and those recovering from COVID-19. Despite its prevalence, it often goes unrecognised or misdiagnosed.

The Role of the Diaphragm in Breathing and Stability

The diaphragm is the main muscle responsible for breathing. It sits below the lungs and contracts to pull air into the lungs during inhalation. But the diaphragm does more than just help us breathe. It also plays a crucial role in stabilising the core and supporting the lower back and pelvis.

When the diaphragm works well, it helps maintain good posture and supports the spine. Dysfunctional breathing patterns often involve shallow, upper chest breathing, which means the diaphragm is not fully engaged. This can reduce core stability and increase strain on the lower back and pelvic muscles.

Research shows that people with chronic low back pain often have impaired diaphragm function. This dysfunction can increase sensitivity in the nervous system, making pain feel worse and more persistent. Fatigue can also result from inefficient breathing, as the body struggles to get enough oxygen.

How Dysfunctional Breathing Contributes to Pain and Fatigue

Breathing pattern disorders affect the body in several interconnected ways:

• Reduced oxygen delivery: Shallow breathing limits the amount of oxygen reaching muscles and organs, leading to tiredness and poor recovery.

• Increased muscle tension: Upper chest breathing recruits accessory muscles like those in the neck and shoulders, causing tension and pain.

• Poor core stability: A weak diaphragm means less support for the spine, increasing the risk of chronic back pain.

• Heightened nervous system sensitivity: Irregular breathing can trigger the body's stress response, worsening anxiety and pain perception.

• Disrupted sleep: Breathing difficulties can interfere with restful sleep, further increasing fatigue.

  
  

These factors create a cycle where pain and fatigue feed into dysfunctional breathing, and dysfunctional breathing worsens symptoms.

Assessing Breathing Patterns in Physiotherapy

Physiotherapists trained in breathing pattern disorders use a detailed assessment to understand how a person breathes at rest and during movement. This includes:

• Observing resting respiratory rate and rhythm

• Checking for upper chest dominance or breath holding

• Assessing thoracic (mid-back) mobility

• Measuring diaphragmatic excursion (how well the diaphragm moves)

  
  

This assessment helps identify specific breathing problems that may contribute to pain or fatigue.

Treatment Approaches for Breathing Pattern Disorders

Treatment focuses on retraining the breathing muscles and improving coordination between breathing and movement. Common techniques include:

• Diaphragmatic retraining: Teaching patients to breathe deeply using the diaphragm rather than the upper chest.

• Thoracic mobility exercises: Improving flexibility and movement in the mid-back to support better breathing mechanics.

• Breathing-movement integration: Coordinating breath with physical activity to enhance core stability and reduce pain.

• Education: Explaining how breathing affects the nervous system and pain helps patients understand their symptoms and engage in treatment.

  
  

These approaches aim to restore efficient breathing patterns, reduce muscle tension, and improve overall function.

Why Addressing Breathing Matters in Chronic Pain and Fatigue

Ignoring breathing pattern disorders can leave a key factor unaddressed in managing chronic pain and fatigue. By including breathing assessment and retraining in rehabilitation, patients often experience:

• Reduced pain intensity

• Improved energy levels

• Better stress management

• Enhanced physical performance

  
  

Ali Momeni Pour, a physiotherapist in South Kensington, integrates breathing pattern assessment into treatment plans for spinal pain, persistent pain, and anxiety-related conditions. This holistic approach recognises that healing involves the whole person, not just isolated symptoms.

If you experience unexplained pain, fatigue, or anxiety, consider whether your breathing pattern might be contributing. Professional assessment and targeted physiotherapy can make a significant difference.