Is your neck stiff, uncomfortable and painful?
When driving is it more difficult to turn your head?
Neck and shoulder pain affect more than 30% of people (Fejer et al, 2006; Cohen, 2015). This blog explores some strategies to reduce or prevent neck stiffness and discomfort and suggests practices to reduce discomfort and increase flexibility if you already are uncomfortable.
Shifts in posture may optimize neck flexibility
In our modern world, we frequently engage in a forward head position while looking at electronic devices or typing on computers. Prolonged smart phone usage has the potential to negatively impact posture and breathing functions (Jung et al., 2016) since we tilt our head down to look at the screen. Holding the head in a forward position, as displayed in Figure 1, can result in muscle tension in the spine, neck, and shoulders.
Fig 1. Forward head and neck posture in comparison to a neutral spine. Source: https://losethebackpain.com/conditions/forward-head-posture/
Whenever you bring your head forward to look at the screen or tilt it down to look at your cellphone, your neck and shoulder muscles tighten and your breathing pattern become more shallowly. The more the head is forward, the more difficulty is it to rotate your head as is describe in the blog, Head position, it matters! (Harvey et al, 2018). Over time, the head forward position may lead to symptoms such as headaches and backpain. On the other hand, when we shift to an aligned upright position throughout the day, we create an opportunity to relieve this tension as shown in Figure 2.
Figure 2. EMG and respiration recording from a subject sitting with a forward head position and a neutral, aligned head position. The neck and shoulder muscle tension was recorded from the right trapezius and left scalene muscles (Mason et all, unpublished). .
The muscle tension recorded from scalene and trapezius muscles (neck and shoulder) in Figure 2 shows that as the head goes forward or tilts down, the muscle tension significantly increases. In most cases participants are totally unware that their neck tightens. It is only after looking at the screen or focus our eyes until the whole day that we notice discomfort in the late afternoon.
Experience this covert muscle tension pattern in the following video, Sensing neck muscle tension-The eye, head, and neck connection.
Interrupt constant muscle tension
One possible reason why we develop the stiffness and discomfort is that we hold the muscles contracted for long time in static positions. If the muscle can relax frequently, it would significantly reduce the probability of developing discomfort. Experience this concept of interrupting tension practice by practicing the following:
- Sit on a chair and lift your right foot up one inch up from the floor. Keep holding it up? For some people, as soon as five seconds, they will experience tightening and the onset of discomfort and pain in the upper thigh and hip.
How long could you hold your foot slight up from the floor? Obviously, it depends on your motivation, but most people after one minute want to put the foot down as the discomfort become more intense. Put the foot down and relax. Notice the change is sensation and for some it takes a while for the discomfort to fade out.
- The reason for the discomfort is that the function of muscle is to move a joint and then relax. If tightening and relaxation occurs frequently, then there is no problem
- Repeat the same practice except lift the foot, relax and drop it down and repeat and repeat. Many people can easily do this for hours when walking.
What to do to prevent neck and shoulder stiffness.
Interrupt static muscle neck tension by moving your head neck and shoulder frequently while looking at the screen or performing tasks. Explore some of the following:
- Look away from the screen, take a breath and as you exhale, wiggle your head light heartedly as if there is a pencil at reaching from the top of your head to the ceiling and you are drawing random patterns on the ceiling. Keep breathing make the lines in all directions.
- Push the chair back from the desk, roll your right shoulder forward, up and back let it drop down and relax. Then roll you left shoulder forward up and back and drop down and relax. Again, be sure to keep breathing.
- Stand up and skip in place with your hands reaching to the ceiling so that when your right foot goes up you reach upward with your left hand toward the ceiling while looking at your left hand. Then, as your left foot goes up your reach upward to the ceiling with your right hand and look at your right hand. Smile as you are skipping in place.
- Install a break reminder program on your computer such as Stretch Break to remind you to stretch and move.
- Learn how to sit and stand aligned and how to use your body functionally such as with the Gokhale Method or the Alexander Technique (Gokhale, 2013; Peper et al, in press, Vineyard, 2007).
- Learn awareness and control neck and shoulder muscle tension with muscle biofeedback. For practitioners certified in biofeedback BCB, see https://certify.bcia.org/4dcgi/resctr/search.html
- Become aware of your collapsed and slouching wearing a posture feedback device such as UpRight Go on your upper back. This device provides vibratory feedback every time you slouch and reminds you to interrupt slouching and be upright and alighned.
Arrange your computer screen and keyboard so that the screen is at eye level instead of having to reach forward or look down. Similarly, hold your cell phone so that it is at eye level as shown in Figure 3 and 4.
Figure 3. Slouching forward to see the laptop screen can be avoided by using an external keyboard, mouse and desktop riser. Reproduced by permission from www.backshop.nl
Figure 4. Avoid the collapsed while looking down at a cell phone by resting the arms on a backpack or purse and keeping the spine and head alighned. Photo of upright position reproduced with permission from Imogen Ragone, https://imogenragone.com/
If you are squinting, bringing your nose to the screen, or if the letters are too small or blurry, have your eyes checked to see if you need computer glasses. Generally do not use bifocals or progressive glasses as they force you to tilt your head up or down to see the material at a specific focal length. Other options included changing the display size on screen by making the text and symbols larger may allow you see the screen without bending forward. Just as your muscle of your neck, your eyes need many vision breaks. Look away from the screen out of the window at a distant tree or for a moment close your eyes and breathe.
What to do if you have stiffness and discomfort
My neck was stiff and it hurt the moment I tried to look to the sides. I was totally surprised that I rapidly increased my flexibility and reduced the discomfort when I implemented the following two practices.
Begin by implementing the previous described preventative strategies. Most important is to interrupt static positions and do many small movement breaks. Get up and wiggle a lot. Look at the blog, Freeing the neck and shoulder, for additional practices.
Then, practice the following exercises numerous times during the day to release neck and shoulder tension and discomfort. While doing these practices exhale gently when you are stretching. If the discomfort increases, stop and see your health professional.
Cohen, S.P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90 (2), 284-299. https://doi.org/10.1016/j.mayocp.2014.09.008
Fejer, R., Kyvik, K.Ohm, & Hartvigesen, J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal, 15(6), 834-848. https://doi.org/10.1007/s00586-004-0864-4
Gokhale, E. (2013). 8 Steps to a Pain-Free Back. Pendo Press.
Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Mason, L., Peper, E., Harvey, R., & Hernandez, W. (unpublished). Healing headaches. Does success sustain over time?
Peper, E., Krüger, B., Gokhale, E., & Harvey, R. (in press). Comparing Muscle Activity and Spine Shape in Various Sitting Styles. Biofeedback.
Vineyar, M. (2007). How You Stand, How You Move, How You Live: Learning the Alexander Technique to Explore Your Mind-Body Connection and Achieve Self-Mastery. Boston: Da Capo Lifelong Books.
When randomized controlled studies of pharmaceuticals or surgery find that the treatment is no more effective than the placebo, the authors conclude that surgery or drugs have no therapeutic value (Moseley et al, 2002; Jonas et al, 2015). Even though the patients may have gotten better, the researchers often do not explore questions such as, why did some of the patients improve just with the placebo treatment; what are the components of the placebo process; and, how can clinicians integrate placebo components into their practice to enhance the body’s own natural healing response.
To explore these topics further, listen to Shankar Vedantam’s outstanding podcast, A Dramatic Cure, from the NPR program, Hidden Brain-A conversation about life’s unseen patterns. Also, read the background materials on the website https://www.npr.org/2019/04/29/718227789/all-the-worlds-a-stage-including-the-doctor-s-office
Placebo effects can be a powerful healing strategy as demonstrated by numerous research studies that have persuasively explored the central features of the placebo effect. The research has found that the more dramatic and impressive the procedure, the more powerful the placebo effect. For example, branded medicine with brightly colored packaging is more effective than generic medicine in plain boxes, an injection of a saline or sugar solution is more effective than taking a sugar pill, and placebo surgery is more effective than simply receiving an injection (Branthwaite & Cooper, 1981; Colloca & Benedetti, 2005). For a detailed exploration of placebo, nocebo and the important role of active placebo, see the blog, How effective is treatment? The importance of active placebos.
To see the effect of the placebo in action, watch the well-known British stage hypnotist and illusionist, Derren Brown’s video, Fear and Faith (https://www.youtube.com/watch?v=hfDlfhHVvTY). He magically weaves together a narrative that addresses the powerful influences of the natural, physical, and clinical environment and language used during a ‘therapeutic’ interaction. He shows how the influences of role modeling, the words that increase hope, trust and social compliance, and other covert factors promote healing. It uses the cover of a drug trial to convince various members of the public to overcome their fears using a placebo medicine called “Rumyodin” (which is a made-up name of a fake pharmaceutical) and demonstrates that the limits of experience are the limits of your belief.
This blog post serves as a reminder to ask ourselves as educators and therapists, ‘what can I do to include placebo enhancing components into my practice so that my clinical and educational outcomes are more effective?’ Explore ways to optimize your clinical environment, language use during ‘therapeutic’ interactions, and role modeling to increase hope, trust and social compliance and thereby optimize your clients’ own natural healing response.
Jonas, W. B., Crawford, C., Colloca, L. , et al.(2015). To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open, 5: e009655. doi:10.1136/ bmjopen-2015-009655
*I thank Richard Harvey, PhD., for his constructive feedback and James Fadiman, PhD., for reminding me to reframe the term placebo into “the body’s natural healing response.”
I quickly gasped twice and a sharp pain radiated up my head and into my eye. I shifted to slow breathing and it faded away.
I felt anxious and became aware of my heart palpitations at the end of practicing 70% exhalation for 30 seconds. I was very surprised how quickly my anxiety was triggered when I changed my breathing pattern.
Breathing is the body/mind/emotion/spirit interface which is reflected in our language with phrases such as a sigh of relief, all choked up, breathless, full of hot air, waiting with bated breath, inspired or expired, all puffed up, breathing room, or it takes my breath away. The colloquial phrases reflect that breathing is more than gas exchange and may have the following effects.
- Changes the lymph and venous blood return from the abdomen (Piller, Leduc, & Ryan, 2006). The downward movement of the diaphragm with the corresponding expansion of the abdomen occurs during inhalation as well as slight relaxation of the pelvic floor. The constriction of the abdomen and slight tightening of the pelvic floor causing the diaphragm to go upward and allows exhalation. This dynamic movement increases and decreases internal abdominal and thoracic pressures and acts a pump to facilitate the venous and lymph return from the abdomen. In many people this dynamic pumping action is reduced because the abdomen does not expand during inhalation as it is constricted by tight clothing (designer jean syndrome), holding the abdomen in to maintain a slim self-image, tightening the abdomen in response to fear, or the result of learned disuse to reduce pain from abdominal surgery, gastrointestinal disorders, or abdominal insults (Peper et al, 2015).
- Increases spinal disk movement. Effortless diaphragmatic breathing is a whole body process and associated with improved functional movement (Bradley, & Esformes, 2014). The spine slightly flexes when we exhale and extends when we inhale which allows dynamic disk movement unless we sit in a chair.
- Communicates our emotional state as our breathing patterns reflect our emotional state. When we are anxious or fearful the breath usually quickens and becomes shallow while when we relax the breath slows and the movement is more in the abdomen (Homma, & Masoka, 2008).
- Evokes, maintains, inhibits symptoms or promotes healing. Breathing changes our physiology, thoughts and emotions. When breathing slowly to about 6 breaths a minute, it may enhance heart rate variability and thereby increase sympathetic and parasympathetic balance (Lehrer & Gevirtz, 2014; Moss & Shaffer, 2017).
Can breathing trigger symptoms?
A fifty-five year old woman asked for suggestions what she could do to prevent the occurrence of episodic prodrome and aura symptoms of visual disturbances and problems in concentration that would signal the onset of a migraine. In the past, she had learned to control her migraines with biofeedback; however, she now experienced these prodromal sensation more and more frequently without experiencing the migraine. As she was talking, I observed that she was slightly gasping before speaking with shallow rapid breathing in her chest.
To explore whether breathing pattern may contribute to evoke, maintain or amplify symptoms, the following two behavioral breathing challenges can suggest whether breathing is a factor: Rapid fearful gasping or 70% exhalation.
Behavioral breathing challenge: Rapid fearful gasping
Take a rapid fearful gasp when inhaling as if your feel scared or fearful. Let the air really quickly come in and repeat two or three times as described in the video. Then describe what you experienced.
If you became aware of the onset of a symptom or that the symptom intensified, then your dysfunctional breathing patterns (e.g., gasping, breath holding or shallow chest breathing) may contribute to development or maintenance of these symptoms. For many people when they gasp–a big rapid inhalation as if they are terrified–it may evoke their specific symptom such as a pain sensation in the back of the eye, slight pain in the neck, blanking out, not being able to think clearly, tightness and stiffness in their back, or even an increase in achiness in their joints (Peper et al, 2016).
To reduce or avoid triggering the symptom, breathe diaphragmatically without effort; namely each time you gasp, hold your breath or breathe shallowly, shift to effortless diaphragmatic breathing.
The above case of the woman with the prodromal migraine symptoms, she experienced visual disturbances and fuzziness in her head after the gasping. This experience allowed her to realize that her breathing style could be a contributing in triggering her symptoms. When she then practiced slow diaphragmatic breathing for a few breaths her symptoms disappeared. Hopefully, if she replaces gasping and shallow breathing with effortless diaphragmatic breathing then there is a possibility that her symptoms may no longer occur.
Behavioral breathing challenge: 70% exhalation
While sitting, breathe normally for a minute. Now change your breathing pattern so that you exhale only 70% or your previous inhaled air. Each time you exhale, exhale only 70% of the inhaled volume. If you need to stop, just stop, and then return to this breathing pattern again by exhaling only 70 percent of the inhaled volume of air. After 30 seconds, let go and breathe normally as guided by the video clip. Observe what happened?
In our research study with 35 volunteers, almost all participants experienced an increase in arousal and symptoms such as lightheadedness, dizziness, anxiety, breathless, neck and shoulder tension after 30 seconds of incomplete exhalation as shown in Figure 1 and Table 1 (Peper and MacHose, 1993).
Figure 1. Increase in anxiety evoked by 70% exhalation.
Table 1. Symptoms experienced after exhalation 70%.
Although these symptoms may be similar to those evoked by hyperventilation and overbreathing, they are probably not caused by the reduction of end-tidal carbon dioxide (CO2). The apparent decrease in end-tidal PCO2 is cause by the room air mixing with the exhaled air and not a measure of end-tidal CO2 (Peper and Tibbets, 1992). Most likely the symptoms are associated by the shallow breathing that occurs when we were scared or terrified.
People who have a history of anxiety, panic, nervousness and tension as compared to those who report low anxiety tend to report more symptoms when exhaling 70% of inhaled air for 30 seconds. If this practice evoked symptoms, then changing the breathing patterns to slower diaphragmatic breathing may be a useful self-regulation strategy to optimize health.
These two behavior breathing challenges are useful demonstrations for students and clients that breathing patterns can influence symptoms. By experiencing ON and OFF control over their symptoms with breathing, the person now knows that breathing can affect their health and well being.
Blogs that that offer instructions to learn effortless diaphragmatic breathing
Peper, E., Gilbert, C.D., Harvey, R. & Lin, I-M. (2015). Did you ask about abdominal surgery or injury? A learned disuse risk factor for breathing dysfunction. Biofeedback. 34(4), 173-179. DOI: 10.5298/1081-5937-43.4.06
Peper, E. & Tibbetts, V. (1992). The effect of 70% exhalation and thoracic breathing upon end-tidal C02. Proceedings of the Twenty-Third Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Wheat Ridge, CO: AAPB, 126-129. Abstract in: Biofeedback and Self-Regulation. 17(4), 333-334.
The blog has been adapted from our published article, Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
Why is it so difficult to turn your head to see what is behind you?
How come so many people feel pressure in the back of the head or have headaches after working on the computer?
Your mother may have been right when she said, “Sit up straight! Don’t slouch!” Sitting slouched and collapsed is the new norm as digital devices force us to slouch or tilt our head downward. Sometimes we scrunch our neck to look at the laptop screen or cellphone. This collapsed position also contributes to an increased in musculoskeletal dysfunction (Nahar & Sayed, 2018). The more you use a screen for digital tasks, the more you tend to have head-forward posture, especially when the screens are small (Kang, Park, Lee, Kim, Yoon, & Jung, 2012). In addition, the less time children play outside and the more time young children watch the screen, the more likely will they become near sighted and need to have their vision corrected (Sherwin et al, 2012). In addition, the collapsed head forward position unintentionally decreases subjective energy level and may amplify defeated, helpless, hopeless thoughts and memories (Bader, 2015; Peper & Lin, 2012; Tsai, Peper, & Lin, 2016; Peper et al, 2017).
Explore the following two exercises to experience how the head forward position immediately limits head rotation and how neck scrunching can rapidly induce back of the head pressure and headaches.
Exercise 1. Effect of head forward position on neck rotation
Sit at the edge of the chair and bring your head forward, then rotate your head to the right and to the left and observe how far you can rotate. Then sit erect with the crown of the head reaching towards the ceiling and again rotate your head from right to left and observe how far you can rotate as shown in Figure 1.
Figure 1. Head-erect versus head-forward position.
What did you experience?
Most likely your experience is similar to the 87 students (Mean Age = 23.6 years) who participated in this classroom activity designed to bring awareness of the effect of head and neck position on symptoms of muscle tension. 92.0% of the students reported that is was much easier to rotate their head and could rotate further during the head-erect position as compared to the head-forward position (see Figure 2).
Figure 2. Self-report of ease of head rotation.
What does this mean?
Almost all participants were surprised that the head forward position restricted head rotation as well as reduced peripheral awareness (Fernandez-de-Las-Penas et al., 2006). The collapsed head forward may directly affect personal safety; since, it reduces peripheral awareness while walking, biking or driving a car. In addition, when the head is forward, the cervical vertebrae are in a more curved position compared to the erect head with the normal cervical curve (Kang et al., 2012). This means that in the head-forward position, the pressure on the vertebrae and the intervertebral disc is elevated compared to the preferred position with a stretched neck. This increases the risk of damage to the vertebrae and intervertebral disc (Kang et al, 2012). It also means that the muscles that hold the head in the forward position have to work much harder.
Be aware that of factors that contribute to a head-forward position.
- Sitting in a car seat in which the headrest pushes the head forward. Solutions: Tilt the headrest back or put pillow in your back from your shoulders to your pelvis to move your body slightly forward.
- If you wear a bun or ponytail, the headrest (car, airplane seat, or chair) will often push your head forward. This causes a change of the head to a more forward position and it becomes a habit without the person even knowing it. Solution: Place a pillow in your back to move your body forward or loosen the bun or ponytail.
- Difficulty reading the text on the digital screen. The person automatically cranes their head forward to read the text. Solutions: Have your eyes checked and, if necessary, wear computer-reading glasses; alternatively, increase the font size and reduce glare.
- Working on a laptop and looking down on the screen. Solutions: Detachable keyboard and laptop on a stand to raise screen to eye level as shown in Figure 3.
Figure 3. Trying to read the laptop screen, which causes the head to go forward as compared to raising the screen and using an external keyboard. Reproduced by permission from www.backshop.nl
- Being tired or exhausted encourages the body to collapse and slouch and increases the muscle tension in the upper cervical region. You can explore the effect of tiredness that causes slouching and head-forward position during the day by observing the following if you drive a car.
In the morning, adjust your rear mirror and side mirrors. Then at the end of the day when you sit in the car, you may note that you may need to readjust your inside rear mirror. No, the mirror didn’t change of position during the day by itself—you slouched unknowingly. Solutions: Take many breaks during the day to regenerate, install stretch break reminders, or wear an UpRight Go posture feedback device to remind you when you begin to slouch (Peper, Lin & Harvey, 2017).
Exercise 2: Effect of neck scrunching on symptom development
Sit comfortably and your nose forward and slightly. While the head is forward tighten your neck as if your squeezing the back of the head downward into the shoulders and hold this contracted neck position for 20 seconds. Let go and relax.
What did you experience?
Most likely your experience was similar to 98.4% of the 125 college students who reported a rapid increase in discomfort after neck scrunching as shown in Figure 4.
Figure 4. Symptoms induced by 30 seconds of neck scrunching.
During scrunching there was a significant increase in the cervical and trapezius sEMG activity recorded from 12 volunteers as shown in Figure 5.Figure 5. Change in cervical and trapezius sEMG during head forward and neck scrunching.
What does this mean?
Nearly all participants were surprised that 30 seconds of neck scrunching would rapidly increase induce discomfort and cause symptoms. This experience provided motivation to identify situations that evoked neck scrunching and avoid those situations or change the ergonomics that induced the neck scrunching. If you experience headaches or neck discomfort, scrunching could be a contributing factor.
Factors that contribute to neck scrunching and discomfort.
- Bringing your head forward to see the text or graphics more clearly. There may be multiple causes such as blurred vision, tiny text font size, small screen and ergonomic factors. Possible solutions. Have your eyes checked and if appropriate wear computer-reading glasses. Increase the text font size or use a large digital screen. Reduce glare and place the screen at the appropriate height so that the top of the screen is no higher than your eyebrows.
- Immobility and working in static position for too long a time period. Possible solutions. Interrupt your static position with movements every few minutes such as stretching, standing, and wiggling.
These two experiential practices are “symptom prescription practices” that may help you become aware that head position contributes to symptoms development. For example, if you suffer from headaches or neck and backaches from computer work, check your posture and make sure your head is aligned on top of your neck–as if held by an invisible thread from the ceiling and take many movement breaks.The awareness may help you to identify situations that cause these dysfunctional body patterns that could cause symptoms. By inhibiting these head and neck patterns, you may be able to reduce or avoid discomfort. Just as a picture is worth a thousand words, self-experience through feeling and seeing is believing.
Bader, E. E. (2015). The Psychology and Neurobiology of Mediation. Cardozo J. Conflict Resolution, 17, 363.
Fernandez-de-Las-Penas, C., Alonso-Blanco, C., Cuadrado, M. L., & Pareja, J. A. (2006). Forward head posture and neck mobility in chronic tension-type headache: A blinded, controlled study. Cephalalgia, 26(3), 314-319.
Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine, 36(1), 98-104.
Lee, M. Y., Lee, H. Y., & Yong, M. S. (2014). Characteristics of cervical position sense in subjects with forward head posture. Journal of physical therapy science, 26(11), 1741-1743. https://doi.org/10.1589/jpts.26.1741
Nahar, S., & Sayed, A. (2018). Prevalence of musculoskeletal dysfunction in computer science students and analysis of workstation characteristics-an explorative study. International Journal of Advanced Research in Computer Science, 9(2), 21-27. https://doi.org/10.26483/ijarcs.v9i2.5570
Peper, E., & Lin, I. M. (2012). Increase or decrease depression: How body postures influence your energy level. Biofeedback, 40(3), 125-130
Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback.45 (2), 36-41.
Peper, E., Lin, I-M, & Harvey, R. (2017). Posture and mood: Implications and applications to therapy. Biofeedback.35(2), 42-48.
Sherwin, J.C., Reacher, M.H., Keogh, R.H., Khawaja, A.P, Mackey, D.A., & Foster, P.J. (2012). The Association between Time Spent Outdoors and Myopia in Children and Adolescents: A Systematic Review and Meta-analysis. Ophthalmology, 119(10), 2141-2151. https://doi.org/10.1016/j.ophtha.2012.04.020
Tsai, H. Y., Peper, E., & Lin, I. M. (2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23-27.
*This blog was adapted from our published article, The blog has been adapted from our research article, Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.
In a world of turmoil, it is often challenging to think that tomorrow can be different and better. Yet, each day is an opportunity to accept whatever happened in the past and look forward to the unfolding present. So often, we anticipate that the future will be the same or worse especially if we feel depressed, suffer from ongoing pain, chronic illness, family or work stress, etc. At those moments, we forget that yesterday’s memories may contribute to how we experience and interpret the future. Most of us do not know what the future will bring, thus be open to new opportunities for growth and well-being. For the New Year, adapt a daily ritual that I learned from a remarkable healer Dora Kunz.
Each morning when you get out of bed, take a few slow deep breaths. Then think of someone who you feel loved by and makes you smile whether your grandmother, aunt or dog. Then when you get up and put your feet on the ground, say out loud, “Today is a new day- a new beginning.”
Watch the following two videos of people for whom the future appeared hopeless and yet had the courage to transcend their limitations and offer inspiration and joy.
Janine Shepherd: A broken body isn’t a broken person. Cross-country skier Janine Shepherd hoped for an Olympic medal — until she was hit by a truck during a training bike ride. She shares a powerful story about the human potential for recovery. Her message: you are not your body, and giving up old dreams can allow new ones to soar.
Ma Li and Zhai Xiaowei: Hand in Hand. This is a video of a broadcast that originally aired on China’s English-language CCTV channel 9 during a modern dance competition in Beijing, China in 2007. This very unique couple–she without an arm, he without a leg–was one of the finalists among 7000 competitors in the 4th CCTV national dance competition. It is the first time a handicapped couple had ever entered the competition. They won the silver medal and became an instant national hit. The young woman, in her 30’s, was a dancer who had trained since she was a little girl. Later in life, she lost her entire right arm in an automobile accident and fell into a state of depression for a few years. After rebounding, she decided to team with a young man who had lost his leg in a farming accident as a boy and who was completely untrained in dance. After a long and sometimes agonizing training regimen, this is the result. The dance is performed by Ma Li (馬麗) and Zhai Xiaowei (翟孝偉). The music “Holding Hands” is composed by San Bao and choreographed by Zhao Limin.
“Although difficult and going against my natural reaction to curl up in the response to my cramps, I stretched out on my back and breathed slowly so that my stomach got bigger with each inhalation. My menstrual pain slowly decreased and disappeared.
“For as long as I remember, I had stomach problems and when I went to doctors, they said, I had acid reflux. I was prescribed medication and nothing worked. The problem of acid reflux got really bad when I went to college and often interfered with my social activities. After learning diaphragmatic breathing so that my stomach expanded instead of my chest, I am free of my symptoms and can even eat the foods that previously triggered the acid reflux.”
In the late 19th earlier part of the 20th century many women were diagnosed with Neurasthenia. The symptoms included fatigue, anxiety, headache, fainting, light headedness, heart palpitation, high blood pressure, neuralgia and depression. It was perceived as a weakness of the nerves. Even though the diagnosis is no longer used, similar symptoms still occur and are aggravated when the abdomen is constricted with a corset or by stylish clothing (see Fig 1).
Figure 1. Wearing a corset squeezes the abdomen.
The constricted waist compromises the functions of digestion and breathing. When the person inhales, the abdomen cannot expand as the diaphragm is flattening and pushing down. Thus, the person is forced to breathe more shallowly by lifting their ribs which increases neck and shoulder tension and the risk of anxiety, heart palpitation, and fatigue. It also can contribute to abdominal discomfort since abdomen is being squeezed by the corset and forcing the abdominal organs upward. It was the reason why the room on top of stairs in the old Victorian houses was call the fainting room (Melissa, 2015).
During inhalation the diaphragm flattens and attempts to descend which increases the pressure of the abdominal content. In some cases this causes the stomach content to be pushed upward into the esophagus which could result in heart burn and acid reflux. To avoid this, health care providers often advice patients with acid reflux to sleep on a slanted bed with the head higher than their feet so that the stomach content flows downward. However, they may not teach the person to wear looser clothing that does not constrict the waist and prevent designer jean syndrome. If the clothing around the waist is loosened, then the abdomen may expand in all directions in response to the downward movement of the diaphragm during inhalation and not squeeze the stomach and thereby pushing its content upward into the esophagus.
Most people have experienced the benefits of loosening the waist when eating a large meal. The moment the stomach is given the room to spread out, you feel more comfortable. If you experienced this, ask yourself, “Could there be a long term cost of keeping my waist constricted?” A constricted waist may be as harmful to our health as having the emergency brake on while driving for a car.
We are usually unaware that shallow rapid breathing in our chest can contribute to symptoms such as anxiety, neck and shoulder tension, heart palpitations, headaches, abdominal discomfort such as heart burn, acid reflux, irritable bowel syndrome, dysmenorrhea and even reduced fertility (Peper, Mason, & Huey, 2017; Domar, Seibel, & Benson, 1990).
Assess whether you are at risk for faulty breathing
Stand up and observe what happens when you take in a big breath and then exhale. Did you feel taller when you inhaled and shorter/smaller when you exhaled?
If the answer is YES, your breathing pattern may compromise your health. Most likely when you inhaled you lifted your chest, slightly arched your back, tightened and raised your shoulders, and lifted your head up while slightly pulling the stomach in. When you exhaled, your body relaxed and collapsed downward and even the stomach may have relaxed and expanded. This is a dysfunctional breathing pattern and the opposite of a breathing pattern that supports health and regeneration as shown in figure 2.
Figure 2. Incorrect and correct breathing. Source unknown.
Observe babies, young children, dogs, and cats when they are peaceful. The abdomen is what moves during breathing. While breathing in, the abdomen expands in all 360 degrees directions and when breathing out, the abdomen constricts and comes in. Similarly when dogs or cats are lying on their sides, their stomach goes up during inhalation and goes down during exhalation.
Many people tend to breathe shallowly in their chest and have forgotten—or cannot– allow their abdomen and lower ribs to widen during inhalation (Peper et al, 2016). These factors include:
- Constriction by the modern corset called “Spanx” to slim the figure or by wearing tight fitting pants. In either case the abdominal content is pushed upward and interferes with normal healthy breathing.
- Maintaining a slim figure by pulling the abdomen (I will look fat when my stomach expands; I will suck it in).
- Avoiding post-surgical abdominal pain by inhibiting abdominal movement. Numerous patients have unknowingly learned to shallowly breathe in their chest to avoid pain at the site of the incision of the abdominal surgery such as for hernia repair or a cesarean operation. This dysfunctional breathing became the new normal unless they actively practice diaphragmatic breathing.
- Slouching as we sit or watch digital screens or look down at our cell phone.
Observe how slouching affects the space in your abdomen.
When you shift from an upright erect position to a slouched or protective position the distance between your pubic bone and the bottom of the sternum (xiphoid process) is significantly reduced.
- Tighten our abdomen to protect ourselves from pain and danger as shown in Figure 3.
Figure 3. Erect versus collapsed posture. There is less space for the abdomen to expand in the protective collapsed position. Reproduced by permission from Clinical Somatics (http://www.clinicalsomatics.ie/).
Regardless why people breathe shallowly in their chest or avoid abdominal and lower rib movement during breathing, by re-establishing normal diaphragmatic breathing many symptoms may be reduced. Numerous students have reported that when they shift to diaphragmatic breathing which means the abdomen and lower ribs expand during inhalation and come in during exhalation as shown in Figure 4, their symptoms such as acid reflux and menstrual cramp significantly decrease.
Figure 4. Diaphragmatic breathing. Reproduced from: www.devang.house/blogs/thejob/belly-breathing-follow-your-gut.
Reduce acid reflux
A 21-year old student, who has had acid reflux (GERD-gastroesophageal reflux diseases) since age 6, observed that she only breathed in her chest and that there were no abdominal movements. When she learned and practiced slower diaphragmatic breathing which allowed her abdomen to expand naturally during inhalation and reduce in size during exhalation her symptoms decreased. The image she used was that her lungs were like a balloon located in her abdomen. To create space for the diaphragm going down, she bought larger size pants so that her abdominal could spread out instead of squeezing her stomach (see Figure 5).
Figure 5. Hydraulic model who inhaling without the abdomen expanding increases pressure on the stomach and possibly cause stomach fluids to be pushed into the esophagus.
She practiced diaphragmatic breathing many times during the day. In addition, the moment she felt stressed and tightened her abdomen, she interrupted this tightening and re-established abdominal breathing. Practicing this was very challenging since she had to accept that she would still be attractive even if her stomach expanded during inhalation. She reported that within two weeks her symptom disappeared and upon a year follow-up she has had no more symptoms For a detailed description how this successfully cured irritable bowel syndrome see: https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/
Take control of menstrual cramps
Numerous college students have reported that when they experience menstrual cramps, their natural impulse is to curl up in a protective cocoon. If instead they interrupted this natural protective pattern and lie relaxed on their back with their legs straight out and breathe diaphragmatically with their abdomen expanding and going upward during inhalation, they report a 50 percent decrease in discomfort (Gibney & Peper, 2003). For some the discomfort totally disappears when they place a warm pad on their lower abdomen and focused on breathing slowly about six breaths per minute so that the abdomen goes up when inhaling and goes down when exhaling. At the same time, they also imagine that the air would flow like a stream from their abdomen through their legs and out their feet while exhaling. They observed that as long as they held their abdomen tight the discomfort including the congestive PMS symptoms remained. Yet, the moment they practice abdominal breathing, the congestion and discomfort is decreased. Most likely the expanding and constricting of the abdomen during the diaphragmatic breathing acts as a pump in the abdomen to increase the lymph and venous blood return and improve circulation.
Breathing is the body-mind bridge and offers hope for numerous disorders. Slower diaphragmatic breathing with the corresponding abdomen movement at about six breaths per minute may reduce autonomic dysregulation. It has profound self-healing effects and may increase calmness and relaxation. At the same time, it may reduce heart palpitations, hypertension, asthma, anxiety, and many other symptoms.
DeVault, K.R. & Castell, D.O. (2005). Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The American Journal of Gastroenterology, 100, 190-200.
Domar, A.D., Seibel, M.M., & Benson, H. (1990). The Mind/Body Program for Infertility: a new behavioral treatment approach for women with infertility. Fertility and sterility, 53(2), 246-249.
Gibney, H.K. & Peper, E. (2003). Taking control: Strategies to reduce hot flashes and premenstrual mood swings. Biofeedback, 31(3), 20-24.
Johnson, L.F. & DeMeester, T.R. (1981). Evaluation of elevation of the head of the bed, bethanechol, and antacid foam tablets on gastroesophageal reflux. Digestive Diseases Sciences, 26, 673-680. https://www.ncbi.nlm.nih.gov/pubmed/7261830
Melissa. (2015). Why women fainted so much in the 19th century. May 20, 2015. Donloaded October 2, 1018. http://www.todayifoundout.com/index.php/2015/05/women-fainted-much-19th-century/
Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49.
Peper, E., Mason, L., Huey, C. (2017). Healing irritable bowel syndrome with diaphragmatic breathing. Biofeedback. (45-4)
Richard Harvey, PhD and Erik Peper, PhD
In a technologically modern world, many people have the option of spending 24 hours a day/ 7 days a week continuously interacting via telephone, text, work and personal emails or internet websites and various social media platforms such as Facebook, What’s App, Instagram, Twitter, LinkedIn and Snapchat. How many people do we know who work too many hours, watch too many episodes on digital screens, commute too many hours, or fill loneliness with online versions of retail therapy? In the rush of work-a-day survival as well as being nudged and bombarded with social media notifications, or advertisements for material goods, we forget to nurture meaningful friendships and family relationships (Peper and Harvey, 2018). The following ‘values clarification’ practice may help us identify what is most important to us and help keep sight of those things that are most relevant in our lives (Hofmann, 2008; Knott, Ribar, & Duson, 1989; Twohig & Crosby, 2009;. Peper, 2014).
Give yourself about 12 minutes of uninterrupted time to do this practice. Do this practice by yourself, in a group, or with family and friends. Have a piece of paper ready. Be guided by the two video clips at the end of the blog. Begin with the Touch Relaxation and Regeneration Practice to relax and let go of thoughts and worries, then follow it with the Value Clarification Practice.
Touch Relaxation and Regeneration Practice
Turn off your cell phone and let other know not to interrupt for the next 12 minutes, then engage in the following six-minute relaxation exercise. If your attention wanders during the practice, then bring your attention back to the various sensations in your body.
- Sit comfortably, then lift your arms from your lap, holding them parallel to the floor and tighten your arms while making a fist in each hand. While holding your fists tightly closed, keep breathing for a total of 10 seconds before dropping the arms to your lap while you relax all of your muscles. Attend for 20 seconds to the changing sensations in arms and hands as they relax. If your attention wanders bring it back to the sensations in your arm and hands.
- Tighten your buttock muscles and bend your ankles so that the toes move upwards in a direction towards your knees. Keep breathing and hold your toes upwards for 10 seconds and then let the toes move down to the floor, letting go and relaxing all the muscles of the lower trunk and legs. Feel your knees widening and feel your buttock muscles relaxing. Continue attending to the body and muscle sensations for the next 20 seconds. If your attention wanders bring it back to the sensations in your body.
- Tighten your whole body by pressing your knees together, lifting your arms up from your lap, making a fist and wrinkling your face. Hold the tension while continuing to breath for 10 seconds. Let go and relax and feel the whole body sinking and relaxing and being supported by the chair for the next 20 seconds.
- Bring your right hand to your left shoulder. Over the next 10 seconds, inhale for three or four seconds and as you exhale for five or six seconds, with your right hand stroke down your left arm from your shoulder to past your hand. Imagine that the exhaled air is flowing through your arm and out your hand. Repeat at least once more.
- Bring your left hand to your right shoulder. Inhale for three or four seconds and as you exhale for five or six seconds with your left hand stroke down your right arm from your shoulder to past your hand. Imagine that the exhaled air is flowing through your arm and out your hand. Repeat at least once more.
- Bring both hands to the sides of your hips. Inhale for three or four seconds and as you exhale for five or six seconds stroke your legs with your hands from the hips to the ankles. Imagine that the exhaled air is flowing through your legs and out your feet. Repeat a least once more.
- Close your eyes and inhale for three or four seconds, then hold your breath for seven seconds slowly exhale for eight seconds. Imagine as you exhale the air flowing through your arms and out your hands and through your legs and out your feet. Continue breathing easily and slowly such as inhaling for three or four seconds, and out for five to seven seconds. If your attention wanders just bring it back to the sensations going down your arms and legs. Feel the relaxation and peacefulness.
- Take another deep breath and then stretch and continue with the Value Clarification
Value Clarification Practice
Get the paper and pen and do the following Value Clarification Practice.
- Quickly (e.g. 30-60 seconds) list the 10 most important things in your life. For the activity to work, the list must contain 10 important things that may be concrete or abstract, ranging from material things such as a smart phone or a car to immaterial things such as family, love, god, health… If you need to, break up a larger category into smaller pieces. For example, if one item on the list is family, and you only have seven items on the list, assuming you have a family of four, then identify separate family members in order to complete a list of 10 important things.
- To start off, in only 10 seconds, please cross off three items from the list, then explain why you removed those three. If done in a group of people turn to the person explain why you made these choices.
- Next, in only 10 seconds, please cross off three more, then explain why you kept what you kept. If done in a group of people turn to the person explain why you made these choices.
- Finally, in only 10 seconds, please cross off three more, then reveal the one most important thing on your list. Share your choice for the item you kept and how you felt while crossing items from the list or keeping them.
- When engaging with this type of values clarification practice, please remind yourself and others that the items on the list were never gone, they are always in your life to the extent that you can honor the presence of those things in your life.
We have done these exercises with thousands of student and adults. The most common final item on the list is family or an individual family member. Sometimes, categories such as health or god appear, however it is extremely rare that material items make it to the final round. For example, no one would report that their last item is their job, their bank account, their house, or their smart phone. It is common that people have difficulty choosing the last item on their list, often taking more than 10 seconds to choose. For example, they find that they cannot choose between eliminating individual family members. For those who find the activity too difficult, remind them that the exercise is voluntary and meant as a ‘thought experiment’ which they may stop at any time.
Reflect how much of your time is spent nurturing what is most important to you? In many cases we feel compelled to finish some employment priorities instead of making time for nurturing our family relationship. And when we become overwhelmed with work demands, we retreat to sooth our difficulties by checking our email or browsing social media rather than supporting the family connections that are so important to us.
Organize an action plan to honor and support your commitment to the items on your list that you value the most. If possible let other people know what you are doing.
- Describe in detail what you will do in real life and in real time in service to honor and support your relationships with the things that you value.
- Describe in detail what you will do, when you will do it, with whom you will do it, at what time you will do it, and anticipate what will get in the way of doing it. For example, how will you resolve any conflicts between what you plan and what you actually do when there is not enough time to carry out your plans?
- Schedule a time during the following week for feedback about your plans to honor and support the things you value.
Many people experience that it is challenging to make time to honor and support their primary values given the ongoing demands of daily living. To be congruent with our values means making ongoing choices such as listening and sharing experiences with your partner versus binging on videos or, using your smartphone for answering email or texting instead of watching your child play ball.
The values you previously identified are similar to those identified by patients who are in hospice and dying. For them as they look back on their lives, the five most common regret are (Ware, 2009; Ware, 2012):
- I wish I’d the courage to live a life true to myself, not the life others expected of me.
- I wish I hadn’t worked so hard.
- I wish I had the courage to express my feelings.
- I wish I had stayed in touch with my friends.
- I wish I had let myself be happier.
Take the time to plan actions that support your identified values. Feel free to watch the following videos that guide you through the activities described here.
Hofmann, S.G. (2008). Acceptance and commitment therapy: New wave or Morita therapy?. Clinical Psychology: Science and Practice, 15(4), 280-285. https://doi.org/10.1111/j.1468-2850.2008.00138.x
Knott, J.E., Ribar, M.C. & Duson, B.M. (1989). Thanatopics: Activities and Exercises for Confronting Death, Lexington Books: Lexington, MA. https://www.amazon.com/Thanatopics-Activities-Exercise-Confronting-Death/dp/066920871X
Peper, E. (October 19, 2014). Choices-Creating meaningful days. https://peperperspective.com/2014/10/19/choices-creating-meaningful-days/
Peper, E. & Harvey, R. (2018). Digital addiction: increased loneliness, depression, and anxiety. NeuroRegulation. 5(1),3–8. doi:10.15540/nr.5.1.3 http://www.neuroregulation.org/article/view/18189/11842
Twohig, M.P. & Crosby, J.M. (2009). Values clarification. In: O’Donohue & W.T., Fisher, J.E., Eds. Cognitive behavior therapy: applying empirically supported techniques in your practice. Wiley: Hoeboken, N.J., p. 681-686.
Ware, B. (2009). Regrets of the dying. https://bronnieware.com/blog/regrets-of-the-dying/
Ware, B. (2012). The top five regrets of dying: A life transformed by the dearly departing. Hay House. ISBN: 978-1401940652