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Incorporate Breath to Enhance Massage and Bodywork

by Bethany Ward & Larry Koliha

Breath is with us from moments after we are born to the moment we leave this earth. The average adult takes about 16 breaths per minute, about 960 breaths an hour, and over 23,000 breaths a day. Breathing is such an essential part of life that it is easily overlooked it as a means to creating real change for clients.

But including client’s breath in massage and bodywork assessment and treatment can transform your work. Pointing you in directions that you might not have considered otherwise, addressing breath patterns often uncovers underlying problems. Additionally, teaching clients about breath gives them tools to continue affecting change outside your office. In our workshops, we often use breath to facilitate myofascial interventions. Let’s look at some of the things you can do to start addressing breath right away.

Traumatic events or continuous pain often affect breathing patterns. Clients who are in pain may unconsciously hold their breath, extending a pause after inhalation. Although this often starts while clients are experiencing pain, it is common for the pattern to continue long after pain has resolved.

Full exhalations

A good approach to breath work is to encourage clients to focus on full exhalations. Lying supine with knees bent and feet on the table, help the client exhale fully so the lower abdominal area gently and smoothly dips toward the front of the spine. Many people never experience the benefits of a full exhalation. When we do so, more oxygenated air comes in and a naturally full inhalation occurs. Encourage clients to allow for a quiet pause after the end of exhalation. At home, they can practice periods of calming breath, making exhalations approximately twice as long as inhalations.

As you learn to pay more attention to breath, you’ll find that many clients hold their breath away from areas of discomfort, or areas that they don’t trust. The latter case is common with clients who have had an injury that has healed. Reducing breath in an area, creates still areas in the body where things do not move. Health requires movement. If this pattern continues, fascial restrictions will start to build up and eventually cause soft tissue changes that limited range of motion.

Three-dimensional breath

Watch your client breathe without telling them you’re doing so. Do you see expansion of the chest and torso in all dimensions? You should see the body expand from front to back, side to side, and up and down. If you see an area that stays still, put your hands on both sides of the body and ask the client to breathe into this space. You can also ask for breath into this area during your normal soft tissue interventions.

The interplay between posture and breath

As you get more comfortable looking at breath, widen your view and start noticing how clients’ body postures are related to breath. When you take into account whole-body patterns, you will often address underlying causes for long-standing conditions. To assess the comingled relationship between breath and posture, observe your client standing and ask yourself:

  • Are the arms pulled toward neck or ribs? You may need to work forearms, shoulder girdle or neck.
  • Does breath expand evenly through abdominal and thoracic spaces? If not, you may need to free the ribcage and/or educate the client on breathing patterns.
  • Is there a holding in the pelvis or legs? Address any pelvic tilts or shifts and the leg patterns that accompany them.

All of these postural patterns can significantly affect breath. Conversely, breath patterns can influence alignment.

Holdings in the arms and legs have a strong affect on breath, so addressing them first can ease the entire system. When you create your treatment plan, consider working appendicular to axial. After working with arms and the legs, address the ribs and head, and finally work directly with the spine.

Incorporating breath in interventions

When incorporating breath work into manual techniques, combining imagery and a teamwork approach often get the best results. When we ask a client to breathe in an unfamiliar area, it can interrupt habitual sensory patterns and contribute toward myofascial release. Some of the most effective places to ask a client to breathe through may not be anatomically possible, but still trigger significant tissue changes. This is where imagery comes in.

An effective cue that works well is the image of a breathing hole. Cue the client to, “Imagine you can breathe in and out through an opening in your palm [or sole of the foot].” With the head, a fun image is the idea of breathing through a blowhole like a porpoise. This is just one technique. Keep your imagery varied and be creative.

Remember that you are dealing with both structural restrictions, which require manual interventions, and functional patterns, which often require movement re-education. Learning to differentiate and respond appropriately will achieve the best results.

When you incorporate breath into your bodywork assessment and treatment, you learn to pay attention to whole-body relationships. This is often what’s needed to help common chronic conditions such as neck and low-back pain. If a client keeps coming back with the same nagging problems, take a moment to look at their breath and consider it’s global effects on their structure. This perspective often uncovers underlying issues that, when addressed, allow the body to heal itself. When this happens, you and your client will both breathe a lot easier.   

Bethany Ward and Larry Koliha are members of the faculty, which offers seminars internationally. They are returning to Australia to present at this year’s Association of Massage Therapy, Ltd. Annual Conference in Coffs Harbour, following up with myofascial workshops in Perth, Canberra and Sydney during November. To register or learn more about these trainings, contact 02 9211 2441 or [email protected] or download the registration form at Bethany and Larry are Certified Advanced Rolfers and faculty members at the Rolf Institute of Structural Integration. Their websites are and

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