Not All Breathing Practices Are the Same

When Does Someone Need Breathwork & When Do They Need Rehabilitation?

The popularity of breathwork has exploded.

From box breathing to breath holds to mouth taping, millions of people are now using breathing techniques to improve their health, well-being, and resilience.

But important questions are often overlooked:

• What if the problem isn't a lack of breathing exercises?
• What if the breathing itself is dysfunctional?

Before we teach breathing techniques, should we first determine whether the breathing pattern needs rehabilitation?

Breathing rehabilitation is not breathwork, it is different.

Breathing Rehabilitation Restore Dysfunction Assessment first Symptoms present Clinical intervention Restore function

Breathwork Optimise Healthy baseline Technique first Performance goals Wellbeing practice Expand capacity

You cannot consistently optimise a breathing pattern that has not first been restored.

Unlike general breathwork, breathing rehabilitation is a healthcare intervention delivered by qualified health professionals following a comprehensive assessment of the individual's breathing pattern, symptoms, and contributing factors.

The goal is not only optimisation; initially, it is often restoration and tailored to the individual.

Before teaching any breathing techniques, we first ask:

• Is breathing nasal?
• Is breathing low and efficient?
• Is the respiratory rate appropriate?
• Is breathing coordinated with movement?
• Is the nervous system regulated?
• Is there evidence of hyperventilation or hypocapnia?
• Is the client symptomatic?
• Are there any red flags to treatment?

Common presentations include:

• Breathlessness
• Anxiety
• Sighing
• Yawning
• Dizziness
• Poor exercise tolerance
• Fatigue
• Upper chest dominance
• Mouth breathing

These individuals may not need more breathing exercises.

They may need their breathing rehabilitated.

The Process

Dysfunctional Breathing 
     ↓
Breathing Rehabilitation
     ↓
Baseline Calm
     ↓
Intergrated Breathing & Movement
     ↓
Performance

Why This Matters

Not all breathing dysfunction looks the same.

One person may experience breathlessness and anxiety, while another presents with dizziness, fatigue, poor exercise tolerance, or frequent sighing and yawning.

Differential Diagnosis is essential , as breathlessness, dizziness, chest tightness,  palpitations and  poor performance may arise from an underlying disease, condition or biomechanical inefficiency for example asthma , anxiety disorders, chronic fatigue, low back pain, tight structures.

The literature repeatedly emphasises the need for appropriate assessment before treatment.

Or put simply:

Restore → Regulate → Optimise → Perform

Key message

Dysfunctional breathing is frequently misdiagnosed and requires careful clinical evaluation.

Final Thought

At BradCliff, we believe breathing rehabilitation should be undertaken by appropriately trained health professionals, as breathing dysfunction may reflect complex interactions between respiratory physiology, movement, behaviour, health conditions, and the nervous system.

While breathwork may be appropriate for enhancing wellbeing or performance, breathing rehabilitation is a clinical process involving assessment, differential diagnosis, and individualised management of breathing dysfunction.

References :

_{Boulding, R., Stacey, R., Niven, R. and Fowler, S.J. (2016) ‘Dysfunctional breathing: a review of the literature and proposal for classification’, European Respiratory Review, 25(141), pp. 287–294.}

_{Clifton-Smith, T. and Rowley, J. (2011) ‘Breathing pattern disorders and physiotherapy: inspiration for our profession’, Physical Therapy Reviews, 16(1), pp. 75–86.}

_{Gallego-Marcos, J., Barker, N., Cullinan, P., Gardiner, Q., Grammatopoulou, E., Jack, S., Jones, M., Lee, L., McDonnell, L., Mitchelmore, A., Todd, S. and Fowler, S.J. (2023) ‘Breathing pattern disorders: diagnosis and treatment’, Breathe, 19(3), Article 230058.}