An image of a person with their hand on their diaphragm, with the word "breathe" superimposed over it, is used to illustrate the concept of bringing your attention to your breathing.

When I sit or stand still and begin to attend to my client, I bring my attention to my breath, or practice conscious breathing. The physiological change process in the body depends on natural breathing, which is thwarted in the contemporary human, for numerous reasons.

Neurophysiologists tell us the importance of inhalation and exhalation influencing the autonomic nervous system (ANS). Breathe in and sympathetic tone raises the heartbeat. Breathe out and parasympathetic tone increases with the vagus nerve, lowering heartbeat.

Vagal maneuvers such as breathing techniques to stimulate the vagus nerve are very important. A crucial ingredient is direct awareness of the interior of the body by feeling what moves during inhalation.

Conscious Breathing

Breathing is meditation practice. One’s attention regularly returns via mindfulness to the breath in the abdomen as an object of concentration, with the posture of standing or sitting while working. We place our mind in the abdomen over and over and over again as these various layers and levels of tension in the abdomen begin to soften.

We constantly need to reboot our onboard computer. It is clear that when we notice our attention has been captured by our thoughts, we have forgotten this correct placement of the breath. We forget where our hands are or what they are doing.

Mindfulness returns our attention to the abdomen. Whenever working on the client’s abdomen, it is appropriate to ask them to breathe into the point of contact. It seems as if the abdomen and trunk have been squeezed like a water balloon while thinking too much—and with the natural instinct of mindfulness, the diaphragm and abdominal muscles remove their grip in the abdomen, allowing the water back down to its natural fulcrum of the kidneys and bladder. This improves neurovascular function.

The Original Breath

The motion of breathing starts at conception. There is expansion and there is contraction of a single-celled human being. To know the breath deeply is to sense its subtlety both inside and out. Conscious breathing practices generate a unified whole interconnected with the natural world.

Each breath is the original breath.

The breath of air in-forms and out-forms the shape of our body from the top of the head to the bottom of the feet with the action of the respiratory diaphragm and associated muscles of respiration. When we inhale, the physical body receives a supply of oxygen distributed via pulmonary circulation and the blood, and the removal of carbon dioxide when we exhale.

Oxygen delivery and carbon dioxide uptake happens in every capillary of the body. Even a single capillary is breathing—expanding and contracting. This ordinary breath is the favorite target of stress reduction strategies and breathing techniques from different schools and teachers.

With the enormous popularity of hatha yoga now, pranayama techniques gradually introduce a more subtle approach. Conscious breathing meets the evolving needs of the contemporary mind and body.

The popularity of mindfulness meditation helped usher in this needed degree of subtlety by getting people consciously paying attention to the body breathing. When I breathe, I first ask myself, “What am I aware of as I breathe?” Then I ask myself, “What moves?”

A Mindfulness Practice

Sensing the temperature and movement of the air coming in and out of the nostrils is a mindfulness practice that research says lowers stress. Directing one’s breath is consciously aiming one’s breath in relation to specific anatomy, such as up and down the front of the spine or the aorta.

This is a transition to what I call the belly breath, the directed placement of the breath in the lower abdomen to engage the transversus abdominus muscle. This muscle originates from its interdigitation with the respiratory diaphragm, attaches to the costal arch, the anterior superior iliac spine and inguinal ligament, as well as associated fascia in the lower back; specifically, the lumbar fascia.

Gradually, the diaphragm-transversus abdominus muscle relationship is sensed, followed by relaxation of the peritoneal cavity, which holds all the intestines via the fascia of the mesentery. Finally, the pelvic diaphragm can synchronize with the respiratory diaphragm for optimal abdomino-pelvic function.

These muscles and related fascia expand during inhalation and relax during exhalation. The abdomen naturally expands during an inhale. It is the normal and natural breath into the belly until it becomes normal without effort.

At a more subtle level anatomically, the breath into the lower abdomen is directed to the bifurcation of the abdominal aorta into the common iliac arteries. This is the area of the hypogastric plexi of the ANS. This place can be visualized as a large pearl of translucent light the size of a golf ball. It is where the neurovascular systems of the abdomen meet the pelvis.

 The belly breath leads organically to the slow breath or, with more concentration, by techniques such as coherent breathing and others associated with changing heart rate variability (every heartbeat is different), respiratory sinus arrhythmia, and vagal tone, the pacemaker of the heartbeat at 70 beats per minute.

Inner & Outer Healing

As is said in Genesis, “God formed the man from the dust of the ground and breathed into his nostrils the Breath of Life, and the man became a living being.” This is the birth of a whole new understanding of breathing necessary for the contemporary human to experience inner and outer healing with greater embodied awareness. The starting point is the therapist’s own attention to their breathing.

Every time I change hand positions while treating, I return my attention to my belly breathing. The essence of manual therapy practice is always returning attention to the abdomen and then feeling one’s heartbeat. Research is clear that the client naturally attunes their neurological and cardiovascular systems to the safety and empathy of the therapist who is aware of their breath and heartbeat. Such empathy is so easy to build with breath and heartbeat awareness.

As mentioned, the respiratory diaphragm interdigitates with the transversus abdominis muscle. During inhalation this muscle expands, pulling the lumbar spine anteriorly, begins to stretch the related abdominal fascia and moves the lymphatic fluid toward the cisterna chyli, which collects all the lymphatic fluid from the lower extremities, pelvis and abdomen. It is located close to the crura of the diaphragm in the posterior abdomen. It transfers all the related lymph to the left thoracic duct by the junction of the jugular and subclavian vein.

Every conscious breath we take enhances the movement of lymph and improves the function of the immune system.

In a typical, stressful body type, the lower lobes of the lungs are restricted by too much tension in the respiratory diaphragm, pleura and pericardium.

The vagus nerve is compressed and decreases vagal tone. Consequently, the upper lobes of the lungs must work harder to take more air in, since the majority of oxygen receptors are in the lower lobes. This causes paradoxical breathing with too much lift in the upper ribs, creating tension in the scalenes, the secondary muscles of respiration. Consequently, the heart must work harder.

Most Americans are metabolically unhealthy. This is a major consideration when treating the contemporary client. (And most clients are not breathing correctly.)

The expansion of the abdomen occurs on inhalation. I tend to focus on the inhalation into the belly because it tones the sympathetic nervous system, which can assist vasodilation of the endothelium in the entire vascular system. Most people have a damaged endothelium because of metabolic ill health, and the very first response of the vascular system is to lose vasodilation, which is regulated by the SNS via its neurotransmitter of nitric oxide.

The initial sense of breathing is simply bare attention on how the air comes into the nose, expands the body and then exits.

drawing of a woman meditating

Reconnect with the Exhale

One of the ways meditation is taught is to have a slight allegiance to the exhalation. This is to let go of too much thinking with the exhalation so a felt sense is developed of thoughts exiting back out into space with the breath.

Exhalation pulls the drain plug of our mind. When you notice too much thinking while working, reconnect with the exhale for a quick return to mind-body balance by increasing empathy.

This tones the heart via the vagus nerve. Right posture and right breathing with awareness of the heartbeat are an enormous playground of somatic and emotional empathy. This translates into our hands automatically. Our heart is in our hands.

Excerpted from chapter 22 in:“The Biodynamics of the Immune System,” by Michael J. Shea, Ph.D. © 2023 Healing Arts Press. Printed with permission from the publisher Inner Traditions International. Available on Amazon.

Michael J. Shea

About the Author

Michael J. Shea, PhD, is a licensed massage therapist in the state of Florida since 1976 (MA 3064). He is an expert in the field of craniosacral therapy and myofascial release. “The Biodynamics of the Immune System” upon which this article is based, is his seventh book following the success of “Myofascial Release Therapy, a Visual Guide to Clinical Applications.”