Integrative Medicine

Your Perception Matters

In a world of uncertainty it is always important to know what we don't know. In the world of health it is safe to say that we really don’t know enough. One thing that we are starting to get a grasp on is how very important our mindset and perceptions are in determining our health.

For many years now people have been aware of the “placebo effect.” In these studies, participants assume that the sugar pills they are taking are actually providing some type of therapeutic effect. The powerful influence of our mindset goes well beyond what we can comprehend. However, there are some poignant examples in fairly recent research that demonstrate how our brains can change the outcomes of our health.

Perception Alters Our Physiology

Consider this, in 2007, 84 hotel maids were divided into two groups. One group was instructed that their work alone was enough to achieve the recommended amounts of weekly physical activity. The other group was given no instruction at all. Four weeks later, the researchers checked in with both groups of hotel maids to re-measure some important health markers. The group that was told they were doing enough physical activity actually showed improvements in their blood pressure, hip-to-waist ratio, and a decrease in their body mass index (BMI). The group that was given no instruction showed none of those positive changes. These improvements were made without either group changing their physical activity!

It is phenomenal to think that by simply challenging our own perceptions we can see improvements in our health. The keyword in the previous sentence being perception.

Perception of Stress

Most individuals around the world are very familiar with stress. Not stress in the way an engineer might think about it, but stress from a mental and biophysical stand point. We can see that stress is having major impacts on our health. Interestingly enough, the degree that we perceive stress has a negative impact on our lives is related to having poor health and the risk of premature death. So, while most of us have stress, how we feel about that stress changes what it does to our bodies.

Perception Can Be Misleading

It is through these same perceptions that marketers make money. Someone who is skilled in psychology and knows how to adjust an audience’s perceptions, can play a big role in our behaviors.

For example, I often hear people use the following terms to describe their bodies: words such as tear, degeneration, bone-on-bone, the worst [insert body part] that a doctor has ever seen, disc bulge, nerve pinch, etc. All of these terms lead to perceptions of what someone feels about their body, and these perceptions influence their health. For this reason around 1 o’clock in the morning there will be numerous TV advertisements about the next best treatment option for all of the above problems. Most of those options have little to no research to support their use, and are most likely to only make a difference with the “placebo effect”.

There are a great deal of studies that show how individuals with numerous types of structurally pathologies will have no symptoms (references with the asterisks). Which indicates that in the realm of which pathologies count and which ones don’t probably comes down to what our perception of those pathologies mean. None of this indicates that the pain is all in your head. By no means. Only that what we think about what is going on in our bodies, actually changes our response to any given symptom.

The Brain Changes

The beauty in all of this is that our minds are extremely plastic. Our thoughts, beliefs and perceptions are constantly changing. As we continue to learn we change the way we perceive the world, as well as changing the way our bodies respond to the world we live in. Meaning, what we felt yesterday, (sadness, pain, fatigue, etc.) does not dictate what we will feel tomorrow (joy, strength, energized, etc.).

A lot of times all we need, to change the trajectory of our perceptions is some guidance. Someone to help us by setting a road map for our nervous system to change. That is where a skilled professional can be a huge help. From coach to psychologist, trainer to physical therapist, and chiropractor to physician you should be offered a plan to help you feel well and think well.

Keller, A., Litzelman, K., Wisk, L. E., Maddox, T., Cheng, E. R., Creswell, P. D., & Witt, W. P. (2012). Does the perception that stress affects health matter? The association with health and mortality. Health Psychology, 31(5), 677.

Crum, A. J., & Langer, E. J. (2007). Mind-set matters: Exercise and the placebo effect. Psychological Science, 18(2), 165-171.

*Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

*Campbell, J., & Colvin, L. A. (2013). Management of low back pain. BMJ, 347, bmj-f3148.

*Guermazi, A., Niu, J., Hayashi, D., Roemer, F. W., Englund, M., Neogi, T., ... & Felson, D. T. (2012). Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ, 345, e5339.

*Girish, G., Lobo, L. G., Jacobson, J. A., Morag, Y., Miller, B., & Jamadar, D. A. (2011). Ultrasound of the shoulder: asymptomatic findings in men. American Journal of Roentgenology, 197(4), W713-W719.

*Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6), 392-398.

Dry Needling in Physical Therapy

Poking into a structure that has been hurting may not make intuitive sense for pain relief. However, there appears to be value in having small filament needles inserted into an irritated structure.

The History of Needling for Medicine

Needling has been going on for millennia as more of an Eastern medicinal practice. Acupuncture as a practice may date back almost 8,000 years, though more certainly there is evidence of the practice appearing around 2,300 years ago. It was in those ancient texts that we can find information about meridians and the flow of Qi (chi), as well as how ancient Chinese people used acupuncture to resolve a variety of medical concerns.

Dry needling originated from studies based upon the principle of injecting very irritable muscles in the body with a small needle and some form of pain relieving substance. Then, it evolved as practitioners realized that they were seeing positive outcomes from the needle pokes alone without any injected substance. Thus, here we are currently with a more Western Medicine practice of using a small filament needle to address a muscle or fascia tissue that has become tender and painful (sometimes referred to as a trigger point).

The most frequently asked question that remains is: what is the difference between dry needling and acupuncture? The answer to that question is tricky due to the fact that both involve using the same or at least similar needles and the needles are poked into the skin to treat a given pathology. However, acupuncture is a treatment designed to affect the “energy” and Qi while working through meridians, while dry needling is a treatment designed to affect a specific muscle and the surrounding fascia and nerve tissue.

Research to Support Dry Needling

In comparison to other forms of therapies, dry needling itself is a relatively new treatment option. With any new treatment option the research is new and growing. However, at this point we are starting to see more randomized controlled trials and other studies about the effects of dry needling in rehabilitation. We have at this point research for the following conditions and anecdotes for treating a host of others;

  • Knee pain

  • Hip pain

  • Tendinopathy

  • Headaches

  • Neck pain

  • Shoulder pain

  • Low back pain and Sciatica

  • Plantar Fasciitis

  • Tennis Elbow

  • Myofascial Pain Syndrome

  • Fibromyalgia

Does it Hurt?

Between 60% and 70% of individuals will experience temporary pain during the actual treatment session. It is also not uncommon to experience soreness following the treatment. Not everyone does, but you may feel that for 24-48 hours you have soreness at the site of the needling. Icing and gentle massage to the area can help with the soreness. However, remember that this procedure is done to help reduce pain related to musculoskeletal problems, so any temporary soreness should not interfere with the benefits of having needling performed.

Making the Benefits Last

Dry needling itself should not be the only thing you do to help your painful condition. You should be performing exercises including stretching that have been prescribed by your physical therapist. The needling is intended to help you have less pain and move better.

Call now to schedule! 952-303-4550 Or book online at

White, A., & Ernst, E. (2004). A brief history of acupuncture. Rheumatology, 43(5), 662-663.

He, C., & Ma, H. (2017). Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials. Journal of Pain Research, 10, 1933.

Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252-265.

Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133-149.

How to Reduce Stress with Diaphragmatic Breathing

“Slow down. Take a deep breath.” These are words we have all heard from our parents or mentors. The advice to focus on your breathing is more helpful than they probably even realized.

Many of us remember those dreadful days sitting in high school psychology class learning about the autonomic nervous system. The terms “sympathetic” and “parasympathetic” may ring familiar. While the terminology may sound confusing the basic phrase we commonly use to describe the sympathetic nervous system is “fight or flight,” and the common phrase for the parasympathetic nervous system is “rest and digest.”

Finding Balance in the Nervous System

As our bodies seek for balance, the sympathetic and parasympathetic nervous systems work as opposites of each other. For example, if you trip while you are crossing the street, you want your sympathetic nervous system to kick into high gear so that you pick yourself up and run across the road before getting hit by a car.

On the other hand, you do not want that same sensation of panic and protection when you are about to lay down to fall asleep. It is also not pleasant to feel that urge of “nature calling” from a parasympathetic drive while you are playing in a high level athletic event. The balance between those two systems helps us to stay healthy. More and more people in the United States are living in a constant state of “fight or flight.” In other words they are living in a constant state of stress and anxiety.

The Negative Impacts of Stress

Anxiety and stress weigh heavy as they negatively affect multiple bodily functions. Rapid heart rate, rapid breathing rate, high blood pressure, elevated pain states, digestion problems, lack of attention, and emotional reactivity are just some of the common effects of stress on our body.

All of these changes are managed by hormones (chemicals) in our blood. For the sake of simplicity, the hormone you want to think about is cortisol. An increase in cortisol is a sign of your sympathetic (fight or flight) nervous system getting turned up. Which is great when it is needed, but detrimental when it is not.

Most of us can think of individual moments when we know we are under a moment of increased stress such as moving, changes in jobs, or family emergencies. During those moments, our appetite changed, we noticed more tension in the shoulders or back, maybe a really fast heart rate, and potentially even some irritable bowel syndrome. Those are times where you may have started to notice some achy joints in your body. You become aware that you aren’t feeling quite as robust as you did 5 or 10 years prior. When stress is persistent, our bodies begin to sense the harmful effects of stress.

Conscious vs. Unconscious Breathing

This is where some of the research on breathing can improve our life! Now, I know that if you are reading this article, you have most certainly been breathing up to this point. No one taught you how, you just do it. In and out. Inhale and exhale. You just assume that when you fall asleep tonight that your lungs will continue to fill with air and provide your body with much needed oxygen.

That is because some of your breathing is managed by your brainstem (lower brain level) which does not require any cortex (higher brain level) functioning. However, at the same time, we have the ability to use our higher brain levels to override the basic brainstem breathing function. This is why you can hold your breath underwater, or when someone tells you to take a deep breath, you can do it on command.

The Anatomy of Breathing

Now we need to work through some of the basic anatomy of breathing. Most people recognize their lungs as two big balloons sitting inside their chest somewhere around their heart. That is a good starting point. Around your lungs there will be some ribs that run from the sternum and around to the thoracic spine (upper back), and then just below the lungs is an odd shaped muscle called the diaphragm.

The diaphragm is a dome-shaped muscle that runs from front to back and side to side and works to divide the space where our lungs are (thoracic cavity) from the space where our intestines are (the abdominal cavity). When the diaphragm contracts it effectively lowers the dome allowing an increased amount of space in the thoracic cavity for the lungs to expand and fill with air. However, as a back-up or secondary mechanism we can also generate space for the lungs by raising our rib cage using accessory breathing muscles.

These two different types of breathing have become popularized by the names horizontal (diaphragmatic) or vertical (accessory) breathing. Diaphragmatic breathing as a practice is effectively breathing in as large of a breath as you can with your lower ribs and abdominal space expanding out slowly without your shoulders elevating to compensate, and breathing out slowly while contracting your abdominal muscles to help exhale or expel the air in your lungs. On the other hand, vertical breathing looks more like you are shrugging and lowering your shoulders with each breath. The physiology of our bodies change based upon our breathing patterns.

The Benefits of Diaphragmatic Breathing

Sessions of focused diaphragmatic breathing can last anywhere from 5 to 30 minutes. The sessions usually involve a coach helping you become aware of your breathing pattern. Also, you will learn how to more effectively breathe with your diaphragm and maintain your focus on your breath as a mindfulness practice.

Research has shown that you can see positive effects on your blood pressure, pulmonary function, and increase your heart rate variability (HRV; one of the easiest ways to track your balance of sympathetic and parasympathetic drive) with diaphragmatic breathing. In a randomized controlled trial, researchers looked at the effects of a 30-minute session including 15 minutes of quiet normal breathing and 15 minutes of diaphragmatic breathing for 20 sessions over an 8 week period. They noted that after the study period participants in the diaphragmatic breathing group had significantly lowered their negative affect, improved their attention, while also lowering their cortisol levels in their blood. This study helps to highlight how diaphragmatic breathing can have a role in our physiology, emotion, and our attention, or in other words our mind, body, and spirit.

The Vagus Nerve

Returning to the ideas of the sympathetic and parasympathetic nervous system we can see that diaphragmatic breathing plays a role in helping with the balance between those two systems. The way it works is beautiful. In our bodies we have a very important nerve that often does not get enough discussion—the vagus nerve. The ever-so-important cranial nerve exits the brain and travels a convoluted path around many muscles and organs before reaching its destiny around the colon. The vagus nerve is the major player in the parasympathetic nervous system. Meaning that it is the connection of our “rest and digest” between our brain and our body.

Where things get really cool is that we can manipulate the drive of our vagus nerve called “vagal tone” by adjusting our breathing. That’s right, the slow controlled diaphragmatic inhale and slow exhale with some abdominal contraction can increase your vagal tone and thus rev up your parasympathetic nervous system to help you to relax. Remember “rest and digest!” As we increase our parasympathetic activity, we will naturally decrease our sympathetic nervous system activity, thus decreasing cortisol levels and decreasing stress.

A literature review on the topic of breathing highlights the vast ways that diaphragm breathing can help our health. The list includes

  • Improved heart rate

  • Improved blood pressure

  • Improvement in quality of life

  • Improvement in exercise tolerance

  • Improved blood lipid levels

  • Reduced anxiety and panic

  • Alleviate pain

  • Improve mood

  • Reduced fatigue

  • Reduced insomnia

  • Improvements in GERD

That list is convincing enough to practice diaphragmatic breathing at least 2 times a week. It may be important to get a coach that can help you through the process.

Step-by-Step Instructions for Diaphragmatic Breathing

So, how do you do it? Don’t feel discouraged; I have written out clear instructions to help you get started.

First; positioning does matter. You should get into a relaxed and comfortable position. Lying on your back with your knees bent up, lying flat on your back, or sitting in a very comfortable chair are all good choices.

Second; take a deep breath in. Preferably through the nose, though if necessary you can breathe in through the mouth. The key is to focus the breath so that you notice your lower ribs and abdominal region expand without your chest and shoulders elevating. Sometimes placing both hands on your abdominal region or one hand on the abdominal region and the other on the chest can be helpful. You should feel your hand on your abdomen moving, meanwhile your hand on your chest does not move. This breath in should be slow and purposeful. Your focus should be entirely on how you are breathing.

Third; breathe out. Now, after taking a slow purposeful breath in there will be a temptation to quickly exhale somewhat like a sigh so that you can quickly get back to breathing in. Resist that temptation. When breathing out, breathe out through the mouth with the lips slightly pursed together.

Breathing out should not feel like you are trying to blow out birthday candles on your 10th birthday, but rather that you feel some resistance to the breath at the mouth. The next thing that you should feel is that during the process of breathing out you should be slightly crunching your abdominal muscles. Your positioning will change what you feel in the abdominals. Lying down flat with the knees straight will require the most focus on the abdominals. You should feel that you are pushing out most, if not all, of the air from your lungs.

Fourth; repeat steps one to three.

Setting Goals for Diaphragmatic Breathing

The amount of time you should spend doing diaphragmatic breathing depends on what your goal is and how much time you have. I recommend to start with 5–15 minute sessions for 2 days a week. Three to five days a week is likely superior, butI cannot guarantee that from a research standpoint.

Another suggestion if you are willing to set aside more time is to do 15 minutes of normal breathing with your eyes closed while focusing on your normal shallow breath followed by another 15 minutes of diaphragmatic breathing as instructed above. The benefit of this method is that it helps your body learn to distinctions between the two breathing patterns.

Seeking Out Help

I do not intend to establish an argument that diaphragmatic breathing can or should replace psychological or physical treatments by a skilled and licensed professional. It is a great option for those that are looking to add some focused mindfulness into their regimine. It is not a “cure-all,” but rather a great tool to have in your arsenal.

As more individuals seek out ways to improve their health, it will become increasingly important to have well-established and researched interventions for those in need. There are certainly other options to help those in need of some mindfulness. I also recommend that individuals trial a free week of the Headspace (available to download in the iTunes or Android app stores).

If you or a friend or family member would like more information about diaphragmatic breathing, or are in need of other health related treatment, please feel free to reach out to me via email, phone, or schedule an appointment.

Rickard, K. B., Dunn, D. J., & Brouch, V. M. (2015). Breathing Techniques Associated With Improved Health Outcomes.

Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., ... & Li, Y. F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in psychology, 8, 874.

Mehling, W. E., Hamel, K. A., Acree, M., Byl, N., & Hecht, F. M. (2005). Randomized controlled trial of breath therapy for patients with chronic low-back pain. Alternative Therapies in Health and Medicine, 11(4), 44-53.

Hopper, S. I., Murray, S. L., Ferrara, L. R., & Singleton, J. K. (2018). Effectiveness of diaphragmatic breathing on physiological and psychological stress in adults: a quantitative systematic review protocol. JBI database of systematic reviews and implementation reports, 16(6), 1367-1372.