Every patient or clinician who is familiar with PRI knows how important breathing is when performing PRI exercises. The reason for this is the effects that breathing has on the Autonomic Nervous System (ANS). The ANS is what controls our heart rate, respiratory rate, perspiration, digestion, and the other functions of our body that we do not think about on a moment to moment basis.
The ANS has two divisions, sympathetic and parasympathetic. The sympathetic division is what works when we are anxious, scared, angry or anything else that gives us a big rush of adrenaline, it is the “fight or flight” response. When you are in a sympathetic state your breathing becomes shallow and rapid while your posture becomes more upright, or extended, which means your muscles have increased tone. You are stuck in the inhalation phase of breathing. The parasympathetic division is what is working after you eat a big meal and get sleepy, hence why it is often referred to as the “rest and digest” response. When you are parasympathetic your breathing slows down and your muscles relax which allows you to achieve a position of flexion. You are in the exhalation phase of breathing.
The ability to get between these two states is called neutrality. The tests a PRI practitioner performs lets us know if you are neutral. If you have increased sympathetic tone then your joints will be in a poor position and not be able to move certain ways, for example your hip may not be able to fully adduct. This test result shows us that you are not neutral. Essentially, with these tests we are evaluating the state of your ANS.
The ANS is the reason why sometimes PRI practitioners ask questions that may seem unrelated to what you have come in for. You may come in because you have knee pain when you run but then get asked questions about if you get headaches regularly, have stomach pain, or wake up multiple times during the night. This is because studies have shown that people with chronic headaches (1), stomach pain (2), and sleep apnea (3,4) have increased sympathetic tone. The answers to these questions help us know if you have a problem regulating your ANS, or getting neutral.
If you are stuck in a sympathetic state before you run, during your run, and after you run then you are putting extra stress on certain areas of your body, which in this example may be your knee. By helping you slow down your breathing, such as with a balloon in a 90/90 position (5), we can help you get into a parasympathetic state. This will put your muscles and joints into a better position to function which often relieves the stress that may have been causing those areas to hurt. If this worked, then our tests would show that you are neutral which in the example before means that your leg would now be able to adduct. This is why we focus on breathing with every patient that we treat.
- Trevor Rappa of Resilient Performance Physical Therapy
- Jason J. Gass, and Alan G. Glaros. “Autonomic Dysregulation in Headache Patients” Appl Psychophysiol Biofeedback 2013 Dec;38(4):257–63. doi: 10.1007/s10484–013–9231–8.
- C. Botha, AD. Farmer, M. Nilsson, C. Brock, AD. Gavrila, AM. Drewes, CH. Knowles, Q. Aziz. “Preliminary report: modulation of parasympathetic nervous system tone influences oesophageal pain hypersensitivity.” Gut 014 May 28. pii: gutjnl-2013–306698. doi: 10.1136/gutjnl-2013–306698.
- Monaco, Annalisa, Ruggero Cattaneo, Luca Mesin, Edoardo Fiorucci, and Davide Pietropaoli. “Evaluation of Autonomic Nervous System in Sleep Apnea Patients Using Pupillometry under Occlusal Stress: A Pilot Study.” Cranio®(2014): 0886963413Z.000. Web.
- F. Abboud, and R. Kumar.“Obstructive sleep apnea and insight into mechanisms of sympathetic overactivity.” J Clin Invest 2014 Apr 1;124(4):1454–7.
- Boyle K, Olinick J, Lewis C. The Value of Blowing Up a Balloon. N Am J Sports Phys Ther. 2010;5(3):179–188.
