Why Blow Up A Balloon?
When we first train someone, handing them a balloon and asking them to get into a specific position to blow it up might seem a little odd. Okay, it seems very odd. Blowing up a balloon may be the last thing someone expects when they come in to lose weight or get stronger. There is a rhyme and reason, though. And it's way more beneficial than you might think.
We are certainly not the first ones to use a balloon in this setting. We use a lot of the concepts and information from the Postural Restoration Institute, which is where we first heard about this. Yes, we thought it was a little strange until we learned more and actually did what they prescribe. Since then, the results have been fantastic, and all three of us (Ashley, Kara, and I) use their various breathing exercises on a daily basis.
It's been well-established that poor breathing patterns and impairments of posture and trunk stability are frequently associated with musculoskeletal complaints like knee or low back pain (1). Muscles such as the pelvic floor, transverse abdominis, and diaphragm are key to stabilizing your spine and maintaining good posture. When we get the pelvic floor to face the diaphragm, we're creating something called a Zone of Apposition (ZOA), which is the ideal position to create stability and balance in the system. When we're having our clients put their feet on a bench and slightly lift their hips off the floor, or stand against a wall and round their back while breathing, we're having them create this ZOA, among other things.
The diaphragm, while commonly thought of as a muscle purely for breathing, does also play a role in stabilizing the spine. This makes breathing an integral part in the treatment of lower back pain, although it's often overlooked (2). Creating this ZOA allows the rest of the core musculature to function optimally, along with the diaphragm, to create a very stiff canister to protect the spine. Think of a pop can that's sealed versus a pop can that's open. Crushing the can would be very difficult while sealed, but very easy while open. The same rules apply to the core. The diaphragm helps control the pressure in the upper body to keep this stiffness, similar to the closed pop can.
When we don't have this optimal ZOA, where the lower back is arched and the pelvic floor and diaphragm are both facing a little more forward, there is much less stability created (3). The diaphragm is less able to draw air in and stabilize the upper body, which causes the over use of accessory muscles to breathe (4). This is referred to as hyperinflation. Typically, clients will feel this as tightness in the neck, upper back, and chest. In addition, the lower back tends to become excessively arched and tight because the diaphragm, which attaches to the lumbar spine, pulls it forward as it is being used to attempt to get air in. This can cause, among other things, lower back pain.
So, where do the balloons fit into all of this? Getting clients to forcefully exhale is a great way to get the core musculature to aid in the process of creating the ZOA by pulling the ribs down and inhibiting/relaxing the muscles along the spine. Using a balloon creates resistance during exhalation, requiring an increase in the usage of the abdominal muscles to exhale. You can think of it similarly as how we would add resistance to a lunge, for instance, to strengthen your legs.
In conjunction with providing resistance, the balloon is a fantastic way for clients to learn how to breathe optimally by getting all of their air out. To counteract hyperinflation, the Postural Restoration Institute recommends five full exhales per exercise. After the first breath, keeping the balloon in your mouth while inhaling through the nose allows the surrounding muscles of the chest area (such as the pec muscles) to relax and stretch while the ribs stay down. It is this ribs-down position during inhalation that many people are unable to do, which is great for people with rounded shoulders, depressed shoulders, or people with scoliosis (5). In general, though, full exhales using the balloon as a visual cue, allow people best use their diaphragm as a muscle of respiration in an ideal position.
Next time you're training with us, or when you start, it should look a little less weird when we hand you a balloon. Okay, it'll still look weird, but at least now you'll know why we do it.
1. Hodges P. Is There a Role for Transversus Abdominis in Lumbo-Pelvic Stability? Manual Therapy. 1999;4(2):74-86.
2. Hodges PW, Heijnen I, Gandevia SC. Postural activity of the diaphragm is reduced in humans when respiratory demand increases. J Physiol. 2001;537(3):999-1008.
3. Lando Y, Boiselle PM, Shade D, et al. Effect of Lung Volume Reduction Surgery of Diaphragm Length in Severe Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 1999;159(3):796-805.
4. De Troyer A, Estenne M. Functional Anatomy of the Respiratory Muscles. Clin Chest Med. 1988;9(2): 175-93.
5. Boyle, KL, Olinick, J, Lewis, C. The value of blowing up a balloon. North American Journal of Sports Physical Therapy. 2010; 5(3): 179-188.