– Derek M. Hansen – October 30, 2009 –
As a running coach and conditioning consultant, I get many requests each week to work with different athletes. I do my best to accommodate most of these requests, referring the odd one to other colleagues where appropriate. One of the most recent requests, however, involved a unique problem. It was the parents of a young female athlete that was having significant difficulty preparing for and performing an endurance running test for her sport (an outdoor field sport). The test is commonly known as the “Beep” test or Leger test, involving increasingly faster shuttles over 20 meters. Athletes achieve specific levels within the Beep test, which can involve well over 10 minutes of constant shuttles. This particular athlete needed to achieve Level 10.5 in order to satisfy the testing requirement for her team.
The issue, however, was that this athlete was experiencing chest pains during the upper levels of the Beep test. When I was told about the chest pains, I thought that perhaps this problem was outside of the scope of my professional experience. They wanted me to create a workout plan for her and I was more concerned that I was going to only exacerbate the problem. My last CPR recertification was almost two years ago and I didn’t want to have to fly into action during a workout with a teenage athlete. Worst-case scenario thoughts were flying through my head and I wanted to dissuade the parents from pursuing a “workout” solution.
Through further discussions with the athlete’s parents, it was determined that the necessary specialists had been previously consulted (i.e. cardiologists and respirologists) and all of them concluded that there were no physiological problems and there would be minimal risks associated with continuing with an intensive training program. There were no allergies or asthma diagnosed, and use of inhalers and other medication resulted in no improvements. So what could it be?
A conversation with a soccer coach colleague provided me with greater insight into the possible cause. According to her, she has seen more and more cases of athlete anxiety – particularly among females – that have directly impacted their performance and well-being. She attributed the anxiety to the higher expectations and greater pressure athletes are putting on themselves these days. She confessed that she had been witness to athlete “melt-downs” and nervous breakdowns over issues that were never a problem in the past. Could this current case be an example of “exercise induced anxiety” I wondered to myself?
I agreed to meet with the family and go over some possible options for the athlete. My first plan was to simply assess the athlete by having her run some very simple workouts and observe her in action. I brought my video camera as well as my heart rate monitor. The video camera would help me document key issues with regard to her running mechanics, while the heart rate monitor would allow us to document how hard the athlete was working throughout the workout. This particular heart rate monitor (Suunto T6C) recorded the heart rate information to be later analyzed on my computer via USB connection. It also gave us instant feedback on her heart rate throughout the workout.
I had her run some 400m intervals on a running track at a moderate pace. I gave her three-minute breaks between runs and by the third repetition she was exhausted. The one thing that I picked up on when talking to her after the runs was that she felt like her breathing was forced at the 120-meter mark of the run. At the pace she was running, I thought that maybe she would feel something about 200-250 meters into the run. The fact that she felt significant respiratory stress early in the run led me to believe something was up.
Analysis of her running mechanics revealed that she used her arms in a tight, cradled, cross-body swinging motion. It looked like she was carrying a baby in her arms while running. Such arm mechanics would only exacerbate any existing breathing problems with her shoulders and neck tightening, thereby leading to restrictions in the upper torso. However, this alone could not be the reason for her level of respiratory distress.
We then began to run a series of 100m and 200m intervals at about 70 percent of top velocity on the grass soccer field with me running alongside her. As we got into the latter stages of each run, I would notice her breathing rhythm would shorten and she would be almost be gasping for breaths. It was as though she didn’t know how to breathe properly. At that moment I realized that she needed lessons in how to breathe, particularly during periods of physical exertion.
I quickly fell back on my knowledge of breathing exercises as it relates to battle situations. One of my past clients, Academy Award winning actor, Benicio Del Toro, was kind enough to pass on to me a number of books by author David Grossman including “On Combat” and “On Killing”. In “On Combat”, Grossman covers the topic of “battle breathing” taught to police officers and emergency response team members to deal with the stress of deadly force encounters. Grossman would teach individuals to gradually draw a breath in through their nose over a four second period, hold it in their abdomen for four seconds, then slowly blow the breath out their mouth over four seconds. This would be performed over a period of time in order to stimulate a parasympathetic response (“rest and digest”) in their autonomic nervous system.
I instructed my female athlete to perform the “battle breathing” method during her recovery periods between runs (i.e. 4 seconds in, 4 seconds hold, 4 seconds out). During the runs themselves, I would instruct her to simply perform a three second inspiration and a three second expiration to manage her breathing. Later in the day when I reviewed her heart rate data throughout the workout, the results were quite dramatic. Before we implemented the breathing management guidelines, her heart rate easily jumped up to 180 beats per minute (bpm) or higher during runs. Additionally, between runs her heart rate would not drop below 135 bpm. Once we implemented the breathing management guidelines, her working heart rate did not rise above 170 bpm for the same running pace and during her recovery periods, her heart rate dropped to as low as 110-115 bpm.
Once I had the opportunity to review all of the heart rate data and the video of her running mechanics, I then provided the athlete with some recommendations for her training as follows:
– Practice your breathing exercises on a daily basis to help develop relaxed, efficient breathing patterns for both everyday activities and exercise. The 4+4+4 breathing pattern will teach you to take advantage of full inspiration and expiration without rushing your breaths. When exercising, resist the temptation to take more breaths of shorter duration. Trust that longer, more relaxed breaths will be more than adequate to fuel your body.
– Purchase an affordable heart rate monitor to allow for biofeedback training during workouts and recovery periods. Being aware of your working and recovering heart rates during exercise will assist you when implementing your breathing exercises. Because you are in the process of getting back into shape, ensuring that you are not over-exerting yourself and triggering any anxiety during exercise will be critical. Initially, maintaining your heart rate below 160 bpm during interval training will ensure that you are in a safe zone. As you get more accustomed to higher intensity training and more efficient breathing patterns, bringing your heart rate above 170 bpm for short periods of time will be much more tolerable. Once you see you can work at these higher heart rate zones without breathing restrictions, your confidence will build.
– When performing your running intervals, as well as your running drills, ensure that your shoulders are relaxed and your arms track smoothly forward and back, as opposed to across your body. Practice easy arm swings in front of a mirror so that you are aware of proper swing mechanics and good shoulder position. During a workout, practice or game, periodically shrug your shoulders ups, then drop them down so that you are aware of the down and relaxed position.
– Stay hydrated and drink water or a diluted sport drink regularly to ensure that your throat does not get dry and irritated during workouts and games. Any irritation in the throat can lead to respiratory distress and tightening of the neck and chest.
After I provided these guidelines and we ran a few workouts together, I could see that the athlete and her family were relieved that an appropriate solution was made available to them. For the past few months, they thought that she was experience anything from allergies to a heart condition. I then provided them with a basic interval training program that progressively built her fitness, without excessively stressing her cardio-respiratory system. She has had significantly less respiratory distress and is finally getting back into full game shape. More importantly, she is regaining her confidence in her athletic ability.
After going through this process, it made me wonder if other athletes and recreational fitness participants could be going through similar problems. It seems that more and more individuals are being diagnosed with asthma and respiratory issues. While many experts point to the environment as the main cause of these breathing problems, I often wonder if for many individuals that this is a self-fulfilling prophecy. Stress and anxiety are at all-time highs for society, particularly amongst our youth. I have recently acquired many books on the art of meditation – a practice that heavily relies on the execution of “mindful” breathing habits. Perhaps like the art of running, we need to take a few steps back and spend more time teaching our youth the fundamental mechanics of life. Breathing, eating, sleeping, listening and running all seem like activities that should be carried out easily and automatically, but they are all areas where we could use more attention and direction.