About hypopressive breathing

You’ve no doubt heard of Kegel exercises, deliberate contractions of the pelvic floor intended to tone the layer of muscles that support the pelvic organs. But if you’re dealing with pelvic floor issues (or hoping to prevent them) and haven’t yet been introduced to the Abdominal Hypopressive Technique (AHT), you’ll want to read on. AHT may be a beneficial addition to your pelvic floor and core conditioning repertoire.

Developed in the 1980s by Dr. Marcel Caufriez, AHT is a breathing exercise that involves three basic steps: 1) diaphragm inspiration (a wide and full inhale that expands the ribcage on all sides); 2) thorough air expiration; 3) gradual contraction of the transversus abdominis and intercostal muscles as the diaphragm rises.

Maximizing the inward motion of the abdominal wall at the end of an exhale while simultaneously maintaining wider ribs reduces pressure on the abdominal and pelvic cavities. This is why the technique is called “hypopressive,” derived from the Greek hypo, “under” (in the sense of “less”) + pressure. Living as we do under the constant pressure of gravity, everyday life in a human body is, as you might imagine, hyperpressive. We further increase abdominal and pelvic pressure when we engage in high-impact activities. And as every woman who has been through it can attest, we push this pressure to the limit during pregnancy and childbirth.

With hypopressive breathing, core and pelvic floor exercises can be performed without increasing pressure on these “pushed-to-the-limit” parts of the body in pre- and post-natal women.

But AHT is not just for childbearing women, and it’s not just about briefly alleviating pressure that will return as soon as we finish our exercise session. Instead, the decrease in abdominal pressure obtained through this technique has been proven to cause a reflex activation of pelvic floor and transversus abdominis (“corset”) muscles—activation that is necessary not only for truly functional conditioning of core muscles, but also for pre- or reconditioning the pelvic floor, no matter what your gender or reproductive status.

Hypopressive breathing may also help improve the synergy of pelvic floor and core muscles. When these muscle groups are well-conditioned and working together the way that they should, they’re better able to cope with and respond to the pressure that everyday life (not to mention pregnancy) puts on them.

AHT’s biggest fans

This technique can be helpful for anyone wanting to relieve back pain, reduce waist size, and improve core strength, respiration, and posture. But there’s no question that the biggest fans of AHT will be women who want to prevent or address pelvic floor dysfunction related to pregnancy and childbirth. Urinary incontinence or urgency? Pelvic organ prolapse? It’s worth giving this technique a try.

AHT has also been shown to help prevent or correct diastasis recti, a separation of the rectus abdominis (“six-pack”) muscles. Thanks to the massive amount of pressure pregnancy places on the abdominal wall, diastasis recti occurs to a greater or lesser degree in approximately two-thirds of pregnant women. Separation of the rectus abdominis not only creates a probably unwelcome pooch, but also contributes to lower back pain and exacerbates pelvic floor dysfunction. It can even cause shoulder issues! And guess what happens if you do conventional abdominal exercises to address this separation? That’s right: you simply increase pressure on the abdominal wall and pelvic floor, making the problem worse. Performing exercises that effectively recruit the transversus abdominis, diaphragm, and pelvic floor muscles while minimizing pressure is the best possible strategy for dealing with diastasis recti.

Enter the Abdominal Hypopressive Technique

While demonstrations of quite extreme versions of this technique can be found all over the Internet, there are times when less is more. This is one of those times. Extreme hypopressive breathing is contraindicated for pregnant and newly (6-8 weeks) postpartum women, as well as for women with IUDs. People who have recently (within 3 months) had surgery or who have high blood pressure, abdominal illness, pulmonary disease, or anxiety should also avoid exaggerated forms of hypopressive breathing.

Moderate hypopressive breathing, however, should be appropriate for almost everyone. The good news is that you’re not missing out on anything if you can’t engage in “extreme” forms of AHT: research suggests that the technique on its own isn’t the panacea it’s sometimes hyped up to be. Instead, effective muscle recruitment is still key—but adding gentle hypopressive breathing can help with this.

If you are pregnant, have recently given birth, or are experiencing pelvic floor difficulties, please check with your health care professional to make sure this technique (in its moderate form) is appropriate for you.

I also highly recommend consulting with a pelvic floor specialist for advice and a program of exercises custom-designed for your particular situation, as well as direct feedback on how effectively you are performing the exercises. (At Body Harmonics, we are fortunate to have pelvic floor physiotherapist Erin Fraser on staff. You can book an appointment with her here.)

One of the greatest benefits of AHT is that pelvic floor muscles will reflexively activate, even if you do not consciously engage them! But when you are able to do so, go ahead and incorporate that gentle drawing up of the pelvic floor: studies like this one prove that adding voluntary pelvic floor muscle contractions to your Pilates exercises improves their effectiveness at conditioning these muscles.

In the this short video I introduce you to AHT and talk you through some simple but effective exercises that are great for postnatal women and those dealing with diastasis recti, low back pain and pelvic floor issues.

How will I know if I’m doing it right?

First of all, let comfort be your guide. If something hurts or feels wrong, leave it out. It’s also worth noting that some people may experience anxiety during hypopressive breathing, even in its more moderate forms. This is more common in people who suffer from anxiety disorders, but it can also happen to people who don’t have a history of anxiety. If you encounter this, take a step back from AHT, at least for a while. Some people are able to revisit hypopressive breathing and gradually become comfortable with it, but some find that it always triggers anxiety and therefore simply doesn’t work for them.

Looking for a full length pre-natal video workout? Just subscribe to BhonDemand.com to access our new Prenatal: Full Body Conditioning video.

Want to know more?

Hypopressive breathing is just one small piece of the puzzle. To find out more about where and how this technique fits into the bigger picture, check out Body Harmonics’ upcoming courses on breathing mechanics, pelvic floor health, exercise during pregnancy, and diastasis recti repair. Courses are open to movement professionals and Pilates enthusiasts alike!

Breathing Mechanics and Protocols

Location: San Francisco Bay
Date: Friday, August 7, 2020
Time: 12 – 6pm
* Note that AHT is not part of the Breathing Mechanics and Protocols course. A moderate form of the technique is introduced in the courses below.

Towards a Healthy Pelvic Floor

Location: Guelph, Ontario
Date: Friday, October 16, 2020
Time: 12 – 6pm

Movement and Exercise for Pregnancy

Location: Guelph, Ontario
Date: Saturday, October 17, 2020
Time: 12 – 6pm

Post-Natal Conditioning and Diastasis Recti Repair

Location: Guelph, Ontario
Date: Sunday, October 18, 2020
Time: 12 – 6pm