Breathing Benefits Your Knees
Can knee pain be linked to how you breathe?
Breathing Fixed Woman’s Knee Pain
In 2016, a woman over 70 years old asked me if changing her breathing could help alleviate her knee pain. She had bone-on-bone arthritis, had been taking anti-inflammatory medications for over a decade, and had been doing knee injections 3 times a year for years. She was scheduled for a knee replacement and had tried all other treatment options. She was willing to consider non-traditional ideas to restore her knee health. We began working on her breathing mechanics. In one week, her knee pain went away. She was shocked! I warned her that she had a lot of work to do to make the changes stick. She stopped all injections and anti-inflammatories. Nine years later, she still has not had a knee replacement and is not dependent on anti-inflammatories.
Balancing Our Knees
How is this possible? Over time, our body develops patterns of holding ourselves. Some people lean forward, others lean backwards. Both are detrimental to our breathing mechanics and how our body weight goes through our knees. In the case above, this lady developed a pattern of leaning forward and overarching her lower back. This developed over years and was made worse by prolonged sitting.
Compensating for the Lean
When we lean forward, our lower back muscles dominate along with the front hip muscles. Our hips tip forward, and the side ab muscles become weak from disuse. This results in our back muscles also dominating breathing. It causes our ribs to lift up in front when we inhale, and our back works as a hinge to help them move upward.
The Lean Impacts Breathing
This is an inefficient way to breathe. It creates a significant amount of muscle tension throughout the body, as it puts the body in a state of fight-or-flight. The back muscles tighten up, and the front hip muscles tighten up. This feedback loop leads to ever-tighter muscles.
Knees are Pulled out of Alignment
When the hips are rolled forward, and the body is breathing in a fight or flight state, the knees suffer. These changes cause an abnormal pull on the kneecap because the quads and hip flexors pull the kneecap up and out of place. It gets jammed and does not slide down like it should when the knee bends. Often, a diagnosis of patellofemoral syndrome is a result of these positional and breathing changes.
Knees Take an Uneven Load
With this mispositioning, weight is directed through the inside front of the knee instead of straight through the thigh bone into the calf bone. The uneven pressure on the knee joint eventually causes knee pain. Often, this pain is attributed to osteoarthritis.
Joint Misalignment Causes Pain
The woman described above had arthritis, but that wasn’t the real cause of her pain. Her pain stemmed from the poor positioning of the joint, which caused tissues to rub against each other abnormally. When she fixed the joint pressures, the pain went away even though the arthritis was still there. She was still bone-on-bone in her knee.
Check Your Posture
To check your posture, stand and sit in front of a mirror. Do both so you can see how your body position shifts depending on the position.
Watch Yourself Breath
Watch yourself breathe calmly. It will take a few minutes to settle in and see your true habits.
• Do your ribs lift up in front?
• Do you feel or see your lower back acting like a hinge, lifting up your front ribs?
If either is true, you can improve your breathing. Next, try these two:
• Can you inhale without reaching for air by lifting your ribs up?
• Can you let your belly button spill out forward in a relaxed way when you exhale instead of sucking it in?
If you can’t do both, you can improve your breathing.-
Ribs Flared, Back Arched
As you breathe, observe your rib cage position. Are the lower ribs flaring out, or are they in line with the side abdominal muscles just below the ribs? If they are in line, your ribs are in a good position. If there is a drop-off or a bump, your lower front ribs are flared out, and you are hinging with your back, then your breathing mechanics are poor. The good news is you can fix this.
Tight Hips Don’t Lie
Now check the hips. The muscles in the front of our hips become tight from prolonged sitting, stress, and overuse of the lower back. When you are seated, put your fingers on the front crease of your hips. If the area feels tight, the muscles are contracted. You might not be able to feel this if you aren’t used to feeling if a muscle is tight or relaxed, so try lifting your knee up a bit. You should be able to feel a muscle tighten in the front of your hip when you do this. Now lower your knee and relax your thigh. Your hip muscle should fully relax. If not, there is work to do.
Tilted Hips Are Tight
When standing, look at yourself in a mirror from the side. Are your hips tipped forward with a strong arch in your low back? That’s a sign of tight hips. Try tucking your tailbone under and rolling your hips without bending your knees? It can be tricky. Try it gently. If you feel any strain in your lower back, stop. It means your hip flexors are too tight.
Many Factors Lead to Pain
Now that you’ve checked your breathing, you know what to work on. But there can be other factors in the knee pain puzzle, including how you walk, your foot position, and how you use your neck and shoulders. But getting your breathing right needs to come first. It affects how your muscles work.
Benefits of Better Breathing
As you learn to breathe differently, you can add in exercises to strengthen the back of the thigh to help the hip flexors relax in front. This will help the top of the hips roll back into a neutral position. It also opens up the front of the hips and gives your knees a break. All these benefits start with changing how you breathe!
Dr. Amy Novotny, PABR® Institute
