The Surprising Link Between How You Breathe and Your Stress Levels

Stress is something we all face, and the causes are often familiar: work demands, family issues, financial strain, and health concerns. But there’s another, often overlooked factor that can significantly contribute to heightened stress levels—your breathing.

In recent years, research in athletic physical therapy has revealed that the way you breathe plays a critical role in your body’s stress response. According to Seth Oberst, DPT, the primary modes of breathing—through the mouth or through the nose—can either exacerbate or help mitigate stress.

Mouth Breathing vs. Nose Breathing: What’s the Difference?

At first glance, it might not seem like a big deal whether you breathe through your mouth or your nose, but the two are far from equal in terms of their impact on your body.

Mouth breathing, which many people subconsciously default to, can actually increase stress levels in several ways:

1. Head Posture and Airway Alignment
When you breathe through your mouth, your head tends to jut forward in an effort to keep your airway open. This seemingly small change in posture initiates a cascade of negative effects that ripple through your entire body. Poor posture can lead to chronic tension in the neck and shoulders, further aggravating stress.

2. Reduced Nitric Oxide Intake
When you breathe through your nose, your body naturally produces and mixes nitric oxide into the air you inhale. This compound helps dilate your blood vessels, allowing for better oxygen circulation and supporting your immune system. Mouth breathing, on the other hand, bypasses this nitric oxide production, forcing you to take in larger quantities of air to compensate—an inefficient process that taxes your system.

3. Over-Activation of the Sympathetic Nervous System
Breathing through the mouth tends to increase activity in the sympathetic nervous system—the part of your body responsible for the “fight or flight” response. This system, when overstimulated, can lead to heightened stress, faster heart rates, and increased muscle tension. Over time, this constant state of over-activation can make it harder to relax, leaving you feeling perpetually on edge.

4. Disrupted Sleep and Restless Nights
You might think that physical or mental exhaustion would automatically lead to a good night’s sleep, but mouth breathing can actually disrupt your ability to rest properly. Because mouth breathing is less efficient at delivering oxygen to the brain, you may find yourself tossing and turning at night, waking up still feeling tired and unrested. This lack of quality sleep further exacerbates stress levels, creating a vicious cycle of fatigue and tension.

The Power of Nose Breathing

In contrast to mouth breathing, nose breathing can have a profoundly calming effect on both your body and mind. The nose acts as a natural filter and humidifier for the air you take in, warming it and removing harmful particles before it reaches your lungs. Nose breathing also activates the **parasympathetic nervous system**—the “rest and digest” system—which helps reduce stress, lower your heart rate, and promote a state of calm.

Moreover, because nasal breathing supports better oxygen exchange and reduces the need for over-breathing, it prevents the shallow, rapid breaths that are often associated with anxiety and panic. Over time, habitual nose breathing can help to lower baseline stress levels and enhance your overall sense of well-being.

How to Shift from Mouth Breathing to Nose Breathing

If you’re accustomed to breathing through your mouth, switching to nose breathing might feel uncomfortable at first. But with practice, you can retrain your body to make nasal breathing your default mode.

Start by dedicating 3–5 minutes a day to intentional nose breathing. Find a quiet space, close your mouth, and focus on taking slow, deep breaths in and out through your nose. You may feel resistance or a bit of difficulty at first, especially if your nasal passages are slightly congested or if you’ve developed the habit of shallow mouth breathing. Stick with it—the goal is to gradually build comfort and strength in your nasal breathing muscles.

The Long-Term Benefits of Nasal Breathing

Incorporating nasal breathing into your daily routine can lead to a host of long-term benefits, including:

– Reduced stress and anxiety
– Improved sleep quality
– Better focus and mental clarity
– Enhanced athletic performance
– Lower blood pressure and heart rate
– Decreased muscle tension and fatigue

Need Help? We’re Here for You

If you’re struggling with stress or want to improve your breathing technique for overall wellness, our experienced athletic physical therapy team in Bethesda and McLean can help. We can work with you to develop personalized breathing exercises and techniques that will not only optimize your breathing but also support your physical and mental health.

Remember, while you can survive by mouth breathing, thriving requires that you breathe with intention. Take control of how you breathe, and in turn, take control of your stress.

Make the most of your visit: 3 questions to ask your physical therapist

Whether you’re attending in-person or virtual physical therapy, your success largely depends on how engaged and involved you are in the process. A physical therapist’s role is to identify issues, develop a personalized treatment plan, and guide you toward recovery. However, as the patient, your active participation is just as crucial. Asking the right questions during your sessions can empower you to take control of your health and recovery journey.

Here are three essential questions to ask your physical therapist to ensure you get the most out of your sessions in McLean or Bethesda.

1. Why Did This Happen, and How Can We Prevent It from Happening Again?

One of the key goals of physical therapy is not just to treat the symptoms but to address the root cause of your pain or injury. Whether it’s a recurring injury, chronic pain, or post-surgery rehabilitation, understanding *why* the issue occurred in the first place is crucial to preventing it from becoming a long-term or recurring problem.

By asking your physical therapist about the underlying cause, you’ll gain insights into the factors that contributed to the issue—whether it’s poor posture, repetitive strain, muscle imbalances, or even lifestyle habits. With this knowledge, you and your PT can develop a plan to not only treat the current problem but also take proactive steps to ensure it doesn’t happen again. This might include correcting your movement patterns, strengthening weak areas, or making adjustments to your daily activities.

2. What Should I Be Doing at Home to Support My Recovery?

Physical therapy sessions are often limited to a few hours per week, but your recovery continues long after you leave the clinic. The majority of your time will be spent outside of the physical therapist’s office, which is why it’s critical to know what exercises, stretches, or adjustments you should be doing at home.

Ask your physical therapist for a clear and detailed home exercise program that complements your in-person treatment. This plan should be tailored to your specific needs and capabilities, ensuring you’re doing the right movements to support your progress. A good physical therapist will not only show you the exercises but also explain why they are important, how to perform them correctly, and how often you should do them.

On the flip side, it’s equally important to know what not to do. Certain activities or movements could slow down your recovery or even worsen your condition. By clarifying both the “dos” and “don’ts,” you’ll feel more confident in managing your rehabilitation at home.

3. How Can You Measure and Ensure I’ll Make Progress?

The ultimate goal of physical therapy is to make meaningful progress toward your recovery goals, whether that’s reducing pain, improving mobility, or returning to your favorite activities. However, many healthcare systems focus on generic benchmarks, such as returning to basic activities of daily living (ADLs) or reaching a general “baseline.”

While these objectives are important, physical therapy should go beyond just meeting minimum standards—it should be about helping you achieve your personal goals. By asking how your progress will be tracked and measured, you set the expectation that the focus is on your individual needs, not just generalized outcomes set by insurance companies.

Your physical therapist should provide a clear roadmap for your recovery, outlining the specific milestones and indicators they’ll use to track your progress. This could include improved range of motion, increased strength, reduced pain levels, or functional abilities tied to your lifestyle. Regular check-ins and reassessments will ensure that your treatment stays on track and is adjusted as needed.

Physical therapy is a partnership, and the more actively engaged you are, the better your results will be. By asking thoughtful questions and staying informed, you’ll not only deepen your understanding of your treatment plan but also enhance your ability to manage your health outside of therapy sessions.

Fact or Fiction: Do our bodies actually fall out of alignment?

We are excited to begin a series of posts discussing common myths in the realm of athletic physical therapy. Today’s myth commonly applies to back pain physical therapy as well.

Many of our patients have been told that their body may be “out of alignment”, or that their joints need to be “re-aligned.” Unfortunately, this is not the greatest advice.

Human beings are never in a static position. Even at rest, the simple act of breathing creates movement. By definition, being in alignment means that our bodies are in a straight line, or that all parts of our body are consistently in the appropriate relative positions to one another.

We cannot consistently be in alignment because we are always moving. If our body was constantly aligned, we would be unable to move anywhere.

Your body can feel as if it is out of alignment when you overuse or rely upon specific movement strategies or body positions. This can happen for a myriad of reasons and results in feelings of stiffness and discomfort that often temporarily feel better with an adjustment.

An adjustment can be helpful if the causes of stiffness or discomfort are also addressed. The root causes of stiffness or discomfort are typically addressed by focusing on movement limitations that are present.

Any relief provided by an adjustment will be temporary when the root cause of the discomfort or stiffness is left unaddressed. Check out the article below for some activities that may help!

3 Home Exercises to Help Your Back Pain

We hope that this provided some insight into a common rehab myth. Stay tuned for more to come!

Could this be the missing piece of your marathon training?

In a previous blog post, we introduced mat Pilates and how it helps people that are struggling with back pain. However, many athletes use Pilates to improve other aspects of their performance and CHP’s own, Dr. Ciara Petry, uses it as part of her physical therapy treatment sessions.

As you know, Bethesda and Chevy Chase are packed with athletic people and runners of all levels. Many of these runners are preparing for a variety of races. Running volume increases as a runner prepares for a race, which increases the need for cross training. Cross training allows runners to enhance qualities that improve running performance. However, it is important to avoid adding more pounding to the body in the process.

At Cohen Health and Performance, we have found Pilates to be incredibly helpful in this regard. Weekly supplementation of Pilates training helps to improve performance and/or reduce the risk of running related injuries.

Pilates includes low impact and multi-planar movements that enhance core stability, mobility, and other foundational components necessary for healthy running.

In an article published in 2018, Finatto et al performed a study measuring the effect of a 12-week Pilates mat program on running performance. The participants in this study were separated into 2 groups. Both groups participated in a run training program, however one of the groups also participated in classic mat Pilates training 2x/week for 1-hour per session. The study found that the Pilates group had been more resilient to fatigue when running. It was also found that runners in the Pilates training group significantly improved their 5-km times, thus suggesting that distance runners can transfer the gains made in Pilates to running!

Integrating Pilates into a runner’s performance training just 1-2x/week can improve running efficiency and performance. How cool is that?!

Here at CHP, we help our athletes conquer injury and optimize performance. Reach out today to schedule a running analysis with one of our performance physical therapists and to Dr. Ciara Petry, a certified Mat Pilates instructor, for personalized Pilates sessions!

Article for Reference: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194057

Why Some Warmups Aren’t Useful

As performance physical therapists in Bethesda and Chevy Chase, we work within a very knowledgeable and active community. Our clients and patients understand the importance of warming up.

Warming up is commonly touted as essential for anyone wishing to avoid injury during exercise, performance training, or running.

We agree with this statement; however, warmup routines are often implemented in a non-productive way.

There is a time and place for everything, however this does not mean that you need to stretch, roll around on the ground, and perform “activation” drills prior to being ready for exercise.

In addition to increasing total body temperature, a warmup routine should prepare the body for the specific workout that is going to take place. For this reason, we call warming up “movement preparation.” The body is being prepared to move!

Movement preparation should include drills that train the skills necessary for the day’s workout. Many times, these drills will look similar to the exercises within that day’s work out.

If you are getting ready to run, perform activities that practice things necessary to run effectively. If you are going to lift weights, practice movements similar to the lifts you are going to perform (ie. If you are going to squat, then squat in your warmup!).

This advise applies regardless of whether you are healthy, injured, in performance physical therapy, or training for performance.

Below are 2 drills that we often use during movement preparation prior to running. Each drill practices single leg balance, the ability to shock absorb on one leg, and trunk rotation. These are all attributes necessary for running.

Single leg knee to chest
Forward lunge with cross connect

Furthermore, if you have been sitting at a desk for the majority of the day, you may need a more comprehensive warmup. On the other hand, if you have an active job requiring you to move in a variety of different ways then your warmup may not need to be as comprehensive.

Movement preparation is necessary, however it is essential to be purposeful, rather than mindlessly performing the same thing before every workout.

2 Simple Drills to Improve your Running Times

As a dedicated runner you likely have suffered an injury at some point. Perhaps it forced you to seek performance physical therapy. Whether you realized it or not, this injury limited your ability to train effectively.

At CHP, we consistently help runners in Chevy Chase and Bethesda overcome injuries that otherwise would limit their ability to train, ultimately causing disappointing results.

There is not a one size fits all solution to helping all runners; however, we often discover that runners are limited by their hamstrings.

Are you concerned that hamstring stiffness or weakness could be limiting your performance?

Your hamstring is responsible for keeping your heel close to your bottom during the heel recovery phase of the running cycle. This portion of the cycle occurs as you bring your leg back underneath your body to prepare it to strike the ground again. The closer you can keep your heel relative to your bottom, the better! This allows you to efficiently move your leg faster through space, resulting in faster times. Below is a drill we prescribe to many runners to improve this attribute.

When running the hamstrings also need the ability to lengthen as the thigh is in front of the body. This should be achieved without drastically changing the position of the pelvis. Many runners struggle to maintain control of their pelvis as the hamstring lengthens. This increases the stress placed onto a variety of soft tissues through the lower body and alters foot strike position. Below is a drill to improve these capabilities.

A thoughtful and more scientific approach to training, specifically designed for runners is likely all that you need to drastically improve your running performance. It may not even require you to train any harder, just smarter!