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Deborah: You know, it's hard to have a good day when you're experiencing fascial pain, but there's been good progress around new techniques to help manage myofascial pain. It turns out, it comes down to breathing.

I'm Deborah Howell and our guest today is Amy McLurkin, a physical therapist at High Pointe Therapy at Deaconess The Women's Hospital. Well, welcome to you, Amy.

Amy McLurkin: Well, thank you, Deborah. It's exciting to be here and I'm excited to maybe help some people learn what they can do to help manage their pain.

Deborah: That is the plan. So let's dive right in. What is myofascial pain syndrome?

Amy McLurkin: Well, myofascial pain syndrome is actually a muscular pain disorder that's characterized by persistent pain, fatigue, stiffness, and tender knots in the muscles. And these muscle areas of tenderness can develop into something called trigger points. And those trigger points are very sensitive hyper-irritable parts of the muscle. And they can actually refer pain directly in the area of the tenderness or actually make you refer pain or feel pain in areas that you can't even imagine or you would think would be associated with that.

Deborah: Fascinating. So why are breathing techniques included when a person has myofascial pain syndrome?

Amy McLurkin: Well, that's a great question, Deborah. Did you know that we actually breathe 20,000 times a day? And that breathing is actually voluntary and involuntary. And so when we're talking about breathing, of course, and you're doing something that many times a day, it's bound to have an effect on the body because nothing in the body occurs in isolation.

Now, I think what's important for us to know too is that there are different sets of muscles that are responsible for different parts of our breathing. So the first group are what we call the belly breather muscles. And this is primarily done by the diaphragm and the muscles of the ribcage, which are called the intercostal muscles. Their job is to expand the lungs to open everything up, open the rib cage, and really promote that wonderful oxygen exchange. The other group of muscles are what we would call the shallow breathers. These are what we call the accessory muscles. And most of these muscles, Deborah, really are in the neck area.

So you think of the muscles that most of us, if we sit at a computer for many hours during the day, if you just take your hand up at the base of the neck of the muscle, that area is a prime area for developing soreness and trigger points and myofascial pain. So those shallow breathers, their main job is to actually elevate your ribs when we're either doing heavy exercise or we're in an emergency situation, things like that.

But I think if we understand when myofascial pain occurs, that can change the way our body is actually using those muscles in breathing. And so that's why we want to talk about what breathing techniques can do.

Deborah: Sure. And so, Amy, how would a person know if their breathing pattern is contributing to their pain?

Amy McLurkin: Well, I think the first thing is that we almost have to take a body inventory. And when we say body inventory, I mean that we want to talk about, "Okay, is my neck tight? Is my low back tight. When I sit at a computer, am I slouched? Does my head drift forward? Are my shoulders rolled forward? And just kind of anticipate and understand how our posture can influence our breathing pattern and our pain.

And so when we have myofascial pain syndrome, we frequently see that altered posture and that altered posture then is going to inhibit and change the way again our breathing pattern occurs.

Deborah: So mom was right, posture really is important.

Amy McLurkin: Mom was right. She was so right.

Deborah: What's the most frequently issued breathing technique? And how would a person incorporate that into their day?

Amy McLurkin: Well, I think what we can do is first of all go through a little bit of a brief assessment of how we're actually breathing. So do you want to do that with me right now?

Deborah: Sure. I'm game.

Amy McLurkin: Okay. Well, the first thing is, if you're sitting in a chair. you want to make sure that your feet are flat on the floor and that you're sitting more upright. We're not slouched. We don't have our elbows and our forearms resting on the desk. And if you really want to, you can actually stand or if someone's listening to this at home, they can actually assess this lying down. And if we're actually in the clinic when we're looking at this, we do recommend and always assess this in what we call a supine, which is an on your back position with your knees bent and your feet flat on the bed.

So at any rate, go ahead and take your hands and put one hand just up on your chest. And then put the other hand just below your rib cage, kind of on your belly. So not really down on the belly button, but just above your belly button.

Deborah: Okay. I'm there.

Amy McLurkin: Okay. Now, just take a big deep breath in.

Deborah: Through the nose?

Amy McLurkin: Through your nose, in through your nose. And just do it two or three times. And what I want you to feel right now is I want you to tell me which hand do you feel moving the most or do both hands feel like they're moving the same?

Deborah: The right hand, which is higher up on the chest area, is definitely doing more of the moving.

Amy McLurkin: Okay. Now, you know what I'm going to tell you, right? That's not the way we want to see it done.

Deborah: All right, belly. Kick in.

Amy McLurkin: That's right. Okay. So if you were at home, what I would say to you, if you were my patient is, I would have me lie down on your back and again, with your hips and knees bent and your feet flat on the table. And then what I would say is keep that one hand on your chest and keep the other hand just where it was on the belly. And your goal is-- this sounds horrible, doesn't it? If I say, imagine you swallowed a balloon. And if I was going to blow up that balloon, that big part of the balloon is going to be down in my belly. Correct?

Deborah: Right.

Amy McLurkin: So when I take a deep breath in through my nose, what I want to do is try to encourage the hand that's on my belly to feel the movement occurring there. So we want the chest hand and the chest itself to be more quiet and be more still. Does that make sense?

Deborah: Yes. And the balloon is inflating as we breathe in.

Amy McLurkin: That is correct. So I do breathe in through my nose. So again, you want that lower belly-- this is belly breathing. This is deep breathing and this is what's most important when we're talking about changing pain with myofascial pain syndrome. So I'll let you try at a time or two and tell me if you've got it.

Deborah: I've got it. I'll tell you though, it's not easy. I can see how daily practice would be definitely advisable to make it more of a natural feeling.

Amy McLurkin: Exactly. And again, it's funny, isn't it? Because if you watch a toddler, toddlers do it without even thinking. Of course, they also sit straight up with their legs out in front of them. I don't know many of us that can do that anymore.

Deborah: Not me.

Amy McLurkin: No, not me either.

Deborah: I do have a question, Amy. I'm breathing in through the nose, shall I be breathing out through the mouth?

Amy McLurkin: Go ahead and breathe out through your mouth, but I didn't want to tell you that on the phone because I didn't know if it would make a big noise.

Deborah: I'm blowing above the microphone.

Amy McLurkin: There you go.

Deborah: Alright.

Amy McLurkin: But yes, from technique, Deborah, that would be correct.

Deborah: Okay. Wonderful. You know, I tell you what, after doing this about 10 or 12 times, my voice actually feels stronger.

Amy McLurkin: It makes a big difference.

Deborah: That's weird, isn't it? I mean, it's giving me more strength.

Amy McLurkin: No, that's actually what you want it to do. And that's one of the amazing things. You remember. I said nothing in the body happens in isolation.

Deborah: Right

Amy McLurkin: when we breathe in normally like when we actually recruit that diaphragm, the diaphragm, of course it's active in all stages of breathing, but that's the muscle group or that's the muscle that really kind of gets pushed off to the side.

When people have myofascial pain syndrome, they tend to use all of those muscles that are up there on the side of the neck and the top of the shoulders to do the breathing. So they're always lifting their rib cage. And they're keeping a chronic pain cycle going. So they're asking these little tiny muscles that are really just meant to work in case of an emergency or heavy exercise, they're now taking over and essentially being the prime mover instead of the diaphragm.

So if we tap into our diaphragm again and we get that belly to expand, just like it's supposed to, then you're going to get several things that actually occur in the body. And one is you're going to increase your oxygen exchange. And we know from the stiffness that exists in myofascial pain syndrome and the tightness that exists in those muscles that we're not getting good oxygen exchange into that tissue. So the more I deep breathe, guess what happens? I get more oxygen in there. So I'm helping to get rid of the soreness and the waste by-product of muscle metabolism that lingers in the muscle when I hurt.

The other thing that it does is it actually slows your heart rate. It stabilizes your blood pressure and it kind of resets or creates a relaxation effect on your nervous system. So even though we're talking about myofascial pain syndrome in particular, deep belly breathing is a wonderful thing to do in any situation where you might be a little bit anxious or you've just been busy and on the run. My goodness with all the shopping that happens this time of year, you know, people can work on it in their car.

Deborah: Amazing because I've been running around, like you said all week. And just doing this breathing as you are talking, the brain fog lifted a little bit.

Amy McLurkin: And again, that's that oxygen exchange that you're getting.

Deborah: Wow.

Amy McLurkin: The techniques that we teach, there's some variations, of course. And we talked just about the basic, you know, putting the hand on the chest, putting the hand on the belly, and then what we want to talk about too, and include is how can I specifically change that breathing?

So what I would encourage you now to do is when you inhale through your nose, that you will do it for a four-count inhale. And then when you get to that fourth count, you actually are going to hold your breath for four counts. And then when you exhale through your mouth, you're going to exhale for four counts. So it's just what we call a four-four-four technique.

Deborah: I think I've got it. Four-four-four.

Amy McLurkin: Four-four-four.

Deborah: And I'm activating my diaphragm.

Amy McLurkin: You are right. And you're relaxing those muscles in the base of your neck, which again are the key areas that most people are going to have or see a change with that. But, believe it or not, some people that even have tightness, you think of where the rib cage ends and the low back begins in that area, they even feel a relaxation that occurs in that area, especially when they're lying down on their back for starters.

So I think it's always best, like I said, just to reiterate that it is best to try it out initially when you are in that lying down position. But then, the wonderful thing is once you become attuned to your breathing pattern, that progressing it into a seated position or even into standing becomes quite easy. And then you find that you can do it several times a day.

Deborah: And if ever you forget, just find a toddler and watch how they breathe, right?

Amy McLurkin: You've got it right.

Deborah: Well, this has been some really excellent information, Amy. Thank you so much for being with us and thanks for all you do.

Amy McLurkin: You're welcome. Thank you, Deborah.

Deborah: This is the Women's Hospital, a place for all your life. To schedule an appointment or to learn more about myofascial pain and treatment options at the Women's Hospital, head on over to www.deaconess.com/highpointe to get connected with one of our providers. I'm Deborah Howell. Thanks for listening. Keep breathing and have yourself a great day.