Most injuries are associated with increased stress, anxiety, worry, or fear. Did you know the opposite effect can also take place? When we experience prolonged periods of elevated stress, anxiety, worry, or fear, our physical pain can actually get worse! With such a tricky relationship between pain and stress, it can be overwhelming to know how to help manage your pain in between visits with your physical therapist. This month, we asked a few of Renew Physical Therapy’s physical therapists for some insight into this topic, and for some tips you can try at home.


Q: How can different types of breathing affect our physiology? 

A (Tana Chiarelli, PT, DPT, COMT): The mechanism of breathing is special in that it falls under both voluntary and involuntary control. We can choose to alter our breathing pattern, but if we are not focused on it, breathing occurs naturally. Different types of breathing are related to other systems in our body – our “fight or flight” versus our “rest and digest” modes. Quick, rapid breathing signals to our body that we need to be alert and on guard, meaning our heart rate quickens and our muscles tense. Slow, long breathing signals to our body that we are safe, meaning our systems relax and down shift into a more relax/repair mode (hint – we can use this to our advantage!). 


Q: What are some simple breathing exercises that people can try at home? 

A (Brent Wong, PT, DPT, COMT): A new research study (Balban, et al., 2023 Breath Practice) looked at three different types of breathing exercises:

  • Cyclic breathing (aka physiological sigh): 2 inhales, extended exhale
  • Box breathing: equal parts inhale/holding/exhale
  • Cyclic hyperventilation: longer inhales than exhales 

The research found that five minutes of breath work a day improves mood and reduces anxiety, with cyclic breathing being the most effective (even more effective than mindfulness meditation)!


Q: What is the “physiological sigh,” and why is it important? 

A (Kyle Mendes, PT, DPT, OCS, COMT, CCI): The “physiological sigh” is a breathing pattern first discovered in the 1930s to help people manage claustrophobia (Huberman, 2021 Physiological Sigh). It helps our body by increasing our oxygen levels and reducing our carbon dioxide levels. 

The breathing pattern is: two inhales through the nose (one big inhale, one quick inhale), then a long exhale (CALS Wellness Committee, April 13, 2023 CALS Wellness Committee). 

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