Breathing exercises

Breathing exercises activate the parasympathetic nervous system and are helpful in reducing pain, stress, and anxiety. Regular practice will make it easier for you to use them as coping mechanisms during flares. It doesn't have to be complicated or take a lot of your time. Make it a habit to go to bed 5 minutes earlier than usual and just focus on your breathing. As the exercises become easier and feel more natural, you can increase the amount of time and practice multiple times a day - even while performing your daily activities. 

Belly breathing

Belly breathing (a.k.a. diaphragmatic, abdominal, or deep breathing) is breathing that moves your belly, unlike chest (or thoracic) breathing which moves your rib cage. It encourages full oxygen exchange, slows the heartbeat, and can lower or stabilize blood pressure. 

1. Lie down on a flat surface or in your bed with your knees slightly bent. You can place a pillow under your head and/or knees for support if that's more comfortable.
2. Place one hand on your upper chest and the other on your belly, just below your rib cage.
3. Breathe in slowly through your nose, letting the air in deeply, towards your lower belly. The hand on your belly should rise as your stomach presses into it, while the other hand should remain still.
4. Tighten your abdominal muscles and let them fall inward as you exhale through pursed lips. The hand on your belly should move down to its original position.

Equal breathing

Equal breathing focuses on making your inhales and exhales the same length, usually around 3 to 5 counts. It is called sama vritti in Sanskrit and is often used in yoga to lower stress, increase calm, and help you focus. 

1. Sit down in a comfortable position and close your eyes. 
2. Slowly count to 4 as you inhale.
3. Take a slight pause at the top of the inhalation, when your lungs are full of air.
4. Slowly count to 4 as you exhale.
5. Take another slight pause to feel empty before the next inhalation.
6. Continue this same pattern for several minutes.

You can experiment with changing the number you count to, but make sure your inhalations and exhalations are the same length.

Alternate nostril breathing

Alternate nostril breathing, known as nadi shodhana pranayama in Sanskrit, is a breathing practice for relaxation that is often used in yoga.

1. Sit down in a comfortable position and place your left hand on your left knee.
2. Lift your right hand up toward your nose. 
3. Exhale completely and use your right thumb to gently close your right nostril.
4. Inhale through your left nostril, and then close it with your right index finger. 
5. Release your thumb and exhale out through your right nostril.
6. Inhale through your right nostril, then close it.
7. Release your index finger to open your left nostril and exhale through this side. This is one cycle.
8. Continue this breathing pattern for several minutes. Finish your session with an exhale on the left side.

Humming bee breathing

Humming bee breathing, also known as bhramari pranayama in Sanskrit, is a great breathing exercise to free the mind of stress, worry, anxiety, or anger. Additionally, the humming sound vibrations have a naturally calming effect.

1. Sit down in a comfortable position, close your eyes, and relax your face.
2. Place your index fingers on the cartilage that covers your ear canal.
3. Take a deep breath in.
4. As you breathe out, gently press the cartilage and make a loud humming sound (like a bee) while keeping your mouth closed. 
5. Breathe in again and continue the same pattern.

Box breathing

This is a technique that is easy to remember, which can be a good thing if you are in a lot of pain.

1. Inhale while counting to 4.
2. Hold your breath while counting to 4.
3. Exhale while counting to 4.
4. Wait for a count of 4.
5. Continue the same pattern for several minutes.

If it helps, you can trace your finger in a square pattern while you breathe, or you can close your eyes and visualize traveling around your square. 

Visualized breathing

Pairing the breathing exercises with visualization can make them even more effective by taking your mind off the stressful situation and helping you focus inward. This can be done in different ways:

• As you breathe in, visualize your breath as a colored cloud floating in through your nostrils and down to your lungs or your belly. Then, as you breathe out, picture it floating out of your body the opposite way.
• As you breathe in and out, picture relaxation entering your body, and stress, pain or tension leaving your body.