How Breath-Control Can Improve Your Concussion Recovery: The Science of Slow Breathing
In February 2021, I shared a post on Instagram about breathing in concussion recovery that garnered some attention (by my account’s standards). I wanted to dive deeper into the topic for you because it goes FAR beyond only concussion recovery. How far beyond? Just check out the title of this peer-reviewed article below.
How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing
By the end of this, I hope that you see the value of taking time to breathe each day and how that can help shift your physical and psychological orientation to your world.
Let's eat dessert first: The benefits of slow breathing.
Nutshell: Slow breathing increases your parasympathetic nervous system ("recover & restore system") activity, and that tends to make you feel calm and content.
How do we know?
We know this because when we hook you up to fancy biofeedback ("body/biology feedback") tools, we see that your heart rate variability (HRV) and respiratory sinus arrhythmia (RSA) both tend to increase with slow, paced breathing.
From a "brain" perspective, EEG data show us that your alpha-wave activity increases and theta-wave activity decreases, and blood flow to specific "regulatory" brain regions increases.
Additionally, questionnaires and surveys that study participants completed help explain the subjective findings (e.g., feeling "pleasantness," ease, and relaxation).
Heart Rate Variability (HRV) is a measure of how much your heart rate varies from beat-to-beat, and is strongly linked to breathing rate. We use fancy measures like the Standard Deviation of Normal-to-Normal interval (SDNN) and the frequencies, like very-low-frequency (VLF), low-frequency (LF), and high-frequency (HF) to gather information about your autonomic nervous system.
SDNN is a broad measure of your heart rate changes from beat-to-beat (e.g., HRV).
VLF gives us a window into your sympathetic ("fight or flight") activity.
LF gives us a window into your parasympathetic ("recover and restore") activity.
HF provides us with a window into your RSA (below) and your vagus nerve activity.
Respiratory Sinus Arrhythmia (RSA) describes a healthy, normal heart rate variation that correlates with your breathing and is strongly linked to your autonomic balance. Naturally, as we inhale, our heart rate should increase, and as we exhale, it should decrease. The better your RSA, the better your homeostasis regulation, oxygen uptake, and overall gas exchange (e.g., CO2:O2).
EEG brain waves give us a broad-picture view of activity over various regions of the brain. Generally, we see an increase in alpha-activity and a decrease in theta-activity. Alpha-waves tend to correlate with inward-directed attention like that seen in meditation. Theta-waves are associated with deep meditation and altered conscious states.
Blood flow is shown in special imaging of the brain (i.e., BOLD fMRI imaging). Studies show increased circulation in the prefrontal, motor, parietal cortices, pons, thalamus, hypothalamus, sub-parabrachial nucleus, and periaqueductal gray - All regions that are associated with regulation of internal states.
How and why does our breath impact our hearts and brains?
It turns out that there are a lot of very fancy and useful ways that our individual body systems work together synergistically to keep us alive and performing optimally.
Generally speaking, slow breathing (<10 breaths/min) increases parasympathetic activity via vagus nerve (CNX) activation. Through interoception, the vagus nerve also provides feedback from your heart, lungs, and gut back up to your brain.
Your heart rate varies (e.g., RSA) with breathing through some cool mechanisms related to the actual mechanics of breathing:
When you inhale, pressure in your chest (i.e., intrathoracic pressure) decreases. The decrease in pressure causes blood to return to your heart faster, which triggers a stretch reflex (i.e., Bainbridge Reflex) in your heart to pump quicker.
Simultaneously, specific fibers (i.e., c-fibers) decrease vagus nerve input to the heart, increasing heart rate when you inhale.
Exhalation has an opposite effect, causing your heart rate to decrease.
It turns out that breathing through your nose is also proving to be a crucial player in this mix - historically, culturally, and scientifically. It appears that the nerves in your nasal cavity are sensitive to chemical and mechanical stimuli. Animal and human studies have found that mechanical stimulation (e.g., breathing) of the nasal cavity through nasal-breathing changes your autonomic and brain states. They've actually found brain waves oscillating in sync with breathing rate. This type of synchronization is only really otherwise found in deep meditation, psychedelics, and sleep.
Why does this matter in concussion (and life)?
In a concussion, your autonomic system is often disrupted, and this dysregulation can be a reason for delayed recovery and persistent post-concussion symptoms (PPCS). Symptoms of brain fog, difficulty concentrating, difficulty remembering, more emotional, irritability, sadness, depression, anxiety, sleep troubles, etc... can all be positively affected by paced breathing.
For example, many patients with concussion report to me that their memory is "off." When tested, however, their memory is excellent, but their ATTENTION is off. After 1-2 weeks of paced breathing, they report better sleep and mental clarity. Part of this is likely the sleep. The other part is probably the fact that paced breathing improves synchronization of your default mode network (DMN; "daydreaming/autopilot network"). Better regulation of when you're on autopilot and when you're focused can save you tons of energy, help you feel more mentally clear - and you'll report that your memory is better. Hmmm...
What's a person to do with all of this jargon and information?
Breathe - around 4 to 6 breaths per minute. Most people do best with 6.
Inhale for 5 seconds through your nose. Not a massive breath. Your normal breath, maybe +10-20%.
Don't hold your breath at any point.
Exhale for 5 seconds out your nose. Not forcefully, no abs.
Repeat.
Imagine your lungs filling with air the way a bucket fills with water - from the bottom-up. Fill the base of your lungs first, all the way up the apex near your collarbone.
Keep your neck and traps light - easy effort.
Your belly and ribs should move in and out together. Don't let one race in front of the other too fast.
Play this 5 in, 5 out nasal breathing game for 10-20minutes. Repeat 1-2 times per day.
My favorite resources:
Xhalr.com (GIF above; free breath pacing website)
Calm meditation app
Headspace meditation app
Inner Balance by Heart Math (at-home biofeedback tool)
Common feedback & my response:
Person: "But I can't sit that long... It's hard for me... 10min is a long time"
Me: We're training your attention and emotional regulation, little one. It comes with time. Start with 5min if you have to.
If you’d like to receive comprehensive, integrative acute concussion care or finally overcome your persistent concussion symptoms; please reach out below! I work to find the root cause of your symptoms and provide you with simple, innovative rehabilitation and metabolic recovery options.
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.