There is a question I now ask almost systematically at the first consultation, especially when a patient arrives with chronic pain that doesn't respond to standard treatments. This question has nothing to do with the painful area, posture, or sport.
The question is: how do you breathe?
Most of the time, patients look a little surprised. They came for their back, their neck, their shoulders — not to talk about breathing. And yet, this is often where everything starts to unlock.
This article explains why. What I am about to describe is not a personal view — it is what the scientific literature of the last twenty years shows in a convergent way, and what I verify every week in clinical practice.
What science has discovered about breathing and pain
For a long time, breathing was considered an independent automatism — an autonomous system that could not really be influenced. Research in neuroscience and pain physiology has significantly changed this perspective.
Today, we know that breathing is one of the very few systems in the body that functions both automatically and voluntarily. You breathe without thinking about it, but you can also decide to change your breathing. And it is precisely this dual nature that makes it a privileged gateway to the autonomic nervous system — which regulates, among other things, the perception of pain.
Clinical studies show quite clearly that people suffering from chronic pain almost always present altered breathing patterns. Breathing too fast. Breathing too shallow. Chest breathing rather than diaphragmatic breathing. Involuntary apneas during movements or periods of concentration.
And this is not a consequence of pain — it is often part of the mechanism that maintains it.
What happens physiologically
When you breathe in a short, high chest manner — that is, using mainly the upper chest without engaging the diaphragm — several things happen simultaneously in your body.
First, you activate the sympathetic branch of your autonomic nervous system. This is the branch that prepares the body for action, defence, and alertness. The heart rate accelerates. Postural muscles contract. The digestive system slows down. The perception of pain amplifies — because a body on alert more easily interprets sensations as threatening.
Second, certain muscles are overloaded. When you breathe with the upper chest, it is the neck muscles — the scalenes, the sternocleidomastoid, the upper trapezius — that are solicited to lift the ribs with each breath. Multiplied by 15 to 20 breaths per minute, over hours, over years, you create a chronic fatigue of these muscles that manifests as exactly the cervical and trapezius pain that so many of my patients describe.
Third, the diaphragm — which should be your main breathing muscle — progressively loses its mobility and strength. And the diaphragm is not only a breathing muscle: it is also a central actor in trunk stability, abdominal venous circulation, and visceral functioning. A diaphragm that no longer moves correctly creates cascading dysfunctions.
Fourth, and this is the point I find most striking clinically, you keep your nervous system in a state of permanent vigilance. And permanent vigilance of the nervous system is one of the best-documented factors for amplifying chronic pain.
What I observe in practice
Here is a pattern I encounter regularly. A patient comes in for chronic low back pain or persistent cervical pain. We examine the painful area, work on the contractures, prescribe exercises. Everything goes correctly — and yet the pain always comes back.
What sometimes changes the trajectory is looking outside the painful area. And looking, in particular, at how the person breathes.
Often, I then see short, high, almost suspended breathing. The belly barely moves. The shoulders rise slightly with each breath. And when I ask the patient to observe their own breathing, they discover they have been breathing this way permanently without realising it.
From there, the work changes. We don't remove attention from the painful area — but we add a parallel axis: restoring functional diaphragmatic breathing. And in a large proportion of cases, this addition unlocks what care focused solely on the painful area could not unlock.
This is not miraculous. It is physiological.
The central exercise — guided diaphragmatic breathing
Here is the exercise I give as a first step to my patients. It is simple, requires no equipment, and can be done at any time of day. Its simplicity should not be misleading: practised regularly, it measurably modifies the state of the autonomic nervous system.
Lie on your back, knees bent, feet flat on the floor. If you prefer, you can also do it seated, your back resting against a wall or backrest. What matters is that your body is relaxed and your chest can move freely.
Place one hand on your belly, just below your navel. Place the other hand flat on your chest. This double position allows you to observe where the movement is happening.
Inhale slowly through the nose, feeling the hand on your belly rise — while the one on your chest stays practically still. This is exactly the opposite of what many people do naturally today.
Exhale slowly through the mouth, slightly open, feeling the hand on your belly fall. The exhalation should be at least as long as the inhalation — ideally a little longer.
Do five breaths this way. No more, at first. This is not a performance exercise — it is a relearning exercise.
Repeat this series of five breaths three times a day: upon waking, in the middle of the day, and before sleeping. If possible, also add a series before moments you identify as stressful — an important meeting, a difficult conversation, an emotionally charged situation.
Why this exercise works — beyond the obvious
What makes this exercise particularly powerful is what happens during the long exhalations.
When your exhalation is longer than your inhalation, you activate what is called vagal tone — the activity of the vagus nerve, which is the main nerve of the parasympathetic branch of the autonomic nervous system. This branch is exactly the opposite of the sympathetic branch: it slows the heart rate, relaxes postural muscles, restarts digestion, calms the perception of pain.
Practised regularly — and this is the important point — this exercise does not only calm the present moment. It progressively modifies the baseline tone of your nervous system. You become less reactive to stress, less quickly tense, less sensitive to pain.
That is why the benefits are measured in weeks of regular practice, not in minutes of intense practice.
The role of muscle relaxation in parallel
There is one thing to understand: if your body is already extremely tense, particularly at the level of the diaphragm and chest, the breathing exercise can be difficult to implement. A contracted diaphragm does not move freely. Stiff intercostal muscles limit chest expansion. The result is frustrating — you try to breathe with your belly, and you don't quite manage.
In this case, in practice, I begin by preparing the body. Localised heat on the diaphragm region and chest to release contractures. Gentle massage of the abdominal area and intercostals. Once this work is done, diaphragmatic breathing becomes much more accessible.
If you recognise this difficulty in yourself, I recommend associating the breathing exercise with muscle relaxation work beforehand. A few minutes of heat on the solar plexus area and on the chest before the exercise can transform the quality of the practice. The tools I use and have selected in the Soothing warmth & comfort collection are precisely those that allow you to achieve this prior state of relaxation at home.
What you can observe in a few weeks
If you begin practising this exercise three times a day, here is what my patients generally report after three to six weeks of regular practice.
The first thing that changes is sleep quality. Falling asleep becomes easier, sleep becomes deeper. That alone is often worth the effort.
Then, the overall tension in the body decreases. You feel the shoulders rising towards the ears less. You notice more quickly when you start tensing — and you can intervene before the tension sets in.
The perception of pain changes. Not necessarily the pain itself at first — but the way it affects you. The same intensity of pain can be much less invasive when the nervous system is no longer in a state of permanent alert.
And finally, certain specific pains diminish. Cervical pain linked to overuse of accessory breathing muscles. Diaphragm tensions that radiate to the back. Upper back contractures related to chest breathing.
A final word
Breathing is probably the most powerful and most underused lever in modern physical therapy. It does not replace manual work, specific exercises, or attention to posture. But it often conditions the effectiveness of all the rest.
If you are reading this article and have been suffering from chronic pain for a long time, I propose this: for three weeks, add this breathing exercise to your daily routine. Not as a replacement for what you are already doing. In addition.
And observe what changes. Not with expectations — with curiosity.
Your breathing speaks to your nervous system permanently. Learning to speak to it consciously means learning to modify what your body listens to.
— Physical Therapist, founder of Reprogrammer Boutique