Breathing Exercises for Pain Relief

Article by Lucas Rockwood

Adaptive vs. Maladaptive Pain

It's helpful to separate pain into two different buckets. We often think of pain as a terrible thing, but that’s not always the case. In fact, most pain is adaptive pain. It doesn't feel good, but it's there to keep us safe. This is called nociception - the ability for us to sense and react to negative stimuli in our environment.

For example, imagine you're cooking in the kitchen, and a pan accidentally goes on fire. You run over, grab the pan with your bare hand and the nociceptors, the pain receptors in your hands, signal your brain to pull back your hand. It hurts, but that’s an adaptive response. Your brain is communicating with your body and your body is doing what it should to protect you.

However, if that pain were to linger for months after that initial minor burn, it would become what’s called maladaptive pain. This rarely happens with something like an epidermal burn, but it happens very often with things like joint pain and autoimmune conditions. It’s almost as though a fire alarm is going off in your body, but there’s no longer a fire. This is the type of pain we might categorize as chronic and breathing exercises have shown to be very effective in helping to ease this type of pain.

What the Science Says

There are literally thousands of positive published studies connecting breathing with pain management, particularly in relation to knee pain, back pain and conditions such as fibromyalgia. However, this literature is often overlooked because the mechanisms of action aren’t always clear. So even though there is an overwhelmingly positive body of evidence to support breathing exercises as a means of controlling pain, not many people know how to put those exercises into action.

Generally researchers use slow breathing, deep breathing and reducing your breathing rate, or slow deep breathing with an extended exhale, one or more, or a combination of these techniques. This type of breathing tends to emphasize diaphragmatic engagement and a slower respiration rate, so that's what we'll focus on in this article.

Here are some of the key findings:

It can help with lower back pain

Research published in the Journal of Sports Rehabilitation in 2015 reported improvements in either pain or quality of life for adults with non-specific lower back pain who followed breathing programs ranging from daily to 2-3 times per week over 4-8 weeks. As a result, researchers concluded that trainers and physical therapists should consider breathing exercises for back pain treatment.

It can relieve fibromyalgia symptoms

In a study published in the Journal of Complementary Medicine in 2018, a group of women with fibromyalgia were split into two – a control group, and another who performed 30 minutes of breathing exercises, seven times a week for twelve weeks. The study found that breathing exercises produced relevant benefits on pain threshold tolerance on tender points located in the upper half of the body, and the functional capacity to perform daily tasks.

It can help ease anxiety in knee surgery patients

A Turkish study published in 2020 in Annals of Medical Research looked at the effect of diaphragmatic breathing exercise (DBE) on pain, depression, and anxiety in total knee reconstruction surgery patients. The effect on anxiety in particular–with patients noting they felt better, calmer and more at ease–led the researchers to recommend that DBE should be incorporated into routine plans of care for patients undergoing knee reconstruction surgery.

Slowing down the pace has a bigger effect

In a Belgian study, published in The Journal of Pain in 2019, healthy volunteers performed four different breathing patterns, including unpaced and paced at varying frequencies while receiving painful heat stimuli. Compared to unpaced breathing, participants reported less intense pain during the instructed breathing patterns. The conclusion? Paced breathing can reduce pain. The hypoalgesic effect is enhanced when breathing is paced at a lower frequency and when expiration is longer.

Download PDF pose chart

4X8 I Feel Great Breathing Exercise

This is slow, deep breathing, with an extended exhale that will hopefully create a pain-relieving response.

We'll use a practice called ocean breath, which makes a sound in the back of your throat. You do this by closing off your glottis at the back of your throat and breathe through your nose. You should have an audible whisper both on the inhale and the exhale.

We'll do this in a seated position, inhaling to the count of four and exhaling to the count of eight. This means that you need to regulate that exhale, so that it comes out at half speed and you don’t run out of air.

• From a seated position, scoot away from the back of your chair if you can.
• Plant your feet on the floor, rest your hands on your knees, relax your shoulders.
• Close your eyes and inhale through your both nostrils for 1-2-3-4.
• Exhale through your nose slowly for 8-7-6-5-4-3-2-1.
• Inhale 1-2-3-4.
• Exhale 8-7-6-5-4-3-2-1.
• Repeat this process eight more times, keeping your eyes closed and shoulders relaxed throughout.
• Slowly open your eyes and return to normal breathing.

5 Tips for Best Practice

1) Always make sure that you’re sitting down and in a safe environment before practicing.

2) This type of breathing can make you sleepy. So, never do it while driving or operating machinery.

3) Use the ocean sound on both the inhale and the exhale to help promote vagus nerve stimulation (and a rest and digest nervous system response).

4) Remember to exhale twice as long as the inhale, so slow down your breath on the way out to stay in control.

5) Try this practice this right before bed every evening and if you find it helpful include it multiple times throughout the day.

Please do not discontinue any kind of medication without checking with your doctor first. In all cases, you should check with a trusted healthcare provider before starting any self-care routine.