What is Dysfunctional Breathing? A Physical Therapy Guide
Dysfunctional Breathing

Breathing is a vital function of the human body that regulates oxygen, carbon dioxide, and pH levels. However, a disordered breathing pattern can be the first sign that something is wrong. Dysfunctional breathing is defined as “inappropriate breathing which is persistent enough to cause symptoms with no apparent organic cause.” Unlike hyperventilation syndrome, it can cause various symptoms such as shortness of breath, chest tightness, musculoskeletal pain, hyperarousal, depression, anxiety, and sleep disturbances. In this article, we’ll explore the causes and types of dysfunctional breathing and how to address it.


Causes of Dysfunctional Breathing

Dysfunctional breathing can be caused by fear or pain. Fear can lead to sensitization of the nervous system, contributing to the development of dysfunctional breathing. Pain, whether acute or chronic, can also cause the development of dysfunctional breathing patterns.


Types of Dysfunctional Breathing

There are three types of dysfunctional breathing: upper chest/thoracic dominant, paradoxical, and deep sighing/frequent yawning. Upper chest/thoracic dominant breathing is where the chest/upper rib cage expands more than the lower rib cage/belly. Paradoxical breathing is when the abdomen moves inward during inhalation and outward during exhalation. Deep sighing/frequent yawning is characterized by frequent sighing or yawning, which is often caused by air hunger.


Understanding Normal Breathing

To understand dysfunctional breathing, we need to know what normal breathing is. Normal breathing involves the diaphragm in a synchronized motion of the upper and lower rib cage and abdomen. Inhalation should be 2-4x shorter than exhalation. You should feel your lower rib cage and abdomen expand with normal breathing. If you have overactivity of the accessory muscles, you may notice thoracic breathing, where the chest/upper rib cage expands more than the lower rib cage/belly.


Treatment for Options

While there is no “gold standard” method for assessing breathing, seeking evaluation from a physical therapist is recommended for anyone experiencing chronic or acute musculoskeletal pain or a heightened “fight or flight” state. A detailed assessment and specific exercises and tips/tricks can help regulate your nervous system, breathing pattern, and get you feeling relaxed and pain-free.


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Brooke attended the physical therapy assistant program at Orangeburg-Calhoun Technical College after studying exercise science at the University of South Carolina, Aiken. She has been practicing as a Physical Therapy Assistant since 2021 and serves patients and clients both in ProActive’s aquatic therapy programs and at the clinic.

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Rafi Salazar OT

Rafael E. Salazar II, MHS, OTR/L (Rafi) is the CEO & President of Proactive Rehabilitation & Wellness, as well as the Principal Owner of Rehab U Practice Solutions and the host of The Better Outcomes Show. Rafi’s career trajectory includes 10+ years of experience in healthcare management, clinical operations, programmatic development, marketing & business development. He even spent some time as an Assistant Professor in a Graduate Program of Occupational Therapy and has served on numerous boards and regulatory committees. Today, Rafi helps innovative healthcare companies humanize healthcare through his consulting workHe also leverages his experience as a professor and academic to speak and train on the topics around humanizing the healthcare experience.

Rafi also authored the book Better Outcomes: A Guide to Humanizing Healthcare