Use Your Breath to Be a Better Massage Therapist, #2 of 5

*this is a series of connected blog posts about how to cultivate an awareness of your own breath, and your client’s breath, in order to give a more effective massage. 

this is the second post in the series.*


Noticing the Breath

The other day, a new client emerged from my treatment room and said, “That was great! I never breath during a massage.” Her remark was revealing. She was, of course, wrong: she is always breathing, whether she intends to or not, just like all of us beings who are not yet dead. And yet her remark was more incisive than she realized, revealing her disconnection from, and obliviousness to, what is happening inside of her own body. 

After a decade of massaging and teaching, I think the same is true of most of us therapists. We are so eager to do a good job, so eager to help and to heal, that all too often we “never breath” while we work. As a result, we are missing out on a terribly profound therapeutic tool, and doing a disservice to our career longevity. 

A disclaimer: as I tell the therapists in my continuing education classes, I am an expert at nothing. I am not trained in any particular breath-related school of thought, and I do not presume to know the right way to breath. Rather, I am pretty sure that there is no one right way for all of us to breath. There are many wonderful schools of thought, developed over thousands of years, about ways to refine the breath; I will leave such specific recommendations—the proper ratio of inhalation to exhalation, or when to use the mouth and when to use the nose—to the experts. Rather than telling you (and our clients) how you should be breathing, I want to cultivate, first and foremost, a more subtle awareness of how we are—and are not—currently breathing, and of what happens, in both our work and the rest of our lives, when we grow beyond our habits and let our bodies breath as they are designed to.

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Like the best things in life, using the breath in your sessions—what I call “massaging with the breath”—is quite simple, but grows in complexity and satisfaction the more you practice. Working with the breath means simply noticing how the client is (and is not) breathing, and then using all of the great techniques you already know—plus a few adjustments and a few verbal suggestions—to guide him or her towards a more effortless breath. 

The most fundamental shift we must make is to let the client’s body guide our work. We often believe we have to work hard in order to make a difference, and thus we often try to force the client’s body to change in the way we think is best. Attending to the breath reveals that the belief we can fix a client is counterproductive; our clients grow more, and in beautiful and unexpected ways, when we awaken the capacity to change that is already within them, rather than forcing change onto them. What is often most difficult about massaging with the breath is that it requires you to work less, rather than more.

Let me describe how massaging with the breath manifests in a session of mine, so that you can see how you might adapt this practice into your own work. There are three steps. The first step is to become aware of how your client is breathing as you work on him. The second step is to make your client aware of his own breathing. The third step is to show your client—as we’ll see, through your touch and through a bit of talk—how he can find a breath that is fuller, and easier, and that will help him feel better.

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First step: becoming more aware…

In a typical session, I begin—like most of us, I am guessing—with compression to the client’s back. Just like you, in this first minute or two I am assessing the quality of the client’s tissues; but just as important, I am assessing the quality of his breath. This sounds fancy but is really quite simple: I am just noticing what parts of his back move, and which parts don’t. 

What you’ll find, as you compress and observe, is that the ways that we breathe are as varied as the shapes of our bodies. Any generalizations are thus difficult to make. That said, one pattern is especially common. When my clients step away from their busy lives and lie down on my table, their breathing is typically shorter and faster than it wants to be, and requires more effort than is necessary. To put it simply, for many clients, breathing is harder than it should be; breathing is yet another kind of work.[i]

I suspect the same is true of many, if not most, of the people you see, too. As you compress your next client’s back, and begin to observe movement alongside musculature, what you’ll likely find is that on the inhalation, the upper back moves just as much, if not more, than the lower back and abdomen. The ribs will push up against your hands as he inhales; often you can even feel the muscles of the shoulders and the neck contracting, pullingthat next breath into the body. Depending on the exact pattern of muscle recruitment, this can be considered “apical” breathing, or “paradoxical” breathing, or just plain “inefficient” breathing.[ii]

No matter the particular pattern, the client is working harder than he needs to. (The irony is that the client is rarely aware of the unnecessary effort he is expending to force that inhalation, even though he is painfully aware, as we shall see, of the various symptoms that emerge as a result.) In each of these patterns the client is using the secondary, or accessory, muscles of respiration to force that inhalation, rather than allowing the breath to happen passively, via the unconscious activation of the diaphragm. Those secondary muscles are a broad group that wraps the ribs, shoulders and neck, from the sternocleidomastoid to the scalenes, from the pectoralis minor to some of the intercostals.[iii]Recruitment of these secondary muscles is necessarily to expand the rib cage quickly and significantly, and thus is essential when we are doing aerobic activity, whether running to catch the bus, or in the case of our prehistoric ancestors, running from that lion on the savannah. And yet that recruitment is terribly counterproductive for the vast majority of our daily lives, when we are not fleeing predators, but rather, sitting on our butts.

This kind of unnecessary effort means that for most of us, our musculature is working harder than is needed, all the time. That effort-full breath is a vicious circle; once we have unconsciously learned this pattern, it reinforces itself. When we are awake and when we are asleep, whether we are in a stressful meeting or whether we are “relaxing” on the couch watching TV.

You’ll feel this cycle as you assess your client. After you observe where and how the client’s back expands on the inhale, notice what happens on the exhale. The client’s body will begin to sink as the breath leaves the body, but then more often than not, a few seconds later comes a moment when the client stops her own exhalation. For no apparent reason, and without any conscious awareness, she reverses direction—she sucks the breath in and begins that effort-full inhalation once again. Some clients—swimmers or singers or those versed in yoga—tend to let the exhale empty more fully than others. But rare is the client of mine who allows her body to sink all the way down to the natural endpoint of the exhale.  We seem nearly unable to simply let our breath do what it was designed to do—function with the minimum effort needed in each particular situation. Instead, like a meddlesome boss or a helicopter parent, we insist on getting in the way of our own bodies, often without even realizing that effort-full pattern we’ve created, or its long-term costs.

The more clients you assess in this way, the more you’ll glimpse this epidemic of unnecessary effort that is all around us. After all, by some estimates we take 20,000 breaths a day. For the vast majority of each day, we are not engaged in aerobic exercise, or doing other activities that require the use of those secondary muscles. So that means that each of us stuck in this habitual cycle is contracting these muscles of the upper back and neck 20,000 more times than we need to.[iv]Every single day! Is it any wonder that so many of our clients—even though they work in a wide range of jobs, and have a great variety of body types and postures and injury histories—are all complaining about the same aches and tension in their upper back and neck? As Paul Ingraham writes, “these muscles aren’t built for routine respiration, and they exhaust and eventually injure themselves. If this occurs, it has a cascade of uncomfortable consequences over time.”[v]

Moving beyond the musculature, the consequences of our habitually hurried breath are even more devastating for our nervous system. As mentioned, that short, effort-full breath is inextricably linked to the “fight or flight” instinct of our sympathetic nervous system. Indeed, Tom Myers refers to this kind of chest breathing as a “sympathetic stimulus.”[vi]This aspect of our nervous system—which makes our heart race, which diverts blood from our internal organs to our extremities, which spikes our adrenaline—has helped keep the human species alive for thousands of generations (see: running from the lion on the savannah). But that state of vigilance is not designed to be our norm. A life dominated by the sympathetic nervous system is a rough one, priming us for everything from heart disease and hypertension to depression and ulcerative colitis. Not to mention that pervasive, looming feeling of stress and tightness that we see in so many of our clients.[vii]

But from this morass, there is hope. Each of us has developed our habits for a reason—even those counterproductive ones. Once we recognize these habits, we can un-develop them—we can all learn to inhabit our bodies anew. That’s where massaging with the breath comes in. Though we don’t usually think about our massage sessions as being about our breathing, in nearly every session we are reckoning with the tightness and pain and tension that is propagated by this disordered, effort-full breathing; by following these three steps, we can address at least one of the roots of the problem at the same time that we reckon with the symptoms. 

We’ll talk about those next steps in the next blog posts.


[This post is adapted from “Breath—Your Most Powerful Tool,” Massage & Bodywork, May/June 2016. With my thanks to the ever-marvelous Leslie Young, editor of Massage & Bodywork, for her enduring support.]

[i]“We are a society of shallow breathers: afraid of moving our bellies, afraid of expressing ourselves, living our lives in chairs, and stressed out by our busy minds. Instead of breathing with the diaphragm, people tend to breathe with upper body musculature that is inadequate to the task, with a cascade of musculoskeletal consequences and vulnerabilities.”

Paul Ingraham, “The Respiration Connection: How dysfunctional breathing might be a root cause of a variety of common upper body pain problems and injuries,” (accessed December 1, 2015).

[ii]For more on the “diaphragmatic” and “apical” concepts, see Fiona Rattray & Linda Ludwig, Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions(Toronto: Talus Incorporated, 2000), 34. For the “inefficient” concept, see Leslie Kaminoff & Amy Matthews, Yoga Anatomy (Second Edition) (Champaign, IL: Human Kinetics, 2012), 16; see also, Paul Ingraham, “The Respiration Connection.”

[iii]Frank Netter, Atlas of Human Anatomy (Third Edition) (New York: ICON Learning Systems, 2002), 191.

[iv]Rattray & Ludwig, 33. “The average person breathes 12 to 15 times per minute or 20,000 times per day. Inefficient breathing patterns can lead to dysfunction, both structurally and physiologically.”

[v]Ingraham, “The Respiration Connection.”

[vi]“Fascial Release Technique: Part II, Opening the Breath and Shoulders,” webinar, (accessed December 3, 2015). 

[vii]James P. Fisher, Colin N. Young, and Paul J. Fadel, “Central Sympathetic Overactivity: Maladies and Mechanisms,” (accessed December 8, 2015).