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Massage Today
September, 2002, Vol. 02, Issue 09

Breathing Fresh Air

By Keith Eric Grant, PhD, NCTMB

"Years ago, during a discussion about breathing, someone said to me, 'Do breathing work -- why? Don't we all breathe?' Of course we do. But the quality of our breathing is the point in question, not the fact that we breathe.

The quality of our breathing determines the quality of our lives: health, moods, energy, creativity - all depend on the oxygen supply provided by our breathing. But the pressures of our modern-day life have created an almost literally breath-less culture. How many of us are really living in a state of adequate respiration?"

- Carola Speads4

Breathing fresh air has literal and metaphorical significance. In the beginnings of the industrial revolution, little thought was given to the environment. As a severe result, the particulate air pollution in London from coal burning resulted in "killer fogs" from the 1800s into the 1950s.9 Since then, greater understanding and attention to the system as a whole has freshened the air. This is partly a change from perceiving everything as simple stand-alone machines, to understanding more of the interactions, feedbacks, and true complexity of systems. It is the change of viewpoint from the industrial revolution to the information revolution. The "fresh air" of a wider perspective can contribute significantly to the literal freshness of the air.

The somatic consideration of breathing fresh air returns us to thoughts from last month's column. I brought up the effects of chronic shortening of our anterior line, including compaction of our ribcage and dysfunctional breathing patterns. Philip Greenman notes that alteration in ribcage function can negatively impact respiratory activity, circulatory activity (arterial, venous, and lymphatic), and neural activity.3 During inspiration, as the diaphragm contracts and descends toward the pelvis, the ribs should elevate and expand using secondary muscles of respiration.1,3,6 The reverse occurs during expiration. Lengthening the anterior line restores space for the ribs to function, but does not automatically restore function. Art Riggs comments on working with clients to correct their breathing patterns:7

"Teaching a client to belly breathe as opposed to thoracic breathing is very helpful to ease strain to overworked scalenes and shoulder muscles which are working too hard to lift the ribs. However, make certain that your instructions to breathe to the belly are not misinterpreted. Some new students of abdominal breathing overemphasize the new pattern and lose the ability of the chest to expand. Not only should the belly expand on the in-breath, but the breath should then continue up past the costal arch, and the ribs should expand also.

"Working with the diaphragm can help make it possible for clients to take full breaths. It is important to open the area with preparatory work on the chest and abdominal muscles, and having the client bend the knees will soften the abdominal area for easier accessibility. Work slowly; have a dialogue with the client, and don't be afraid to separate from clients to give them time to recognize and adjust to the changes in breathing patterns for several minutes."

Sometimes, especially in relation to chronic postural patterns, the motion of one or more ribs can become restricted - fixed in either exhalation or inhalation. Directly working the soft tissues of the thoracic regions around the costotransverse, costovertebral, costochondral, and sternochondral regions is a first step toward restoring movement.5 Additional steps can involve direct work on the deep intrinsic muscles of the spine, gentle movements of the ribcage, and gentle resistance against breathing in the manner of post-isometric relaxation.5,7 Gentle resistance techniques can also be used to help a client become aware of and relearn breathing patterns.7

Breathing fresh air also has the metaphorical meaning of taking a new path in looking for solutions to well-known problems. One such problem comes in seeking ways to reach out and help at-risk and disadvantaged segments of our population to help themselves. I've recently become involved in such a project via the Touch Health Association, the community outreach agency of the McKinnon Institute at which I've long been teaching massage.8

Many young mothers are unaware of their children's needs because they lack maturity and/or education to pick up on their cues. An infant massage training program, now in its own gestation, will teach disadvantaged mothers to touch their children in a healthy/healing way that improves infant development and increases their familiarity and comfort with appropriate touch. It is planned that, as these women complete their training in massage therapy, they will be hired through the non-profit agency to bring massage and appropriate touch back to their own communities. We will make use of the community knowledge the young mothers already have and the trust they can access from being part of the community served. The focus of the project is to create sustainable job options for young mothers as well as increase availability of massage to underserved populations.

Much of the coursework is based on results of developmental research from the Touch Research Institute (TRI). In many cases the trainees will not be persons fluent in academic learning and assessment methods - chalk and talk and standardized tests won't cut it. The project will have to move both to use of active visual media and to an experiential/kinesthetic mode of teaching topics such as anatomy.1,6 Assessment will need to be done directly within the context of practice.

What I'm describing is without a doubt at odds with many existing state practice acts - laws written and passed without a thought of using massage as a tool for community intervention. The pursuit of "credentialism" embodied in such laws can have needless impacts on those already disadvantaged.2

"Credentialism is a term sometimes used to describe the promotion of formal qualifications above and beyond those necessary to perform a job. It amounts to promotion of over-training. The required additional training serves as a barrier to people obtaining jobs which they could otherwise obtain and do successfully. This can create a kind of low-skill unemployment trap that falls most harshly on the least fortunate sections of society."2

Such laws were written by people and can be changed by other people. Advocate such change to colleagues and legislators when licensing acts are either being initially considered or are up for a review of need and efficacy. Cherish and preserve the flexibility you do have, working with nonprofit resources and government agencies to create touch-based outreach programs. By caring enough to participate, we can create a breath of fresh air in how we reach out as massage therapists to improve community and culture and stem the tides of despair and violence.


  1. Calais-Germain, Blandine, 1993: Anatomy of Movement, Eastland Press.
  2. Cutbush, Greg, and Greg Martin, 2000: Professional Regulation: Its Impact on Rural Australia, ACIL Consulting Pty Ltd, (
  3. Greenman, Philip E., 1989, Principles of Manual Medicine, Williams and Wilkins.
  4. Speads, Carola, 1986: Ways to Better Breathing, in Bone, Breath, & Gesture - Practices of Embodiment, Don Hanlon Johnson ed., North Atlantic, 1995.
  5. Maitland, Jeffrey, 2001: Spinal Manipulation Made Simple -A Manual of Soft Tissue Techniques, North Atlantic.
  6. Olsen, Andrea, and Caryn McHose, 1991: Bodystories - A Guide to Experiential Anatomy, Station Hill Press.
  7. Riggs, Art, 2002: Deep Tissue Massage: A Visual Guide to Techniques, North Atlantic Books, ISBN 1-556-43387-5, (
  8. Touch Health Association, (
  9. Urbinato, David, 1994: London's historic "Pea-Soupers", EPA Journal, (

Click here for previous articles by Keith Eric Grant, PhD, NCTMB.


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