Your Most Powerful Tool

By David M. Lobenstine

We are people of the body. We are bodyworkers.
This term contains both the beauty and the trap of our profession. First, we are fascinated by the body, by skin and fascia, by muscle and tendon; we pride ourselves on all we can see with our eyes and all we can “see” with our hands. And second, we take the “worker” part of this label very seriously; many of us feel like we are not doing a good job unless we are exerting great effort to change or heal or fix our clients.

But in that devotion is our downfall. When we are too focused on all that muscle and fascia lying on our table, and too determined to fix it, we lose sight of a more delicate aspect of who we are. I don’t mean the ineffable spirit or soul of our clients. I mean something far more humble—an essential ingredient of every moment, for every one of us, an essential aspect of life that is both surprisingly palpable and surprisingly ignored: our breath.
We all know breathing is important: we tell someone to “take a deep breath” when they are upset; we talk about how we’re going to start meditating; we always intend to go to yoga more often than we do. But even as we recognize the value of breathing, we often miss the great opportunity of our profession: every time we begin a session, the breath is waiting for us. I believe attending to the breath—both your own and your clients’—will make you a more effective and more satisfied therapist. And though they likely won’t be able to articulate exactly why, your clients will find their sessions more beneficial. The breath, quite simply, is the great connector—and often the missing link—in our work.
Working with the breath as you massage is useful for many reasons, but the simplest is this: finding your body’s own natural breath—full, slow, effortless—offers many of the same benefits as a great massage. Finding that breath while you receive a massage—and while you are giving a massage—only makes the work that much more wonderful.
A full breath is a visceral—and continual—manifestation of what we want to give the client (and, I believe, what we too often try to force onto our clients): that state of effortless relaxation, those delicious moments where you can feel tightness and tension releasing. When we are aware of the client’s breath, we can more effectively engage the client’s physical body; but perhaps more important, we can engage his or her autonomic nervous system. In particular, the breath that is full and easy deactivates the sympathetic nervous system (the fight-or-flight response so many of us are unknowingly stuck in) and stimulates the parasympathetic nervous system (the rest-and-digest state that is key for our health and healing).
What is good for the client is good for us, as well. When we work with an awareness of our clients’ breath, we can’t help but be more aware of our own breath, and our own nervous system reaps the same benefits. By contrast, when we remain oblivious to the breath, we limit what we are able to do with our clients, and we remain vulnerable to burnout. Let’s change that.

Noticing the Breath
The other day, a new client emerged from my treatment room and said, “That was great! I never breathe during a massage.” Her remark was more incisive than she realized, revealing her disconnection from, and obliviousness to, what is happening every minute inside of her own body.
After a decade of massaging and teaching, I think the same is true of most of us therapists. We are so eager to do a good job, so eager to help and to heal, that all too often we “never breathe” while we work. As a result, we miss out on a profound therapeutic tool and we diminish our career longevity.

Assessing the Breath
Like the best things in life, using the breath in your sessions—what I call “massaging with the breath”—is quite simple, but grows in complexity and satisfaction the more you practice. Working with the breath means simply noticing how the client is (and is not) breathing, and then using all of the great techniques you already know—plus a few adjustments and a few verbal suggestions—to guide him or her toward a more effortless breath.
The most fundamental shift we must make is to let the client’s body guide our work. We often believe we have to work hard in order to make a difference, and thus we often try to force the client’s body to change in the way we think is best. Attending to the breath reveals that trying to fix a client is counterproductive; our clients grow more, in beautiful and unexpected ways, when we awaken the capacity to change that is already within them, rather than forcing change on them. What is often most difficult about massaging with the breath is that it requires you to work less, rather than more.
Let me describe how massaging with the breath manifests in a session of mine, so you can see how you might adapt this practice into your own work. There are three steps. The first step is to become aware of how your client is breathing as you work on him. The second step is to make your client aware of his own breathing. The third step is to show your client—as we’ll see, through your touch and through a bit of talk—how he can find a breath that is fuller, and easier, and that will help him feel better.
In a typical session, I begin—like most of us, I am guessing—with compression to the client’s back. Just like you, in this first minute or two I assess the quality of the client’s tissues; but just as important, I assess the quality of his breath. This sounds fancy, but is really quite simple: I am just noticing what parts of his back move, and which parts don’t.
What you’ll find, as you compress and observe, is that the ways we breathe are as varied as the shapes of our bodies. Any generalizations are thus difficult to make. That said, one pattern is especially common. When my clients step away from their busy lives and lie down on my table, their breathing is typically shorter and faster than it wants to be, and requires more effort than is necessary. To put it simply, for many clients, breathing is harder than it should be; breathing is yet another kind of work.1
I suspect the same is true of many, if not most, of the people you see, too. As you compress your next client’s back, and begin to observe movement alongside musculature, what you’ll likely find is that on the inhalation, the upper back moves just as much, if not more, than the lower back and abdomen. The ribs will push up against your hands as he inhales; often, you can even feel the muscles of the shoulders and the neck contracting, pulling that next breath into the body.  Depending on the exact pattern of muscle recruitment, this can be considered “apical” breathing, or “paradoxical” breathing, or just plain “inefficient” breathing.2
No matter the particular pattern, the client is working harder than he needs to. (The irony is that the client is rarely aware of the unnecessary effort he is expending to force that inhalation, even though he is painfully aware, as we shall see, of the various symptoms that emerge as a result.) In each of these patterns, the client is using the secondary, or accessory, muscles of respiration to force that inhalation, rather than allowing the breath to happen passively, via the unconscious activation of the diaphragm. Those secondary muscles are a broad group that wraps the ribs, shoulders, and neck, from the sternocleidomastoid to the scalenes, from the pectoralis minor to some of the intercostals.3 Recruitment of these secondary muscles is necessary to expand the rib cage quickly and significantly, and thus is essential when we are doing aerobic activity, whether running to catch the bus, or in the case of our prehistoric ancestors, running from a lion on the savannah. And yet, that recruitment is terribly counterproductive for the vast majority of our daily lives, when we are not fleeing predators, but rather, sitting on our butts.
This kind of unnecessary effort means that for most of us, our musculature is working harder than is needed, all the time. That effort-full breath is a vicious circle; once we have unconsciously learned this pattern, it reinforces itself: when we are awake and when we are asleep, whether we are in a stressful meeting or whether we are “relaxing” on the couch watching TV.
You’ll feel this cycle as you assess your client. After you observe where and how the client’s back expands on the inhale, notice what happens on the exhale. The client’s body will begin to sink as the breath leaves the body, but then more often than not, a few seconds later comes a moment when the client stops her own exhalation. For no apparent reason, and without any conscious awareness, she reverses direction—she sucks the breath in and begins that effort-full inhalation once again. Some clients—swimmers or singers or those versed in yoga—tend to let the exhale empty more fully than others. But rare is the client of mine who allows her body to sink all the way down to the natural endpoint of the exhale. We seem nearly unable to simply let our breath do what it was designed to do—function with the minimum effort needed in each particular situation. Instead, we insist on getting in the way of our own bodies, often without even realizing the effort-full pattern we’ve created, or its long-term costs.
The more clients you assess in this way, the more you’ll glimpse this epidemic of unnecessary effort all around us. After all, by some estimates, we take 20,000 breaths a day. For the vast majority of each day, we are not engaged in aerobic exercise, or other activities that require the use of those secondary muscles. That means each of us stuck in this habitual cycle is contracting these muscles of the upper back and neck 20,000 more times than we need to.4 Every single day! Is it any wonder so many of our clients—even though they work in a wide range of jobs, and have a great variety of body types and postures and injury histories—complain about the same aches and tension in their upper back and neck? As science writer and former massage therapist Paul Ingraham writes, “These muscles aren’t built for routine respiration, and they exhaust and eventually injure themselves. If this occurs, it has a cascade of uncomfortable consequences over time.”5
Moving beyond the musculature, the consequences of our habitually hurried breath are even more devastating for our nervous system. As mentioned, that short, effort-full breath is inextricably linked to the fight-or-flight instinct of our sympathetic nervous system. Indeed, Anatomy Trains creator Thomas Myers refers to this kind of chest breathing as a “sympathetic stimulus.”6 This aspect of our nervous system—which makes our heart race, diverts blood from our internal organs to our extremities, and spikes our adrenaline—has helped keep the human species alive for thousands of generations (see: running from the lion on the savannah). But that state of vigilance is not designed to be our norm. A life dominated by the sympathetic nervous system is a rough one, priming us for everything from heart disease and hypertension to depression and ulcerative colitis.7 Not to mention that pervasive, looming feeling of stress and tightness that grips so many of our clients.
But, there is hope. Each of us has developed our habits for a reason—even those counterproductive ones. Once we recognize these habits, we can undevelop them—we can all learn to inhabit our bodies anew. That’s where massaging with the breath comes in. Though we don’t usually think about a massage as being about our breathing, in nearly every session we are reckoning with the tightness and pain and tension that is propagated by this disordered, effort-full breathing. Let’s look at how we can address at least one of the roots of the problem at the same time we reckon with the symptoms.

Initiating the Breath
Once you start to notice how your clients breathe, how do you adjust the session so your clients become aware of what they are and are not doing? You should do the wonderful work you already do; massaging with the breath is applicable to every massage modality I know of, equally useful whether you are doing Swedish massage or myofascial release. However, there are three adjustments—small, but crucial—that will help grow your own awareness further, and the client’s:
1. Low: Experiment with lowering your table one or two notches. When your shoulders keep creeping up toward your ears as you work, and when you muscle your way into the client, you won’t be able to feel the subtle shifts in the client’s breath, and the client won’t feel relaxed enough to alter that breath. However, lowering your table enables you to pour your body weight into the client, rather than push, and thus encourages your own breath to be slower, fuller, and easier.
2. Sink: Experiment with using less lotion or oil. (Or, if you are doing detailed work in a particular area, try using no oil at all.) You’ll be better able to maintain an awareness of the client’s breath if you aren’t slipping and sliding along the client’s skin.
3. Slow: As you move from that initial compression into the rest of your session, maintaining awareness will be easier if you slow down. See what happens if you alternate between the longer, faster, gliding strokes that most of us rely on and moments of pause, where you stop and let your point of contact sink into the tissue. These moments, where you are merely pouring your body weight into the client, not trying to go anywhere or make anything happen, allow you to feel what’s happening within the client’s body, and how the client’s breath is shifting. At the same time, these pauses can prompt a somatic “Aha!”—those moments of revelation in which the client understands her body in a new way. This awareness will be different for each client, and in each session—some clients notice they’ve been slightly contracting certain muscles, even while they’ve been “relaxing” on your table; some clients notice the area of tension that has felt unyielding for as long as they can remember actually does shift and change if they pay attention to it; some clients just feel more at home in their bodies. But none of this is possible if you don’t give your client the time to feel her own body.

Each of these adjustments will help you, and your client, become more aware of her breathing. It can be intimidating to implement such basic adjustments in our own work. (Just like our clients, we tend to be very attached to our own habits!) But, just as the effort-full breath becomes a cycle that reinforces itself, the same is true—in a good way—of these adjustments. As you work slowly, lower your table, and sink, your clients will become more engaged with the session; your work will start to feel easier, and your clients will be happier.  
But to harness the true effectiveness of massaging with the breath, there is one more step: talk to your client. I don’t mean small talk. (Indeed, I think we all do our clients a disservice when we chat during a session.) At various points during the session, I offer simple suggestions or visualizations to help the client notice what is happening with his breath and help him deepen the experience of being in his own body. I talk in a calm, slow voice, and say the minimum amount necessary. With a new client, what that means is during my initial compression to the back, I’ll say something like: “Throughout the session, I am going to use your breath as the guide to our work. I want you to feel at all times that your breath can be easy and full, both in and out. If anything feels too deep, or if you notice yourself holding your breath, just say ‘oww’ and we’ll adjust the pressure. At any point, if you need more pressure, just tell me that, too.”
From the outset, I establish an understanding: I am aware of your breath, and you can be, too. But that’s all I say—I don’t give any explanation. I don’t want to do anything that gets the client into his rational brain; I just want him to be a sensate creature, a sensing creature, one who is feeling and responding on some basic, even nonverbal, level. I find that a lack of rationale is especially helpful for my always-striving, always-thinking (and always-stressed!) clients. Too much thinking often leads to too much effort, exactly the habit we are trying to undo. That’s the paradox here: we are trying to become more conscious of our breathing. But the best way to do that, at least at the start, is just to get out of our own way, and let the unconscious body—the part of us that doesn’t keep a “to-do” list, that isn’t always anticipating the next problem on the horizon—breathe as it wants to.
We are encouraging our clients to cultivate a new habit, but that habit is best grown with the least possible effort. For that reason, the language I use is passive rather than active. I never tell my clients to “take a deep breath.” I never talk about taking an inhale, or making an inhale. Instead, I encourage a full breath by showing the client the power that comes in not doing, because oftentimes the reason he is on my table (even though he doesn’t often phrase the problem as such) is because he is already doing too much in his life. We don’t want to make breathing into something that is another activity, another effort, another thing on that “to-do” list. Hence, we start by introducing the possibility of an effortless exhale. Leslie Kaminoff, yoga teacher and anatomy expert, says the exhale is essentially “an action of removing waste from the system.” Therefore, “if we take care of the exhalation, the inhalation takes care of itself. If we get rid of the unwanted, we make room for what is needed.”8

Expanding the Breath
Once I’ve sparked the client’s awareness, we can play with that exhalation. Try this exercise with a client you like working with and who seems ready for something new. It doesn’t matter what kind of massage you are doing, just allow your palms to come to rest between the spine and each scapula. Then, experiment with a visualization. Here’s one I like:
“As you notice your breathing, I want you to not try to change anything, not try to force anything, not try to fix anything. Each time you exhale, I want you to just imagine that your rib cage is deflating into the table.”
As she exhales, gradually lean your body weight into your palms. Your own compression enhances her own awareness and reinforces that perception of her own pliability; thus, the client can start to feel how her own effortless exhale has the capacity (with a little help from you) to be a tool of relaxation.
Let the client notice her breath for a cycle or two and then continue: “As you follow your exhalation, I want you to notice where that exhalation ends. Notice how your body switches to the inhalation and begins the next breath in. Again, no need to force anything or fix anything. Just notice. Now, on your next exhalation, see if you can lengthen that breath ever so slightly. Imagine the spine sinking a little further into the table, the body melting all the way down to empty.”
This suggestion will make some clients nervous. Your client might begin to allow that lengthening, and then all of a sudden you’ll feel her upper back stiffen as she reverses course and pulls the next inhalation into her lungs. That is because our habits—no matter how counterproductive—are reassuring. Even if the client knows how stressed she is and wants to breathe more fully, she—like all of us—is used to her habits. The rational mind knows change is good, but our habituated body favors the familiar. Just as a muscle can spasm when we ask it to do something unusual, in the opposite way, the breath sometimes seems to spasm when we ask it not to do anything at all!
Thus, it is essential that we convey no judgment as we engage our clients’ breath. In the course of my visualizations, I always say, “You let your inhalation do whatever it wants to do, whenever it wants to do it.” That way, they have a safety net: they know they can always revert back to their habits when they need to feel the reassurance of the familiar. In order to grow, they must feel secure; you must make it clear they are not doing anything wrong if they can’t follow your suggestions right away. After all, no matter how difficult this work is, the client always has another chance: every exhalation is a new beginning, a new chance to try not to try.
Now, as the client absorbs your suggestions, what you’ll usually find is that quite quickly her body feels like it is deflating ever so slightly; literally, it seems like she is flattening or sinking into the table. The body, of course, is not changing at all, but the pliability of that body is, because she is letting her breath empty further than she is used to, oftentimes further than she even realized was possible.
If you can encourage the client to exhale fully, she is doing half of your work for you. As she begins to lengthen her exhalation, she becomes aware of the tension she is holding—tension that is as unnecessary as it is unconscious. That feeling of deflating on the exhale is the most palpable, most corporeal manifestation I know of the often unhelpful mantra that we should just “let it go.” We all know letting go is what we are supposed to do—that letting go will make us spiritually satisfied, self-actualized beings. But it is often not clear how we are supposed to do this. By making the client aware of the transformative depths of her exhalation, you are giving her a very concrete tool she can employ at any and every second of her life.
Ultimately, what you want the client to feel is that she can find a breath that fulfills all of her needs and is still effortless. We want to discourage the recruitment of those unnecessary muscles, but not by replacing one unnecessary effort with another; instead, we do so by revealing the power of being passive. You want your client to feel that the only thing she needs to do to birth a satisfying inhalation is to let her body sink all the way down to the bottom of the exhalation. That’s it. The diaphragm (or, technically, the pressure differential between the inside of the body and the outside of the body) takes care of the rest.9
Realizing the power of passivity is not easy. The final prompt we are going to discuss here helps with that realization. A few minutes after I offer the previous prompts, as I am still working on her back, I say: “Just as before, follow your body all the way down to empty as you exhale. Now, what I want you to do is notice what the very bottom of the breath feels like. Notice there is a moment of emptiness, a pause between the very bottom of the exhalation and the beginning of the next inhalation. Now, once you find the very bottom of the breath, I want you to do nothing. No need to try and inhale. Just let yourself linger in that moment of emptiness.”
If the client trusts me, and really does allow herself to pause and do nothing, something wonderful happens: she is still for a second, or two, or eight, and then—only when it is needed—an effortless inhalation begins. The rib cage and shoulders stay passive, and the inhalation spreads like a beautiful bloom through the abdomen and lower back. Though the client likely can’t articulate this, the instruction to pause quiets the secondary muscles of respiration and allows the client to rely on her diaphragm. Here again, we are bypassing our rational brains, short-circuiting our instinct for action. (By contrast, in this same moment, if you were to tell the client to inhale into her abdomen, or to “take a belly breath,” that breath would still be an effort-full one; the client would just replace the typical concentric contraction of the chest and shoulders and neck with an eccentric contraction of the abdominal muscles, as she—eager to do the right thing—forced the belly to expand.) But each time she notices the pause at the bottom of the breath, and waits for the inhalation to begin itself, your client creates a different pattern, reinforcing the fact that she can create everything she needs by not trying to create anything at all.10
An awareness of the breath is an endlessly flexible tool; the prompts I’ve discussed here are just starting points (see “Other Places to Breathe” on page 83). As with all techniques, massaging with the breath will be more effective with some clients than others. Our breath is so foundational to our lives that an increased awareness of it is, I believe, always a good thing. Some of your clients might not yet be ready for your verbal suggestions; perhaps they have experienced trauma and attending to the breath is too emotionally intense. However, you can still utilize the “low” and “sink” and “slow” principles, and then introduce the verbal suggestions as they become more receptive to your work. But even more important, the best way to become more adept at massaging with the breath is to become more aware of these aspects of your own breath.

Continuing the Breath
Our clients come to us because they want to feel better in their bodies. A breath that is slow, full, and effortless is one of the greatest tools we have to feel better—and literally, to feel more embodied. By making the client more aware of this innate ability, you are helping her to feel better whenever she wants, both in this moment and in the rest of her life.
That perpetual applicability of the effortless breath is important, because the one thing we know with certainty is the massage session will soon be over. Though it is gratifying when a client tells you she wants to stay on your table forever, we should want our massage work to prepare the client to re-enter the world of the standing and to be able to navigate that world more easily. I believe engaging the client’s breath—and making her conscious of the possibilities within that breath—is one of the most concrete and useful means we have to prepare her for the post-massage world. When the client walks out of the room and feels her breath full and easy—even as life’s stresses re-emerge, even with our hands no longer on her—she is empowered.
The beauty of massaging with the breath is that we can’t not breathe. Unlike the daily stretching routine we never make time for, or our attempts at a new workout regimen, or the fitness tracker we keep leaving at home, breathing is something we already do, all the time. Growing our awareness of it gives us the chance to live with a little less effort, to embody our bodies with a little more ease. The breath is our perpetual possibility. With every new exhalation we have the chance to become more aware. To notice exactly what we are doing right now, just at this moment, and just as important, to notice all that we don’t need to be doing right now.

As I tell the therapists in my continuing education classes, I am an expert at nothing. I am not trained in any particular breath-related school of thought, and I do not presume to know the right way to breathe. Rather, I am pretty sure there is no one right way for all of us to breathe.
There are many wonderful schools of thought, developed over thousands of years, about ways to refine the breath; I will leave such specific recommendations—the proper ratio of inhalation to exhalation, or when to use the mouth and when to use the nose—to the experts.
Rather than telling you (and our clients) how you should be breathing, I want to cultivate, first and foremost, a more subtle awareness of how we are—and are not—currently breathing, and of what happens, in both our work and the rest of our lives, when we grow beyond our habits and let our bodies breathe as they are designed to.

Other Places to Breathe
Even though respiration itself happens in our lungs, the ramifications of an effortless breath can be felt throughout the body. Below are a few additional and more specific ways I use the breath in a session.

Front of the Hips
For the client with low-back complaints, I find it helpful to grow his awareness of the front of the hips. Try this prompt with the client lying face down, as you work on the posterior legs and the glutes.
“As I work on your right leg, I want you to notice the front of your right hip. Notice the place where the front of the hip touches the sheet. Like always, I want you to do nothing, force nothing, change nothing. With each exhalation, just imagine the front of the hip melting a little further into the sheet; through the sheet, into the table; through the table, down toward the floor.”
Oftentimes, even in just the first or second exhalation after the prompt, I can feel a loosening—a deflating—particularly in the tissues of, and around, the glutes.  
What’s happening in this moment? The client is becoming aware of the tension he carries unconsciously, and that lengthened exhale is a vehicle for releasing that tension. Particularly for those areas—like the lower back—where tension and pain can feel ever-present, a lengthening and loosening of the muscles nearby can help release that constantly clenched area.
The upper back is another spot that often feels unyielding to the client; here, encouraging a melting through the front of the chest and the arms can help the client find ease in that seemingly stuck area.

Base of the Skull
Our suboccipital muscles are especially good at holding a slight contraction all the time, working even when we don’t need them to. Try this prompt for those clients who always seem to be on high alert, who have a difficult time letting their head relax into your hands when you are doing neck work in supine, or those who get a lot of headaches.
With the client supine, sit at the head of the table, place the back of your palms against the table, and slide your fingertips along the posterior neck until you reach the base of the skull. Your fingertips should be pointing toward the ceiling, with the client’s suboccipitals resting against the pads of the fingers and with the client’s skull cradled in your palms. Then, say something like: “Each time you exhale, imagine the base of your skull melting ever so slightly into my fingertips. Like always, no need to force or change anything, just feel the head able to soften, little by little, just as it’s ready.”
As you say this, keep your fingers soft and stationary, but tip your body forward and back ever so slightly, hinging at your hips, as if you are using a rocking chair. This subtle rocking movement—rather than trying to explicitly pull or stretch the neck—in combination with the spoken suggestion, helps to mitigate that instinct for these muscles to hold and guard, and can offer clients a particularly vivid revelation of how much their own body can let go.
Rubber Band Relief
Though I have focused primarily on the exhalation, as your client becomes more adept at feeling her breath (and you become more adept at offering suggestions for the breath) you can direct the inhalation as well. A conscious inhalation is particularly helpful for pain relief. Here is a visualization that can be helpful for any area that feels uncomfortable: “I want you to feel the discomfort here as specifically as possible. Think about how you would describe it. Achy and dull? Sharp and shooting? Tight and constricting? Now, I want you to imagine a rubber band that is wide enough to cover that painful area; imagine it wrapping all the way around your body, from the spine, around the sides of the body, to the front of the body. As always, slowly follow that exhalation down to empty. Then, as the body begins to inhale, imagine the rubber band being stretched in every direction—feel the front, the sides, the back of that painful area being inflated. Then, on the exhalation, feel that uncomfortable area melting back down to empty.”
You can encourage your client to maintain this rubber band image for as long as feels useful. I find this use of the inhalation a very simple, embodied manifestation of a central and very powerful tenet of meditation: even when our pain feels constant, or chronic, or we feel just plain stuck, if we pay close enough attention, we see that this discomfort—like all of life—is in fact always changing. Just as important, showing clients how they can use the breath to engage with their discomfort, rather than just trying to ignore it, can help clients feel more in control of the session itself, and gives clients a tool for the next time the pain returns in one form or another.

1. Paul Ingraham,, “The Respiration Connection: How Dysfunctional Breathing Might Be a Root Cause of a Variety of Common Upper Body Pain Problems and Injuries,” accessed March 2016,
2. Fiona Rattray and Linda Ludwig, Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions (Toronto: Talus Incorporated, 2000): 34; Leslie Kaminoff and Amy Matthews, Yoga Anatomy, 2nd ed. (Champaign, IL: Human Kinetics, 2012): 16; Paul Ingraham, “The Respiration Connection.”
3. Frank Netter, Atlas of Human Anatomy, 3rd ed. (New York: ICON Learning Systems, 2002): 191.
4. Fiona Rattray and Linda Ludwig, Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions, 33.
5. Paul Ingraham, “The Respiration Connection.”
6. Anatomy Trains, “Fascial Release Technique Webinar: Part II, Opening the Breath and Shoulders,” accessed March 2016,
7. James P. Fisher, Colin N. Young, and Paul J. Fadel, “Central Sympathetic Overactivity: Maladies and Mechanisms,” Autonomic Neuroscience 148, no. 1–2 (June 2009): 5–15.
8. Leslie Kaminoff and Amy Matthews, Yoga Anatomy, 3.
9. Ibid, 6.
10. Ibid, 20.

David M. Lobenstine, LMT, is owner of Full Breath Massage in New York City. He combines an attention to the breath, along with deep tissue and myofascial work, to help clients inhabit their body anew. He also teaches continuing education classes to help LMTs engage with their breath and their clients’ breath. Find him at and