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The Science Behind Breathwork

Updated: Feb 5


Breath Work Image

Breathing is more than an automatic reflex, it is one of the most accessible clinical tools we have for influencing physiology in real time. Because respiration can be both involuntary and voluntary, it provides a direct gateway into autonomic regulation. Slow diaphragmatic breathing, particularly with an extended exhale, shifts the balance away from sympathetic dominance and toward parasympathetic activity via vagal pathways, improving cardiovascular adaptability and emotional regulation (3,5). This is reflected clinically by reduced anxiety, improved sleep, and enhanced stress tolerance, outcomes strongly associated with improved autonomic flexibility and heart rate variability (11, 13).


Breathwork also modulates the endocrine stress response. Slow controlled breathing reduces hypothalamic-pituitary-adrenal (HPA) axis activation and is associated with decreased cortisol, supporting recovery, immune regulation, and improved resilience (8, 10). When practiced at approximately six breaths per minute, paced breathing increases respiratory sinus arrhythmia and HRV, both important markers of stress adaptability and cardiometabolic health (6).


Nasal breathing further improves oxygen uptake efficiency through nitric oxide delivery from the sinuses, while contributing to vascular regulation and antimicrobial defence (4, 6, 12). Finally, breath-based interventions are linked to reduced inflammatory signalling and improved immune regulation, including effects on pro-inflammatory cytokines and immune cell activity (1). In practical terms, breathwork is not simply relaxation training, it is autonomic, endocrine, vascular, and immune modulation delivered through a single behavioural lever.


Box Breathing Video

As a practical introduction, I have included a link to a Box Breathing (4–4–4–4) video, which demonstrates one of the foundational techniques we frequently recommend in clinical practice. This method can be helpful for improving emotional regulation, reducing stress reactivity, and supporting sleep when practiced consistently.


That said, effective breathwork rarely relies on a single technique. In practice, multiple breathing procedures are often combined and progressed over time, guided by how each individual responds physiologically and functionally. Selection is based on factors such as symptom profile, autonomic balance, activity level, and recovery capacity.


Ultimately, when prescribed with precision and applied consistently, breathwork becomes one of the most powerful and accessible interventions in modern healthcare, capable of shaping nervous system balance, stress physiology, vascular health, and immune regulation through a simple, intentional daily practice.


Many of the physiological principles discussed in this article, including autonomic regulation, stress modulation, vascular function, and immune support through breathing, are explored in greater depth in my upcoming book, Trajectory: The Power of Everyday Choices, scheduled for release in late 2026 or early 2027. A dedicated chapter examines how specific breathing strategies can be selected, adapted, and integrated into individualized care programs based on clinical presentation, nervous system profile, and long-term health goals.



References


  1. Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: A systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373(1), 13–24.

  2. Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry, 9, 44.

  3. Critchley, H. D., & Garfinkel, S. N. (2018). The influence of physiological signals on cognition. Current Opinion in Behavioral Sciences, 19, 13–18.

  4. Ignarro, L. J., Buga, G. M., Wood, K. S., Byrns, R. E., & Chaudhuri, G. (1987). Endothelium-derived relaxing factor produced and released from artery and vein is nitric oxide. Proceedings of the National Academy of Sciences of the United States of America, 84(24), 9265–9269.

  5. Jerath, R., Crawford, M. W., Barnes, V. A., & Harden, K. (2015). Self-regulation of breathing as a primary treatment for anxiety. Applied Psychophysiology and Biofeedback, 40(2), 107–115.

  6. Lehrer, P. M., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta analysis. Applied Psychophysiology and Biofeedback, 45(3), 109–129.

  7. Lundberg, J. O., Weitzberg, E., & Lundberg, J. M. (1994). Alveolar nitric oxide in man: Role of nasal nitric oxide in pulmonary gas exchange. European Respiratory Journal, 7(8), 1501–1505.

  8. Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156–178.

  9. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

  10. Sapolsky, R. M. (2015). Why zebras don’t get ulcers (3rd ed.). Henry Holt and Company.

  11. Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in Public Health, 5, 258.

  12. Weitzberg, E., & Lundberg, J. O. (2002). Humming greatly increases nasal nitric oxide. American Journal of Respiratory and Critical Care Medicine, 166(2), 144–145.

  13. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.


DR. BRIAN ABELSON, DC. - The Author

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With over 30 years of clinical experience and more than 25,000 patients treated, Dr. Brian J. Abelson is the creator of Motion Specific Release (MSR), a multidisciplinary assessment and treatment system that integrates biomechanics, fascia science, neurology, manual therapy, exercise rehabilitation, and acupuncture. He is an internationally recognized best-selling author of 10 books and 200+ articles, and has trained healthcare professionals through structured MSR courses and clinical education programs throughout Canada and the United States. Dr. Abelson practices at Kinetic Health in Calgary, Alberta, and continues to develop educational resources focused on long-term function, resilience, and the health trajectory shaped by everyday choices.


For patients, his goal is simple, reduce pain, restore movement, and build long-term independence. For practitioners, MSR provides a practical framework you can integrate directly into daily clinical care.



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Why Choose MSR Courses and MSR Pro?


Elevate your clinical practice with Motion Specific Release (MSR) training and MSR Pro, a comprehensive, evidence-informed approach to musculoskeletal assessment and treatment designed to improve diagnostic precision, hands-on skill, and patient outcomes.

MSR proficiency goes far beyond videos and articles. True clinical mastery requires hands-on training, refinement of palpation and force application, and a deeper command of applied anatomy and biomechanics. MSR is a skill-based system built through deliberate practice, real-time feedback, and mentorship, where clinical reasoning and tactile execution come together.


Here’s why practitioners join MSR:

  • Proven Clinical SystemDeveloped by Dr. Brian J. Abelson, DC, with over 30 years of clinical experience and more than 25,000 patients treated, MSR integrates the most effective components of osseous and myofascial therapies into a cohesive, repeatable framework. The system is grounded in clinical logic and supported by patient outcomes, with a clinic success rate exceeding 90% in decreasing pain and improving function.

  • Comprehensive, Practical TrainingCourses blend rigorous clinical education with hands-on technique development. You’ll strengthen orthopedic and neurological examination skills while learning targeted myofascial procedures, fascial expansion concepts, and osseous adjusting and mobilization strategies that translate directly into daily practice.

  • MSR Pro, Your Clinical LibraryAs an MSR Pro subscriber, you gain access to a growing library of 200+ MSR procedures, instructional videos, downloadable and fillable clinical forms, and in-depth practitioner resources that support the full clinical workflow, from intake to reassessment and exercise prescription.

  • Ongoing Support and UpdatesMSR Pro includes an extensive resource base of 750+ videos, including technique instruction, rehabilitation exercise progression, and clinical application guidance, supported by a large MSK article library and condition-based resources. Content is actively updated and expanded to reflect evolving clinical needs and course development.

  • A System Built for GrowthMSR is designed to help practitioners think clearly in complex presentations, develop adaptable strategies, and evolve as clinicians. This approach aligns with the broader Trajectory principle, better outcomes are built through the cumulative power of consistent, high-quality clinical decisions.


Unlock your practice’s full potential with MSR Courses and MSR Pro, and join a community of practitioners committed to excellence in musculoskeletal care.



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YouTube Channel


Explore Dr. Abelson’s YouTube channel, Kinetic Health Online, with 200,000+ subscribers and 37+ million views.


The channel features a large library of evidence-informed musculoskeletal education, including Motion Specific Release (MSR) procedures that integrate fascial-based concepts, manual therapy, movement science, and select Traditional Chinese Medicine (TCM) principles.

You’ll also find:

  • 70+ essential physical examination videos

  • MSK condition tutorials and clinical education content

  • Hundreds of mobility, strengthening, and rehab exercise demonstrations

  • A dedicated Yang Style Tai Chi playlist, reflecting Dr. Abelson’s decades of teaching experience




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