Segmental Breathing: How Can It Change The Way You Breathe?

Many of our internal mechanisms and functions can be relaxed if we just focus on our breath and use scientific techniques to enhance it.

Studies suggest that targeted breathing exercises can improve lung function by up to 15-20% in people recovering from respiratory conditions. In a country like India, where air quality issues affect millions and post-COVID lung complications remain a concern, understanding segmental breathing has become more relevant than ever.

According to Dr Anjali Mehta, a respiratory physiotherapist at Mumbai's Kokilaben Hospital, "Segmental breathing isn't just about taking deep breaths. It's about precision, about teaching your lungs to expand uniformly, which can be life-changing for recovery patients and athletes alike."

What Is Segmental Breathing?

Segmental breathing is a physiotherapy technique in which you deliberately guide air into specific segments of your lungs. 

The technique involves using your hands to provide gentle resistance or tactile feedback on different parts of your chest and ribcage. This helps you become aware of which lung segments are expanding and which aren't. It's particularly useful when certain areas of the lung aren't functioning properly due to surgery, injury, or respiratory illness.

The lungs are two in number and have 5 lobes: 3 lobes on the right side and 2 on the left. Segmental breathing targets these lobes individually: the upper (apical), middle, and lower (basal) segments. By focusing on one segment at a time, you can strengthen weak areas and improve overall lung capacity.

Why Use Segmental Breathing? Benefits & Applications

• Post-surgical recovery. After chest or abdominal surgery, patients often develop shallow breathing patterns to avoid pain. This can lead to mucus accumulation and potential infections. Segmental breathing helps clear secretions and prevents complications like pneumonia.
• People recovering from COVID-19 have found this technique particularly helpful. Many patients experience lingering breathlessness and reduced lung capacity even months after recovery. Regular practice can gradually restore function.
• For those with chronic respiratory conditions like COPD, asthma, or bronchiectasis, segmental breathing becomes a daily ally. It helps maintain lung elasticity and prevents further deterioration.
• Athletes and singers use it too. Better breath control means better performance, whether you're running a marathon or hitting that high note in a classical raag.
• The technique also addresses atelectasis, the partial collapse of lung tissue. By directing air into specific areas, you can re-expand collapsed segments and improve oxygenation.

People who practice regularly report feeling less anxious. There's a connection between controlled breathing and the nervous system. When you breathe with intention, your body relaxes.

In Indian metros like Delhi or Mumbai, where pollution is a constant battle, maintaining healthy lung function isn't optional anymore. It's necessary.

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How To Perform Segmental Breathing: Step-By-Step

For the lower (basal) segments:

• Find a comfortable position, either sitting upright or lying down. Place your hands on the lower sides of your ribcage, just above your waist. Your fingers should rest along your ribs, thumbs pointing towards your back.
• Take a slow, deep breath through your nose. As you inhale, focus on pushing your ribs outward against your hands. You should feel expansion under your palms. Hold for 2-3 seconds.
• Exhale slowly through your mouth, letting your ribs return to their starting position. The pressure from your hands provides gentle resistance, which helps you become more aware of the movement.
• Repeat this 5-10 times, taking breaks if you feel lightheaded.

For the middle segments:

• Move your hands slightly higher, around the middle of your ribcage. The same principle applies, but now you're directing air into the mid-section of your lungs.
• Breathe in, feel the expansion, hold briefly, and release. The middle segments often need more attention because we naturally don't use them as much during regular breathing.

For the upper (apical) segments:

• Place your hands just below your collarbones. This area can be tricky because upper chest breathing is often shallow and rapid. Here, you want slow, controlled breaths that lift your upper chest without raising your shoulders too much.
• Some physiotherapists suggest placing one hand on your chest and another on your abdomen to ensure you're not just breathing into your belly or chest alone, but distributing the air throughout.

A few practical tips:

• Start with just 5 minutes daily. Don't overdo it initially. Your intercostal muscles (the muscles between your ribs) might feel sore if you're not used to this kind of breathing.
• Practice in front of a mirror occasionally. Visual feedback helps you understand whether you're actually expanding the targeted area.
• If you have had surgery or an injury, start gently. Pain is a signal, not something to push through.
• Some people find it helpful to practice after steam inhalation, especially during the monsoon season when chest congestion is common.

When & Who Should Use It?

• Post-operative patients, especially those who've had thoracic or abdominal surgery. The technique prevents complications and speeds recovery.
• People with chronic lung conditions need this in their daily routine. It's as essential as their medication.
• COVID-19 survivors dealing with persistent breathlessness should consider learning this under guidance.
• Elderly individuals often develop weaker breathing patterns. Regular practice helps maintain lung health and prevents age-related decline.
• Bedridden patients are at high risk for pneumonia. Segmental breathing, combined with position changes, reduces this risk significantly.

When to be cautious:

• If you've recently suffered a rib fracture, wait until your doctor gives clearance. The pressure might aggravate your injury.
• People with an active pneumothorax (collapsed lung) should avoid this completely until stabilised.
• Severe chest pain or haemoptysis (coughing up blood) requires immediate medical attention, not breathing exercises.
• Cardiac patients should consult their cardiologist first. Some heart conditions don't respond well to certain breathing patterns.
• During acute asthma attacks, focus on your rescue inhaler and emergency protocol, not breathing exercises.
• Pregnant women in their third trimester might find certain positions uncomfortable. Modifications are usually possible, but check with your gynaecologist.

Common Mistakes & How To Avoid Them

• Breathing too fast is the most common error. This isn't a race. Slow, deliberate breaths work better than rapid, shallow ones. If you feel dizzy, you're probably hyperventilating.
• Using only the chest or belly defeats the purpose. Segmental breathing requires coordination between your diaphragm and intercostal muscles. Both need to work together.
• Insufficient hand pressure means you won't get proper tactile feedback. Your hands should provide gentle but firm resistance.
• Holding breath too long can cause discomfort. The hold should be brief, just 2-3 seconds, not extended periods.
• Practising only when sick limits benefits. Consistency matters more than intensity. Daily practice, even when healthy, builds stronger respiratory function.
• Ignoring posture compromises results. Slouching compresses your lungs. Sit or lie in positions that allow maximum expansion.
• Some people tense their shoulders while focusing on upper chest breathing. Keep your shoulders relaxed; tension restricts movement.
• Complete exhalation is as important as inhalation. It removes carbon dioxide and prepares your lungs for the next breath.

If you're practising alone without initial guidance, consider recording yourself or asking someone to observe.

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Integrating Segmental Breathing Into Daily Routine

Making this a habit doesn't require major lifestyle changes.

• Morning routine: Practice for 5-10 minutes after waking up, before your chai. Your lungs are fresh, and it sets a calm tone for the day.
• During commute: If you're in Mumbai's local trains or stuck in Bangalore traffic, you can practice modified versions while seated. Obviously, skip the hand placement in public, but the breathing pattern remains the same.
• Work breaks: Between meetings or after lunch, take a few minutes for a quick session. It refreshes you better than scrolling through social media.
• Before exercise, Athletes find that warming up their lungs improves performance. A few rounds before your morning walk or gym session can make a difference.
• Evening wind-down: Combine it with meditation or prayer time. Many people incorporate it into their evening pooja routine or before dinner.
• Post-meal timing: Wait at least 30 minutes after eating. A full stomach makes deep breathing uncomfortable.

Try linking segmental breathing to existing habits.

• Already have a skincare routine? Add breathing exercises afterwards. Consistency comes easier when attached to established behaviours.
• If you're a teacher or someone who speaks extensively, practice during breaks. Your voice projection will improve, and vocal fatigue will reduce.
• For elderly parents living with you, encourage them to practice while watching their favourite TV serials. Multi-tasking with mindfulness works.

Case Examples & Research Highlights

Real stories often explain concepts better than theory alone.

Rajesh, a 52-year-old banker from Pune, underwent bypass surgery last year. His physiotherapist introduced segmental breathing on the second post-operative day. Initially sceptical, he noticed within a week that his breathlessness while walking had reduced significantly. Six months later, he climbs three flights of stairs without pausing, something he couldn't do even before surgery.

A study published in the Indian Journal of Physiotherapy and Occupational Therapy examined 60 post-COVID patients. Those who practised segmental breathing for three months showed a 23% improvement in their six-minute walk test compared to the control group.

Priya, a Bharatanatyam dancer from Chennai, incorporated this into her training after a respiratory infection left her struggling with stamina. Within two months, her breath control during complex sequences improved dramatically. She credits segmental breathing for helping her perform longer pieces without breaking her rhythm.

Research from AIIMS Delhi indicated that elderly patients practising targeted breathing exercises had 40% fewer respiratory infections compared to those who didn't.

A physiotherapy clinic in Kolkata reported that chronic bronchitis patients who combined medication with daily segmental breathing required fewer hospitalisations over a two-year period.

Conclusion

Segmental breathing might seem technical at first, but it's about reconnecting with a bodily function we've taken for granted. 

The technique offers tangible benefits for specific medical conditions while also serving as a preventive measure for healthy individuals. Whether you're recovering from illness, managing a chronic condition, or simply want to breathe better in Delhi's smoggy winters, this practice has something to offer.

Remember, this isn't a replacement for medical treatment. It's a complement, a tool for your well-being. If you have existing respiratory conditions, learn the technique from a qualified physiotherapist before practising independently.

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Frequently Asked Questions (FAQs)

1. What is segmental breathing, and how does it differ from normal breathing?

Segmental breathing is a physiotherapy technique where you consciously direct air into specific sections or segments of your lungs using tactile feedback from your hands. Unlike normal breathing, which is automatic and uses the entire lung somewhat uniformly, segmental breathing targets particular areas that may be underused or weakened. It's like exercising individual muscle groups rather than doing general cardio. The technique helps improve lung expansion in specific zones, making it especially useful for rehabilitation after surgery or illness.

2. How long should I practice segmental breathing each day?

For beginners, 5-10 minutes daily is sufficient. You can split this into two sessions, say morning and evening, if that feels more manageable. As you become comfortable, you can extend to 15-20 minutes. However, quality matters more than quantity. Proper technique with focused attention for 5 minutes beats distracted practice for 20 minutes. If you're recovering from surgery or illness, your physiotherapist will provide specific duration guidelines based on your condition. Listen to your body; if you feel tired or dizzy, that's your signal to stop and rest.

3. Can segmental breathing help with anxiety and stress?

Yes, though it's not the primary purpose. Controlled, intentional breathing activates the parasympathetic nervous system, which helps your body relax. When you focus on directing breath into specific lung segments, you're essentially practising a form of mindfulness. This dual action of physical control and mental focus can reduce anxiety symptoms. Many people find that the structured nature of the technique gives their anxious mind something concrete to focus on. However, if you're dealing with severe anxiety or panic disorders, this should complement, not replace, professional mental health support.

4. Is segmental breathing safe during pregnancy?

Generally, yes, but with modifications and medical clearance. During the first and second trimesters, most pregnant women can practice safely. However, as the pregnancy advances and the uterus expands, lying flat becomes uncomfortable, and certain positions might not work. Side-lying positions often work better. The technique can actually help prepare for labour by improving breath control. That said, every pregnancy is different. Some complications, like placenta previa or a history of preterm labour, might require caution. Always consult your obstetrician or a physiotherapist specialising in prenatal care before starting any breathing exercises.

5. How soon after COVID-19 recovery can I start segmental breathing exercises?

You can typically start once your acute symptoms have resolved and your doctor confirms you're no longer infectious, usually after 10-14 days from symptom onset if you're testing negative. However, if you experienced severe COVID with hospitalisation or continuing symptoms like persistent breathlessness or chest pain, wait for medical clearance. Start very gently; your lungs might still be healing. Some people experience fatigue for weeks after recovery, so don't push too hard initially. A physiotherapist can assess your specific situation and create a gradual progression plan. If at any point you experience chest pain, severe breathlessness, or dizziness while practising, stop immediately and consult your doctor.