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Pilates Breathing for Spinal Health and Flexibility

A dedicated Pilates practice can be a powerful tool to increase spinal health and flexibility, particularly when Pilates-method breathing is included. I struggled with back pain starting at 9 years old. I am hypermobile and my spine was like a Red Vine in the back of a hot car, all goo and no structure. I was able to touch my butt to my head, but not stand up straight.

Kristina in a deep backbend grabbing her ankles from behind and smiling

My backbend at age 36 was still pretty bendy

My posture was my primary struggle, cutting short my foray into gymnastics as a child and forever frustrating my dance technique. I just couldn’t hold myself up well, and it resulted in such intense lower back pain that it kept me home from school some days, laying on the floor with a heating pad.

As a kid in the 70s and 80s there were very few resources other than my pediatrician who gave me aspirin and some exercises that did nothing at all. I assumed it was something I just had to live with.

Pilates Improved my Back Pain

Nothing really made a huge difference until Pilates. Pilates entered my life when, at 32, I was training contortion 6 days a week at San Francisco Circus Center and manipulating my spine in all sorts of creative ways. Contortion had actually reduced my back pain by giving me an impressive new set of muscles, but I focused almost exclusively on back bending since we all like to do what we are good at.

Tiffany Parish, a member of the cutting edge circus and dance company Xeno and founder of Bodicraft Pilates, with the first person to teaching me Pilates breathing for spinal health. She showed me how changing my breathing patterns could unload my spine and get my hip flexors to chill out, helping me counter the compressive forces of contortion.

The Importance of Spinal Health for Longevity

While my struggle with spinal health and flexibility is extreme, it is not unusual. According to the Center for Disease Control, 30-40% of folks in the US have back pain at least once a year. Untended, postural issues and immobility can lead to a host of unpleasant structural issues that don’t get better with neglect.

The good news is that it’s never too late to start working on improving your spinal health and flexibility!

Numerous studies have shown that regular exercise is an important part of preventing and even reversing lower back pain. No one form of exercise has emerged as the silver bullet because the root causes of pain and the application of exercise is so varied, the important thing is to move, try out different forms of strengthening and stretching, and find what works best for you and your body.

Pilates Breathing for Spinal Health

Pilates breathing patterns that emphasize diaphragmatic and rib cage breathing. That means that the rib cage expands on the inhale and relaxes down on exhale. Diaphragmatic breathing gives us more access to our lung capacity and, importantly, it helps our back muscles to relax so that we can get some ease and movement into our spine.

As I explain in my post on diaphragmatic breathing and posture, this breathing pattern gives us more access to the “meat corset” muscles that support our spine and upper body. These muscles wrap around our waist and protect our spine while also supporting its natural flexibility.

This postural shift has potential benefits for folks with upper back and neck pain, since the muscles in those areas can sometimes take over if the diaphragm is sticky or sleepy. Last month’s post contains a breathing workout specifically designed for folks who suspect they may be breathing with their neck and shoulders.

Below is a slightly 20-minute workout with a series of simple but very effective Pilates exercises that focus on using diaphragmatic breathing to access the “meat corset” core muscles that help to lengthen, support, and stretch the lower back. I hope you find them useful.

Happy Bendings!


Improve Your Diaphragmatic Breathing

The diaphragm is a large muscle that bisects our bodies at the base of the rib cage. When it is relaxed it forms a dome shape that arches up inside the ribs, and when it contracts it drops down, pulling air into the lungs. It is our primary breathing muscle, yet many of us struggle to improve diaphragmatic breathing. We can gradually reset this relationship by understanding diaphragmatic breathing and how it works, and by using seated exercises and self-massage to change the way that we breathe.

What is the Diaphragm Muscle?

The diaphragm is the top part of the soup can of core muscles that make up our mid-section and dictate the posture of our upper bodies. We often think of posture as a static position, but because we are always moving through our breathing patterns, our posture is always moving too. The way that we breathe has a profound effect on our posture and therefore on our flexibility too.

Core Muscles The Diaphragm

The diaphragm muscle

Because the diaphragm is on the inside of our body and most of the time it works without us paying attention to it, it’s easy to lose track of our relationship with diaphragmatic breathing. Just as breathing affects posture, so posture affects breathing and the way that we sit and stand influences our diaphragm. Especially if the rest of our core muscles are sleepy, the diaphragm gets neglected, and can become tight and over-active. Read more about that in my last post on how breathing affects posture and spinal flexibility.

What is Diaphragmatic Breathing?

Diaphragmatic breathing means that, as you breathe, the diaphragm is able to move through its full range of motion. As you inhale, the diaphragm drops into a deep, powerful contraction, pulling in air. As you exhale, the diaphragm relaxes, doming up into rib cage. This dynamic improves your ability to move air in and out of your lungs for deeper respiration, more relaxed posture, and potential mobility benefits.

This doesn’t mean that the diaphragm is working alone. In fact, for diaphragmatic breathing to go well, a number of other muscles have to participate.

Muscles that Support the Diaphragm

  • The intercostal muscles lengthen on the inhale and contract on the exhale to allow the entire rib cage to expand and contract with the breath. This is one of the major improvements that happens when you improve diaphragmatic breathing
  • The “meat corset” muscles (the transversus abdominus or TA and internal/external obliques) contract on the exhale to support the body and drive air out of the lungs. These muscles stay engaged and lengthen eccentrically as you inhale (see below about belly breathing)
  • The pelvic floor works dynamically with the diaphragm to support the pelvis and keep the integrity of the mid-body throughout the breath cycle
  • The hamstrings are also important to the breathing process. If the hamstrings are working to anchor the pelvis, the act of inhaling and lifting the rib cage can pull the pelvis into an anterior pelvic tilt, shortening the hips and putting pressure on the lower back

The muscles that would preferably NOT participate in diaphragmatic breathing, unless you are exercising, are the muscles of the upper back, neck, and shoulders. If you are experiencing tension in those areas, look to see if your back arches, shoulders rise, or if your neck visibly contracts as you inhale. If so, you may want to work to improve diaphragmatic breathing.

Diaphragmatic Breathing is NOT Belly Breathing

This point may be somewhat controversial according to many of the breathing tutorials you’ll find on the web, but belly breathing does not strengthen the diaphragm and does not benefit your posture.

While there will always be some movement in the abdomen when we breathe, pushing the belly out to inhale disrupts the vital postural function of the TA and obliques, which should have a constant inwards pressure, especially if you are doing anything dynamic like walking, running,  dancing, or lifting something heavy. A dependence on belly breathing can compromise your ability to get those core muscles working optimally, without doing much for your diaphragm.

Instead of pushing the belly out on the inhale, the TA and obliques should resist the outward pressure, working eccentrically as the diaphragm drops. They are not squeezing as much as they would on the exhale, but they are still doing their postural job. The expansion to accommodate incoming air happens primarily in the rib cage, where the lungs are located.

Exercises to Strengthen the Diaphragm

It is very difficult to improve diaphragmatic breathing without first having some sense of your diaphragm muscle. The video below shows a self-massage technique to get your fingers into this hard-to-find muscle and give it a gentle massage, in part to release the muscle and in part to know what it feels like to engage it.

Then we will go through a series of seated exercises to improve diaphragmatic breathing that mobilize the spine and rib cage while limiting movement in the neck and shoulders. These exercises may feel challenging at first, especially if you are used to either neck breathing or pushing out your belly to inhale. It may feel very hard to breathe. But with time and practice you may find that your respiration will feel more powerful and relaxed.

This earlier video on breathing techniques for back and neck pain has even more tools for feeling that core muscle relationship and how it enables our diaphragm to move through its full range.

Pro Tip: The Best Way to Improve Diaphragmatic Breathing

Inhale through your nose.

Because your have to work a little harder to pull air in through your nostrils rather than your mouth, nasal breathing biases your most efficient inhale muscle: the diaphragm.

Nasal breathing has many well-documented benefits, especially while exercising. One of those benefits is that it makes it easier to feel and properly use your diaphragm. This is why folks with blocked nasal passages are prone to underutilization of the diaphragm. If this is you, hope is not lost. Even a small amount of nasal breathing every day can make a difference in your muscle engagement.

So to maximize the efficiency of your exercises to improve diaphragmatic breathing, inhale through your nose!

Happy Bendings!

How Breathing Affects Posture and Spinal Flexibility

As long as we are alive, we are breathing! So it is very useful to understand how breathing affects both our posture and our spinal flexibility. Many different muscles participate in the breathing process, and breathing is one of the few physical functions that is both automatic and under our control. While there is no wrong way to breathe, taking control of our breath and learning to strengthen our central breathing muscles like the diaphragm is a great tool to improve many aspects of our physical and emotional state, including posture and spinal flexibility.

How We Breathe Affects our Posture

The spine is designed to be extremely mobile, able to move forwards, backwards, twist, and side bend. For more information on spinal mobility check out this blog post on spinal anatomy for back benders.

The ability of our spine to take advantage of this exquisite range of motion depends in part on our posture. If we habitually stand and move in ways that force our back muscles to become tight and over-worked, we will find ourselves with tension, even pain. The muscles in our back and neck can become resentful and stressed out. The way we breath can either help or hinder our back’s ability to relax and feel full mobility.

Breathing Can Relax the Spinal Muscles

One of the most important skills we need in order to relax our spinal muscles is the full exhale. When we exhale all the way our rib cage drops down away from our chin and our diaphragm relaxes, created a dome shape up inside our rib cage. This big, muscular dome, even relaxed, provides a lot of support for the rib cage (called the zone of apposition), so when we exhale fully our upper back and neck muscles get a little break, lengthen out, and the rib cage just floats on that diaphragm.

Surprisingly, many of us don’t do a great job of exhaling. As I explain in my blog post on core muscles and how they coordinate together, a full exhale and relaxation of the diaphragm requires a corresponding increase in participation from the “meat corset” muscles that wrap around your waist (the transversus abdominus, the internal obliques, and the external obliques) as well as the pelvic floor muscles.

If we have neglected to develop our relationship with this group of core muscles, it will be hard for the diaphragm to relax and therefore we will never get that corresponding relaxation in our upper back and neck muscles.

10 Minutes of Breathing to Improve Posture and Spinal Flexibility

I created a 10 minute series of exercises that guide your body through a coordinated breathing routine that facilitates these long, complete exhales while encouraging your waist muscles to participate while your neck and spinal muscles to relax. It is a series of four exercises in increasing levels of challenge, each one building on the last to develop the deep awareness of both diaphragmatic relaxation and core engagement, with a little spinal flexion thrown in since this is the first direction that we want to spine to go if we are working to increase spinal mobility.

All you need to try it out is a spot on the floor and a few pillows to get comfy. No previous fitness experience or flexibility is needed to do this. It is an exercise for any body. If, as the exercises progress, you find yourself feeling tension in your back or unable to find the meat corset muscles, just go back to the first exercise for a while.

This series is a good way to start to strengthen your core muscles if traditional ab strengtheners like crunches feel awkward and miserable, or cause your neck and back to over work. It is also an excellent warm up for a core workout like Pilates, or for anything involving spinal flexibility like contortion, pole, dance, or yoga.

Happy Bendings!

This Hip Flexor Can Contribute to Lower Back Pain: the Psoas

There is one hip flexor muscle that often contributes to lower back pain: the psoas.

The psoas muscle is hard to find and easy to annoy. It is not just a hip flexor, it is also a spinal muscle and the only muscle to bridge the upper and lower body. You can learn more about the location of the psoas and how it relates to the other muscles of the torso by checking out these posts on core anatomy and hip anatomy.

psoas hip flexor illustration

How the Psoas Hip Flexor Causes Lower Back Pain

Because of its attachment points all along the inside of the lumbar spine, when the psoas muscle isn’t properly supported, strengthened, and lengthened it can pull on the vertebrae of the lower back. If this goes on long enough it creates conditions that are conducive to spasms. When you hear someone say that their “back has gone out” (where did it go?) or if you have had that unpleasant sensation of excruciating lower back pain that causes you to lie on the floor and cry for two days, there is a good chance that your psoas was in rebellion.

Studies have also shown a correlation between weak, underused psoas muscles and degeneration of other spinal muscles.

Chronicly tight hip flexors, in particular the psoas, can contribute to long-term spinal pain and can even pull the vertebrae out of place. The psoas can even affect chronic issues liks spondylolisthesis and spinal stenosis.

Two major factors that can contribute to tight hip flexors and cause the psoas to pull on the lower back are sitting for long periods of time and poor posture. Both of these activities can make the psoas squashed, weak, and tight. You can learn more about posture and hip tightness here, and see a posture tutorial here.

How to Take Care of Your Psoas to Prevent Lower Back Pain

The good news is that there are things that you can do to take care of your hip flexors and psoas to prevent lower back pain and injury. While stretching can play a part in this regimen, sitting in a lunge alone will not usually be enough. Lunges can be a great tool, but you have had the experience of sitting in lunges for hours only to find your hip flexors tighten right up afterwards, you will know that stretching alone is not enough to change the way that your hips work.

Most often there needs to be a combination of elements including improving the cooperation of the core muscles to improve the support of the spine, strengthening for the hip extensors (hamstrings and glutes), and a nice, loving targeted routine to strengthen and mobilize the psoas muscle so that it feels free and empowered. I have a routine that I have used for years and has greatly helped my lower back pain, in tandem with all of the other tools mentioned here, in this post on how to have a strong, flexible psoas.

Even though the psoas hip flexor is a difficult muscle to work with because if its internal position and how many different ways it can move, it is worth the investment since it has a profound effect on lower back pain and your long term spinal health.

Happy  Bendings!


Video for you visual learners…







Can Beginner Running Compliment Flexibility Training?

Everyone knows that running and flexibility exist in opposition to each other. Right?

Ask any flexibility coach about cardio cross-training and the vast majority will tell you to stay away from running. Ask any runner about flexibility training and most will groan and treat it as a boring and unpleasant but necessary evil to keep them from turning into one big, gristled tendon.

Convention will tell you that running makes you inflexible and flexibility training and being highly flexible or hypermobile makes you unsuitable for running.

But what if, by focusing on impeccable running technique, proper pre-conditioning, warm-ups, balance, and an almost exclusive application of active over passive flexibility exercises, these two disciplines could complement each other instead of oppose each other?

This is my experiment of one, as I test the capabilities of my own body in the lab of life.

Running with Proper Technique

Fortunately, with running technique I don’t have to invent the tools because someone else has already done it and written the book.

In the process of preparing for and recovering from foot surgery for osteoarthritis in my right foot I started running. I had been working with a client who was a trail runner and he had recommended that I read “Born to Run” by Christopher McDougall. The running technique he describes in the book flipped my preconceptions about running being hard on the joints, positing that with the right technique and preparation running can strengthen and heal our bodies (and be insanely fun at the same time and I’m always down for fun).

My feet and ankles have always been a weak point. As a dancer I struggled with a perfect relevé, always wobbling like a faun. I’ve sprained both ankles more times than I can remember, over-stretched my feet and toes in pursuit of perfect lines, danced for years in high heels, and suffered bouts of tendonitis in my ankles. Now, with osteoarthritis limiting the flexion in my right big toe, it seemed so easy to follow the doctor’s advice and resign myself to a life of supportive shoes, cushy insoles, and a strict avoidance of impact training.

But everything I know about bodies in general, and my body in particular, told me that this medically recommended course of action would cause me nothing but misery. Because I’m hypermobile, constant strengthening and stability work is essential to keep me out of pain. If I’m not working out, everything falls apart very quickly. If I stop challenging my feet and ankles I’ll soon be walking around on a couple of melted marshmallows. What will that do to my knees, hips, back, and psyche? Nothing good.

So McDougall’s book spoke to me. He had also defied countless medical opinions to become an ultramarathoner and running devotee. His book chronicles his training with coach Eric Orton who rebuilt his running technique based on the timeless, tried and true form used by all the world’s best runners like the Tarahumara people of Mexico’s Copper Canyons. The way we ran before our obsession with over-engineered sneakers robbed our feet of their agency and power—what is now called minimalist running because you don’t need much more than your own body to do it.

Learning Beginner Running When Flexible

I started running about one year prior to my scheduled surgery date. I bought myself some minimalist running shoes (the Xero HFS) and hopped on the treadmill a few days a week. I quickly found that the only kind of running that didn’t make my knees and ankles scream at me was sprinting. A steady jog hurt, but sprinting felt great. I couldn’t do it for very long, so my running sessions were all done as interval training, alternating between uphill walks, 1-2 minute sprints, and recovery walks. These training sessions, as well as the extensive foot and ankle strengthening I did every morning, sent me into surgery with the strongest feet I had had since ballet training and certainly aided in my fast recovery.

A few weeks ago, three months post surgery, I started running again as part of my rehab. My cardio was utter crap after three months of inactivity, but as usual I found that a slow jog was painful so I was gasping through 30-60 second sprints with 4 minute recovery walks in between.

It was then that I had the good fortune to find myself on a Zoom call with Chris McDougall and Eric Orton themselves! It was exciting to have the opportunity to chat about fitness in general and beginner running in particular, and share my story.

I described how running had been part of my pre- and re-hab from the osteotomy surgery but that I was really only comfortable with sprinting, and Eric asked me about my cadence.

Cadence? What is cadence?

Eric explained that extensive observation of effective running technique has shown that everyone, regardless of leg length or the speed they are running, has optimal form when their feet hit the ground at 180 beats per minute.

If you aren’t a musician or dancer, I’ll tell you that 180 bpm is a pretty fast clip. Think of The Ramones’ Judy is a Punk or, Eric and Chris’ favorite, the B52s’ Rock Lobster. Eric explained that even if you are chugging along at a stately pace of 4.5 mph you want to keep that quick cadence. At 180 bpm your feet are boinging back up off the ground like the spring-loaded shock absorbers they are designed to be, and there is no time to sink into your joints. Most of your time is spent in the air where gravity can’t hurt you.

At the earliest available opportunity I was back on the treadmill, ready to try out this new approach. I loaded up the B52s in my headphones, momentarily transported back to my efforts to create a mosh pit at the 7th grade dance, and started trotting.

The effects were just as Chris and Eric describe in their new running technique book Born to Run 2, immediately effective and delightful. From 1 minute run/4 minutes walk I was instantly able to do an effortless 2 minutes run/3 minutes walk. A few days later 2.5/2.5. With no joint pain at all. I had been relying on sprinting to protect my joints because, at 7.5mph I had no choice but to spring back up off my feet.

Most people without squishy joints can get away with jogging at a lower bpm without pain, at least for a while, until something starts to feel worn or overworked and then that 70% injury rate for runners kicks in. For better or for worse I don’t have the ability to run slow and heavy at all. Hypermobile folks don’t have any of that desirable stiffness in our connective tissue that many runners rely on to protect their joints and help their muscles work more efficiently. Thumping along I was relying solely on muscles to hold me together, and with the slower cadence my feet were spending long enough on the ground with every stride that the muscles couldn’t hold on and I was sinking down into every joint. Pain appeared almost immediately.

After 30 minutes of high cadence running intervals, never going faster than 5mph, I had no joint pain. The muscles in my feet and calves were singing, but it was a song of new challenge and strength-building, not the lament of damaged connective tissue. To my surprise I woke up the next morning ready to do it again and felt even better the second day. My challenge was to not get so excited that I over-trained, and remember that I’m still in rehab and I need to take it slow.

After two weeks I felt brave enough to try running around the Silverlake Reservoir, away from the safety of the treadmill. Running on uneven surfaces makes me exceedingly nervous. Every pebble and sidewalk crack is a chance for my foot to land funny and my ankle to stage a repeat performance of it’s spectacular 90 degree lateral collapse, which has landed me on my back countless times since I was a kid. But I took it slow, trotted to the sound of the Ramones in my head, and trusted the strength I was building.

The idea of a real, up and down, rocky, trail run still feels impossible in my body. But I know what it’s like to achieve things I once felt were impossible. I didn’t think that I could ever sit on my own head either, but I learned to do that, a little at a time.

Tightness vs. Stiffness for Running and Flexibility Training

In my flexibility coaching I often talk about cultivating stiffness without tightness. Stiffness comes from stability in the joints that results from both healthy connective tissue and neurological control of the full range of motion. Flexibility without stiffness, often found in hypermobile, over-stretched people, is dangerous and debilitating. Tightness is an absence of flexibility. It means that a muscle is in a locked state, unable to either fully contract, fully relax, or both. Tightness has a variety of root causes, but most often it comes from stressed-out muscles that don’t trust each other and lock up to prevent you from moving into a position that your nervous system has deemed unsafe. Tight muscles are no longer working together as a team.

What I have learned from Chris and Eric is that running with proper preparation and form can be a vehicle to cultivate stiffness, even in people like me for whom stiffness is not an innate trait. If running is making you tight it’s because something is going on to foment mistrust and poor cooperation in the muscles and joints. Your form is off or you aren’t prepared.

With this new understanding, I am deeply curious and even optimistic that I could be both a runner and flexible, and that these two skills could actually compliment each other. Goals like running a marathon and being able to do a comfortable standing split and waterfall backbend seem less like pipe dreams and more like a compelling puzzle challenge. I just have to figure out the right pieces and put them in place.

This is my experiment for the next year or two. To take these two historical enemies and cultivate a romance between them, using the theater of my rather worn-in 48-year-old body as a setting. Let’s see what happens!