SaveYourself.ca • Sensible advice for aches, pains & injuries
![[Picture of a man with a respirator, illustrating difficulty breathing.]](/resources/images/man-with-breathing-mask.jpg)
There are many causes for shortness of breath. Some are complex and serious, but there are also surprisingly simple and non-scary possibilities.
published 8/10/07, updated 5/02/12
One of the most commonly reported symptoms in my office is difficulty breathing. It is also one of the biggest diagnostic challenges. Like abdominal pain, dizzyness, or fatigue, breathing difficulties can have many different causes. However, at least two of those causes are minor, common, and treatable. If I can identify them, I can often help patients who are feeling short of breath:
It is downright dangerous for a massage therapist to diagnose shortness of breath — we do not have the skills to do so safely.1 A serious cause of shortness of breath could be missed. Please always alert your doctor about any difficult breathing, and make sure that there is no serious cause. If your doctor cannot find any explanation for the problem and sees no “red flags,” then you can pursue the less ominous possibilities. See the appendix below for a checklist of red flags.
Trigger points — better known as muscle knots — can cause shortness of breath. They are small patches of dysfunctionally contracted muscle tissue, a localized spasm. Trigger points are a huge topic: see the sidebar for an overview.
Trigger points are often located in the muscles of respiration. This may make it difficult and/or painful to move the ribs. Even the diaphragm itself can probably develop trigger points that make it feel weak and tired, and limit its range of contraction.2
Trigger points in the muscles of the throat, neck, chest and back may even be capable of interfering with the nervous system’s control of respiration.3
Trigger points may form in the respiratory musculature for reasons unrelated to breathing. Or they can arise in response to bad breathing habits: a chicken and egg problem. Do you get breathing trouble because you have trigger points? Or do you get trigger points as a symptom of breathing trouble? The answer is undoubtedly both. If there is an obvious problem in the area, such as an old shoulder injury, then it’s a good bet that the shoulder was the “chicken” that started it all, and it may remain the primary source of discomfort and muscular dysfunction in the area.4 In such a straightforward case, treating the trigger points caused by the old shoulder injury might just solve the problem.
On the other hand, if there is no obvious cause of discomfort in the area, but you are out of shape and sit slumped in a chair all day long, it would be a better guess that respiratory dysfunction was the “egg” that started it all, and the real challenge is to learn to breathe better.
Muscle trigger points can often be eased by self-massage or a professional therapeutic massage, or even just a warm bath, a holiday, or . The problem could be solved by a self-treatment as simple as digging with your thumbs into some aching muscles between your ribs. Voila — no more shortness of breath! I’ve seen that happen many times, and even experienced it myself. In fact, my own long personal experience with intercostal trigger points is one of the reasons I wrote this article — I’m all-too well-acquainted with this issue.
Or trigger point therapy could go poorly. It is definitely no miracle cure. Your mileage will vary. Trying to treat them could be an epic journey of rehabilitation, trying to deal with a complex array of trigger points that are both causing and caused by many factors, including really tricky ones like seriously dysfunctional breathing behaviour and intractable emotional factors.
To learn more about trigger points and how to manage them, see my advanced tutorial.
Respiratory dysfunction is usually just chronic shallow breathing. A lifelong habit of breathing shallowly is only a short hop away from being short of breath. Shallow, weak breathing is most a result of trying to breathe with the upper chest muscles instead of the belly and diaphragm. Such habits can easily become reinforced by the trigger points they cause — you get “locked in.”
Why would we breathe “badly” in the first place? Respiratory dysfunction is often driven by psychological and emotional factors.
Water pressure resists expansion of the rib cage and abdomen uniformly on all sides — and therefore it resists diaphragm contraction. Simply deep breathing while submerged to your chin is a simple way to challenge and exercise your respiratory musculature, and much greater resistance is possible with snorkels and breathing tubes. This and other breathing exercises are described in The Respiration Connection.
Water pressure resists expansion of the rib cage and abdomen uniformly on all sides — and therefore it resists diaphragm contraction. Simply deep breathing while submerged to your chin is a simple way to challenge and exercise your respiratory musculature, and much greater resistance is possible with snorkels and breathing tubes. This and other breathing exercises are described in The Respiration Connection.
The way we breathe is a powerful aspect of self-expression. “Emotional constipation,” anxiety, and other habits of mind are common causes of minor breathing difficulties, and perhaps even some serious cases.
The connection could be obvious: you may already know (or suspect) that you have a problem with anxiety, or serious chronic stress, or a deep-seated lack of self-confidence that you know makes you breathe shallowly.
It’s more likely that it will not be obvious, however. Shortness of breath usually sneaks up you slowly. The symptom can be subtle and so slow to develop that we don’t even realize there’s problem until all the contributing factors and bad habits and vicious cycles are too deeply entrenched to break free — the “boiling frog” problem.
There’s also a basic Catch-22 in life, a basic problem with being human, that keeps us from perceiving and correcting our own worst habits and their consequences: the trouble we get into is always, to some degree, a consequence of the lack of the very same awareness and skills we needed to avoid the trouble in the first place, or to deal with it. Since habitually shallow breathing is often also an avoidance mechanism — part of the way that we avoid dealing with certain stresses — the shallow breather is often naturally and strongly inclined to avoid coming to grips with the real issues!
These kinds of problems are identified late if ever, and often go along with a lack of self awareness and denial — it just goes with the territory. Sometimes we get the “wake up call” in the form of being short of breath enough to get nervous about it, at which point we may or may not realize that there’s a connection with lifelong mental habits.
Maybe you feel so stressed that it’s obvious that the stress is “squeezing” the breath out of you … or maybe it’s not. If you’re not sure, it’s time to ask yourself some hard questions: could that be me? Could I be “choking” myself?
Now … what to do about it? Here are some relevant self-help articles:
It’s nice that some patients may be able to find an easy solution to their shortness of breath, or at least be reassured that it’s relatively harmless. Unfortunately, serious causes of shortness of breath actually are also common, and you should go see your doctor no matter what. Here are some of the warning signs for conditions of greater concern:
Do you have episodes of shortness of breath along with wheezing and/or coughing?
Are you tired all the time, and do you look pale?
Are you tired all the time and do you have a dry cough, possibly with chest pain, and does your shortness of breath get worse when you exercise or do other physical activity?
Are your feet and ankles swollen, and is it harder to breathe when you lie down flat?
Have you worked in or around asbestos, wood dust, industrial fumes or in a coal mine?
Any of these symptoms could be associated with a slow, sneaky onset of a serious condition. For more help self-diagnosing, please see this page about breathing difficulties at familydoctor.org: