Biomechanist Katy Bowman and biologist Jeannette Loram talk about coughing.
Katy and Jeannette discuss coughing as a life-saving movement; both in the immediate, to prevent choking, and also in the longer term for adequate clearance of the lungs and the health of our airways. They discuss the anatomy and mechanics of a cough, explaining how the mobility, strength, and coordination of our core muscles affect the strength of our cough.
They discuss postural presentations such as hyperkyphosis and anterior pelvic tilt that can lead to a weaker cough. They also talk about the liabilities of a cough, including abdominal strain, urinary incontinence, rib damage, and back pain.
They discuss how coughing, like giving birth, is not a movement that we want to practice: ‘use it or lose it’ does not apply in this case! Instead, we want to make sure that tension or weakness in our torso is not limiting our ability to cough when we need to. Katy offers a suite of mobility and strength exercises to prepare your coughing apparatus as we head into flu and cold season.
OVERVIEW
(time codes are approximate)
00:06:00 - What is a Cough? (Jump to section)
00:11:00 - Coughing with Pain, Postpartum, and other situations (Jump to section)
00:15:00 - Coughing as a Movement? (Jump to section)
00:17:35 - Anatomy (Jump to section)
00:21:00 - The Intercostals and a Tube of Toothpaste (Jump to section)
00:26:20 - Problems with Coughing (Jump to section)
00:29:50 - Get Ready for Coughing - Your Coughing Plan (Jump to section)
00:40:30 - Coughing - Giving Yourself a Heimlich Maneuver (Jump to section)
00:42:45 - More Anatomy and Pneumonia (Jump to section)
LINKS AND RESOURCES MENTIONED IN THE SHOW
Are the Lungs Outside the Body Podcast #165
Exercise Advent 2021 - Take A Breather (all exercises in one post)
How To Move Your Breathing Parts Better Blog Post (includes exercises)
Literature Discussed
Relationship between Kyphosis and Cough Strength
Action of the Pelvic Floor during Cough
Exercises to improve your Cough (from Instagram)
Candle Blow Out - Another Huff and Puff
Remedies
Honey For Relief in Upper Respiratory Tract Infections
Honey for Treatment of Cough in Children
More on Honey Treatment of Cough in Children
PODCAST TRANSCRIPT
(Theme Music)
This is the Move Your DNA podcast, a show where movement science meets your everyday life. I'm Katy Bowman, biomechanist, author, and I currently have a cough. And I'm Jeannette Loram, biologist, movement teacher, and I tend to be more sneezy than cough-y. Every body is welcome here. Let's get started.
(music fade)
KATY: All right, today we are talking about coughing, a very important movement. I would say a life-saving movement.
JEANNETTE: Yes, absolutely, a life-saving movement. And it really is a specialty movement of our respiratory system. So I would like to encourage our listeners to also listen to our episode on lungs that might help give some context for what we're talking about today.
KATY: We peeled this part out because the episode Are the Lungs Outside the Body, which is a few episodes back - there's so much to the lung tissue itself. And we thought we would pull aside this specific movement to really pick apart. So yeah, you don't have to listen to that one before you finish listening.
JEANNETTE: No, it's not necessary, but it will give you a broader picture.
KATY: Yeah. So interestingly enough, I have had a cough. So this topic, it's been near and dear to my heart, literally. And why coughing is so important. At the beginning, we said it's a life-saving movement. It's life-saving movement in the immediate, if you're choking...
JEANNETTE: That's right.
KATY: ...to be able to expel things up and out of the body. But also longer term. We accumulate things in our lungs.
JEANNETTE: That's right.
KATY: Exhaling is a part of clearing. But so is coughing.
JEANNETTE: Yes. And coughing is obviously a more forceful movement. The longer term health requirement of coughing is that we need this way to get mucus and particulates out of our system. When you've got an illness and you've got a lot of mucus, you need a mechanism to get that out. If you don't, over time, that's a risk for things like pneumonia and airway collapse and things like that. So it's very important both in an acute situation, like you said, when you're choking. But it's also part of long-term health for your airways.
KATY: It's part of your immune system. And I know it's not classified in that way, but it is. I have a really hard time separating musculoskeletal action from immunity because they are so tethered together. And especially with what we've been through in this big pandemic and seeing some of the impact of musculoskeletal weakness on something like breathing - the ability to draw in deeper breaths and to cough, as we're going to see, it's definitely a core strength-based activity. And so during the pandemic, I had put out an article about some of the things that we're going to be talking about. We're going to be talking about the importance of posture. We need to do a whole episode on posture. And interestingly enough, I have a cough right now. So I'm going to probably have Brock, our sound engineer, edit most of it out, but maybe we'll leave a couple of them in there. So you could just be reminded.
JEANNETTE: Right. And that's another thing about a cough that's quite interesting. I can hear you. You're clearing your throat before you're speaking. And we have to remember cough is both something that's a reflex and it's also something that we can do voluntarily. So it's a ...
KATY: Love that.
JEANNETTE: Yeah. And that's distinct from like a sneeze. Which is almost - it's very hard to sneeze.
KATY: Yeah, how could you sneeze on purpose? You can't sneeze out on purpose. I would really like to clear out my nasal passages.
JEANNETTE: Yes.
KATY: Oh, that's very interesting. So, okay, I like that distinction. And then I think also other things that people will be interested in is why coughing can create that - we have a sneeze, pee, a urine leak. What's the relationship between those two things, pelvic floor function and coughing, definitely posture and coughing. There's research on the impact of hyperkyphosis again, from that lung episode. Oh, I had started saying earlier, I really wanted to do an episode on the difference between alignment and posture. Because with posture, we get so fixated on how it looks and the aesthetics. There's so much of tying aesthetics together with movement. But alignment is really more about how it works. And when you've got that hyperkyphosis, that extra curve of your upper back, stiffness in the chest, that can decrease your ability to create a forceful cough. The leverage and the mechanics of coughing depend on these mobilities of the upper back. And so posture really feels like it's sort of thought of as benign now.
JEANNETTE: Yes, it just looks nice, but...
KATY: Or that it's a relic. That it's a relic of puritanical behavior, cotillion, all these things.
JEANNETTE: Right.
KATY: But it's really not. It's really not. There's been definitely different cultural ways of cluing people in. But we're talking about function here and that upper back curve is a big one. And at the end, we'll definitely give everyone some exercises. I think some practical things that they can do because we are going into the season of the cough.
JEANNETTE: Yes, absolutely. This kind of change, this change from summer into fall is often the time. And we are both traveling too. And that adds to the risk. It's half time coming up here and people on planes and the season change. It can all create the perfect storm for a cough infection.
KATY: So get your coughing muscles ready. That's what we're trying to prep everyone for. That you go into the season with a plan - with a movement plan.
JEANNETTE: Brilliant.
JEANNETTE: So a cough at its most basic is a way to clear your airways. Fundamentally, the aim of a cough is to clear your airways. It is a modified breathing pathway. And it has three phases. These occur very, very quickly, so you're not going to be able to separate them perhaps in your experience. But the first thing you do is you have to take a preparatory in-breath, an inspiratory step.
KATY: Right.
JEANNETTE: So in that step, because you need the air in before you push everything out. So you take this big inhale, diaphragm and external intercostals contract. So they increase the space in the thoracic cavity which pulls air in. Then you seal your glottis. You might not be aware of where your glottis is but it's the area of your vocal folds and the area between, the space in between. So there are gaps. So you close that.
KATY: Like doing a Valsalva maneuver.
JEANNETTE: Yes, yes.
KATY: So for those who don't know what that is you would be closing your glottis if you were to take a deep breath in and then ...
JEANNETTE: Hold it, that's right.
KATY: Bear down. Like if you're going to bear down. So you are playing with your own pressures and you have the ability to not just exhale. You can take that breath in. (holding breath noises) You can go ahead - and what I'm doing right now valsalva is more of a downward pressure. But a cough is going to be that plus an upward impetus.
JEANNETTE: That's right, that's right. So you close. And then as the glottis closes your abdominal muscles, your pelvic floor muscles are included in the core. They're your accessory breathing expiratory muscles. They contract. So you get this increase in pressure in the abdomen and the thoracic cavity. You build up this pressure. Then the glottis opens the abdominal muscles and the other accessory muscles still keep contracting to force the air out at high speed.
KATY: Yeah, so let me just give them to the model.
JEANNETTE: Yeah.
KATY: It's like if you're trying to get toothpaste out you're going to squeeze it from the bottom and move it all up to the top. And so the bottom of the toothpaste is your pelvic floor and the sides of the toothpaste tube are your abdominals. And so you don't really want to squeeze the toothpaste right in the middle - the tube of toothpaste because then some goes down. So that coordination of the pelvic floor and the core muscles all come together. And the difference between getting toothpaste out ... So with toothpaste is this lazy, slow grab and sort of milking it up. But with a cough you have that tension happening a bit.
JEANNETTE: Yes.
KATY: You know, it's a forceful, very quick contraction. And now the glottis is open and you've got this bit of air in here that can really help you push it all out and expel.
JEANNETTE: Yes, exactly.
KATY: Three parts, but you will never really detect.
JEANNETTE: No, no, absolutely not. And sometimes they say there's a fourth phase at the beginning, which is where you, if you're doing a reflex cough, it would be where you have the receptors would sense that there's an irritant to sort of stimulate that response. But obviously you've been demonstrating a voluntary cough where that wouldn't be there. So three phases are always present and they're like milliseconds long.
KATY: And I think you could detect if one was sort of awry. For example, that we talked earlier about the leaking of the urine.
JEANNETTE: Yes.
KATY: That would give you a biological feedback of the coordination of that phase being off. And I think it's probably that third phase, it's often troublesome. I mean, I guess taking the deep breath, I know if I'm going to have to take a cough, right? (breath in noise) I'm going to pull in.
JEANNETTE:: Yes, you know that.
KATY: And I can feel that, I can sense that. Now I wonder if people will become aware. It's sort of like before you're about to go underwater. You have to pull it in and then maybe they can - maybe it is detectable.
JEANNETTE: Yeah, maybe it is.
KATY: I don't wanna undersell people.
JEANNETTE: Yeah, I think you're right at that. I do wonder with the pelvic floor and also the back pain. So some people will have back pain when they cough.
JEANNETTE: Yes. And that's a sign that, as you were saying, Katy, that you want this even squeeze: pelvic floor at the bottom, abdominals round the center. If one part is not working so well, more pressure can kind of move towards the back of your abdominal area and cause that discomfort in a bulging disc. So I guess you could feel that too, the kind of leaking pressure somewhere would be an indication. But I'm wondering whether that happens, as we talk about this, in a compressive stage. So the second is the compressive stage and then there's the expulsion stage, which is where your diaphragm relaxes, so it recoils and the item comes out. So I think the pelvic floor issue might come more in the compressive stage.
KATY: Although it's so quick, I don't know if you could feel the difference.
JEANNETTE: Separate it.
KATY: So I've had a couple of situations with breathing. And you're welcome to share if you've had something similar. Right after I gave birth, I needed to cough. I mean, okay, so it was a couple of days later. And I had had complications with the delivery. But I mean, I had my son at home and then I had an artery problem that was related to pregnancy, but not to the delivery phase anyway. So I had been bedridden for a few days and then I came home and I had no core function whatsoever. And I only know my experience, so I'm not sure if it's the same way for everyone who has a baby and doesn't have to be, you know, bedridden for multiple days. And I couldn't cough. I couldn't generate the force of a cough because I was missing ... It was like trying to squeeze the tube of toothpaste with my hands only wrapped around the back of the tube.
JEANNETTE: Right.
KATY: Right? So I could create some, a little bit of upward force, but it was just such a pathetic, like, (coughing sounds) I couldn't wrap the hands all the way around that tube. And so I figured out if I took myself to the edge of a bed or a couch and could lean against it and then let that pressure of the furniture holding the anterior front of my abdomen, that could be the squeeze. Because I just did not have the coordination or the strength. You've got abdominal separation that's happened. And everything's very sort of loose and floppy at this point. And so I had to create it. But I knew how to cough and I knew what the forces would be. I'm like, okay, if I can just create something to squeeze the front of my tube of toothpaste, I'll be fine. And I coughed like that for a few days until being upright and moving around helped.
JEANNETTE: That's fascinating.
KATY: And then also I've had slipped discs before. And oh, you know, a cough is going to come on and you know it's going to hurt. And so again, this is kind of why I do the work that I do to give people more tools. Like I knew that I had to change the direction of the pressure to get into a different shape with my cough so that it wouldn't end up creating that backward blip - pushing into the discs and the nerves in that area. So just letting everyone know when something's going on with your body, so much of what's happening in our body is mechanical. By exploring some of these things like, oh, I can change my mechanics through movement and through strength training, but also just through interacting with the environment in different ways. A lot of times you have options. You don't just have to sit there and take what's going on.
JEANNETTE: That's right. And I think instinctively sometimes we do those things without perhaps thinking, oh, you're thinking, this is the way your brain works. If you're analyzing the thing that you do and realizing what you've done. But I think sometimes we do instinctive things. I'm thinking like pelvic floor, people might sit down. And just that might be an instinctive thing. And that's usually, that's you modulating your pressures.
KATY: Yes, you can sense them. You can sense them and you know how they need to change because again, coughing is so important. It's a life saving move. It's not something that we can sort of let go. Which brings me to another, I think, beautiful point that you brought up about why coughing doesn't really make sense as a movement. So many other movements are use it or lose it or care for it to keep it. The reason we're doing so many of these exercises is so that we're able to do these movements when we need to do them. But coughing is not like that.
KATY: Explain, explain.
JEANNETTE: Well, it was just as I was working through this episode. Well, actually what started me on it was there are specific scenarios where people are sent to breath training. They're given devices because their breathing is very - so their coughing is very ineffective. Which is dangerous for these people because they have issues to do with their respiratory system.
KATY: Or if you were coughing all the time, it would be a problem.
JEANNETTE: It'd be a problem, yes.
KATY: You would have to be actively coughing.
JEANNETTE: And we know that a chronic cough has issues associated with it. Chronic cough has other morbidities associated with it. So you don't wanna get into that habit. So it's a movement we don't practice. And we don't want to practice it. So how do you actually train coughing? It's something that we want it when we need it. And we don't want it when it's not useful to us. So it has to be trained by other things that we do.
KATY: Yeah, the mobilities and strengths that we're going to call on, they need to be there.
JEANNETTE: That's right, for them. And it's a bit like - I was thinking about - it's a bit like when you give birth.
KATY: You're not practicing bearing down any other time or your uterus isn't doing that.
JEANNETTE: It's not contracting like crazy. You just need those muscles to be there when you need them. And that requires, as you say, strengths and mobilities in the parts that are required to do the job.
KATY: I love that. Yes. All you can do when you are pregnant is make sure that you are not creating states of musculature and bones, connective tissue, the nerves that resist this natural phenomenon - the reflexive part that we don't have control over. And the same goes for coughing. So with pregnancy, it's going to be hip and core mobility and making sure that pressures too, right?
JEANNETTE: Yes.
KATY: That you're not getting upward pressure, everything. And with coughing, it's remarkably similar.
KATY: A lot more shoulder girdle with coughing. Let's talk about the anatomy. I think we've touched briefly on it. But now we're talking about what is the anatomy of a cough? We've talked about the stages, but let's just revisit the anatomy of a cough now. We've got the diaphragm.
JEANNETTE: The diaphragm, yeah. So that contracts in the first phase.
KATY: And when it contracts, it's flattening.
JEANNETTE: That's right.
KATY: You know, it's a dome-shaped muscle. So I always think of the torso and the abdomen as sort of a hotel and all the walls and floors are flexible. So if the thoracic - the chest cavity is the second floor and the abdominal cavity is the first floor. Although I guess we should have the pelvic cavity too. All right, so three floors: the chest, the abdomen, and the pelvic floor. Of the upper story - the thoracic story - the floor of that story, what separates it from the abdominal cavity is a diaphragm. But the diaphragm isn't flat. It's like a dome. You know, it's like a little hill that you have in between. And when it contracts, it moves down and flattens. And that's what allows more air to come in.
JEANNETTE: I like to think about it as a jellyfish. When you have a jellyfish that is tight in a kind of little bubble. And then they pulse and it flattens and then it relaxes and it goes back to the dome.
KATY: I like that our example for clarifying the highly nerdy movement of a diaphragm is - it's exactly like a jellyfish. For everyone who knows how jellyfish.
JEANNETTE: I'm sorry, I can't take the marine background out of the way I think.
KATY: No, we can just put you in the water, but we can't take that out of you.
JEANNETTE: Yeah, please ignore that.
KATY: No, but I love it. Yes, it goes from a dome shape and then it becomes longer, flatter, longer in that way. Okay, so we've got that diaphragm movement. We also have ribcage: the external intercostal muscles in between your ribs. You know, if you imagine that skeleton ribcage. In between each of those ribs or muscles, and that helps open and increase the circumference of volume of the thoracic cavity. So you've pulled in your air.
JEANNETTE: Yes.
KATY: And then now we have the tube of toothpaste squeezing.
JEANNETTE: Yes.
KATY: So we've got the pelvic floor coming up and then really importantly, we've got the 360 degrees of core musculature wrapping around that too. So that's rectus abdominis, transversalis. I mean, I would even...
JEANNETTE: Internal, external obliques.
KATY: Yes. Obliques for sure, that's a big part of what makes that compression and squeezing.
KATY: Correct, correct. So, you know, we talked about the muscles in between the ribs. There's three layers of muscles in between the ribs. And so some of those muscles help lift and the deeper muscles, the ones that are closer to the lungs, they help not just recoil, but actually pull in and compress and make the ribcage smaller overall. Sort of like squeezing the tube of toothpaste up around the thorax, up around the thoracic cavity of the spine. So we've got all of these pieces. And then why the spine I think is important is because the ability for those intercostal muscles to lift and lower the rib cage, we talked about this before, really depends on vertebral angle, vertebral position, the position of your vertebrae. So when your upper spine is really curved forward, it reduces the amount that the ribs can both open and close and squeeze. And so I think this is one of the reasons we see ineffective coughing show up with age. Because we also tend to see spinal curvature changes with age. Again we can correlate them with age. But I think we could equally correlate them with length of habit or set of strengths that you have. And chest too. So these aren't necessarily muscles that will be listed under coughing or inspiration, but they are parts of the body that can hinder the movements of some things that we need to do. So really tight chest - they've done some work on, especially folks with COPD, pulmonary disorder, chest stretching, trying to help with the mobility of these areas so they can get actually better exhales in that case, but it's still the same. It's trying to make all these levers available so when these reflexive movements happen, they produce more force. You're not sort of stopping the reflexive movement with your stiffness. Or in the case of your core with weakness or sometimes it's coordination.
JEANNETTE: Yes.
KATY: Or if you've got that really deep pelvic tilt, that can really affect the leverage that the obliques have. So if you have a big anterior tilt stiffness in the lower back - quadratus lumborum, those lower back muscles get really stiff - that really influences how well all of the parts in the pelvic floor and the abdomen can coordinate. Because coordination is almost more important than individual strength.
JEANNETTE: And that's right. Because with the pelvic floor, I think they found that the contraction of the pelvic floor is slightly anticipatory. Like it's actually a little bit before. So it's almost like I'm stabilizing the bottom and now I can get the sides. And just like your tube of toothpaste, you start from the bottom and roll it up. And that can be a thing with leaking, that it's actually a slight delay in that.So it's not necessarily strength per se. It's just a little late.
KATY: It's coordination. You know, I really think of it as coordination. And with babies - this is just to kind of talk about that anticipatory movement. With babies, especially if they're held a lot, they can tell that when you reach for a baby, the baby knows it's about to be picked up and it braces, you know, it's not floppy, dead weight. The baby is assisting you with this movement. It's like, oh, I'm going to be picked up. And I think with coughing, it's a lot like that as well. Certainly with reflexive coughing in your sleep where you're not as mindful, you're not as aware. But when you know a coughing fit is coming up, definitely bringing the core strength to the table, I'm aware that I'm doing it. It's almost like it is a somatic choice. It's me recognizing I need to cough strong right now. So it's almost more than reflexive.
JEANNETTE: Interesting, yeah.
KATY: I'm doing this. I'm on purpose - I am coordinating. But I do that in exercise class, right? I do that before I load my body. You know, if you go to physical therapy for back pain, they're teaching you not necessarily how to brace, although sometimes that's the word that's used for it. It's this preparing for the set of forces you're about to experience. And the more comfortable you are in your body, in your skillset, the bigger your toolbox is for when something like coughing comes on. Because you wanna get it out.
JEANNETTE: And I do think with cough, when we say reflex, it's the initiation...
KATY: That's right.
JEANNETTE: ...that's the reflex. I think coughing is slow enough that you, maybe you can't stop, the cough is going to happen. But I've been coughing today, practicing, but you can sense more so than with a sneeze, which is so fast that it all seems to me to happen beyond like my ... although you can still adjust your position. You've got enough time with a sneeze to adjust your position.
KATY: Yeah, I mean, at least cover your mouth.
JEANNETTE: Cover your mouth. So you have the time to adjust. But I definitely think when I say reflex, it's the initiation. That's not to say that you couldn't in that millisecond bring on part of your abdomen or your pelvic floor to assist.
JEANNETTE: Yeah. So there are some liabilities to coughing as well as the obvious benefits that you wanna get stuff out. So we've already talked quite a lot about pelvic floor. There's also heart effects, which in healthy people, they're not that common. And in healthy people, these changes in pressures in the thoracic cavity do have effects on your heart. They compress the heart.
KATY: It sort of interferes with the doing its cycle of beating.
JEANNETTE: That's right. But in a normal healthy situation, we're able to adapt and we have this slight moment where pressures are and the heart and the circulation receive different pressure inputs. And we can reestablish the equilibrium very easily. But that's not always the case. Some people can actually lose consciousness with a cough. So that's for the more vulnerable sector of the population, I would say. Another one is ribs.
KATY: Yes.
JEANNETTE: So rib fracture with long bouts of coughing.
KATY: With excessive coughing.
JEANNETTE: Exactly, so that can be a thing.
KATY: As well as if you have a fractured rib, it's very difficult to cough.
JEANNETTE: I think it's very painful.
KATY: Very painful.
JEANNETTE: Very painful. And osteoporosis in the ribs - that's one of the common sites for bone loss. But refractures can happen in bones with normal density too during coughing. And that's why coughing can become a liability if it becomes chronic and you have these terrible, long sustained bouts. It can be quite a big load on those rib bones.
KATY: And just in general, muscularly, like I've been ill for a couple of weeks. This is just a very trace of this cough. But there were three to four days of such intense coughing, my abdominal muscles were just - it had been like doing abdominal exercises all day long.
JEANNETTE: Yeah, that's a really good point. Abdominal strain is another common side effect.
KATY: Yes. I mean, it's such a physical experience. And you need a lot of strength for it. So if you can imagine how fatiguing it is when you haven't done it for a long time. And then you go into this three or four, or God forbid, longer than that, coughing phase. And you can feel the effects - the training effects - of that much work. You can sort of imagine then the strength that you would wanna have before going into a bout of coughing. Because I'm relatively strong. I spend a lot of time keeping my shoulders mobile and my core strong and my pelvic floor strong. And I was even fatigued by doing this amount of work. So if you're trying to figure out is becoming stronger really a thing? It really is important to the way your body functions. So how do we do that? Like that's what we're thinking now. It's like, okay, what's my coughing program? If I don't want to be practicing coughing, what are my options? And so that's where we go into movement diet stuff, right? Like what do you need to do to keep your coughing apparati non-resistive and supportive?
KATY: Right, so incoming. (coughs) Hold on. So that was not productive. So that was such a shallow cough for me. So now I have to go deep. So I'm going to have to take a deeper breath in, like I'm going underwater. Because I'm going to, I've never, this is like color commentary on a cough. (coughs) There, now I was able to produce. So one deep breath, right? You know, really being able to take a deep breath in this way - an exercise for that that we have is taking stretch pants or resistance band and tying it around the lower rib cage. Something, you want something sort of stretchy, and then being able to really practice taking a deep breath against the resistance. Because just a shallow inhale is not going to get you the pressure that you need before you close your glottis that allows you to really push on it, right? So you need that deep, "I'm going under" breath. So your rib cage needs to be able to work and open. So that's a good exercise. You're not practicing coughing, but you're practicing strengthening those rib cage muscles to be able to open. And then you can also exhale more deeply to try to pull away your rib cage. Make it small enough so that this thing that you've tied around firmly, but not over tightly can sort of loosen, right? You're able to really contract and make that smaller. When you're doing that, you're most often going to be finding your core muscles assisting. It's really hard to bring just your rib cage down without the obliques anchoring. The rib cage down a little bit more to sort of support that inward motion. So that's a good one. And then something else that I've done this in, I do an exercise advent at the end of every year, and I did one on breathing. So that's also a good one to go back and revisit. Because a lot of those exercises would carry over often.
JEANNETTE: Right.
KATY: And I had just a candle blowout, which is an exercise that is often used in asthma for just the core, for children. Oftentimes it could be a pinwheel. It's this idea of (blowing sound) coordinating your breath where you're using your core musculature to help create a forceful outward flow. So with coughing, you're not doing that breathing, but that coordination of creating that intense directed flow is part of that toothpaste squeeze.
JEANNETTE: Yeah.
KATY: Spinal twists, thoracic stretches, things that help mobilize your upper back and stretch your waist. If your waist is really stiff, that could be a big resistance to creating coughing. So I love doing five or six spinal twists a day. And they're so good for other parts of you too. When you're in that spinal twist, you can practice (blowing sound) some of that directed breathing; the idea of pulling your rib cage in, even if you're not necessarily tied up around the rib cage.
JEANNETTE: Yeah.
KATY: But you're in the spinal twist and then you're starting to ... I think we're so disconnected from parts of our body and therefore parts of our body are disconnected from other parts of our own body. So it's not just you're connected to your body or not. It's sort of a part by part connection. And then, you know, with motor programming, it's really about connecting other parts in a coordinated way. Because, if you're asking me, "what are the parts that you use to ride a bicycle?" And I say, you know, "well, mobilize your hips and your knees and your calves, and you need to have your hands fixed in one position." That's not going to get you riding your bicycle. It's more about the ability for pedaling and balancing to happen at the same time. And coughing is really like that.
JEANNETTE: Yeah, as we said, coordination.
KATY: It's the coordination part. It is really like a larger motor program at hand. And then I had mentioned the chest stretching, you know, getting yourself a sleeping bag or a stack of pillows and then reclining back on them with just your upper body. Hips are on the ground, your legs are stretched out in front of you. And open your chest. You know, you're laying out to the side and you're getting this nice stretch in the pectoralis and practicing bringing the ribs in, in that position. Imagine you have a pinwheel in front of you, that slow coordinated breath that brings the rib cage in and coordinates the abdomen as well. Have you ever tried to do an exercise - let's say it's a lat pullover. All right, so you lay on your back, knees are bent. You've got, let's say a log, something that's got a little bit of weight above you and you're dropping it overhead and then you're bringing it back up. What you're doing in this case is trying to get the abdomen to anchor the rib cage down. Because for so many people, when they go over, they're not using their abdomen to support the pulling over of this weight. So the phenomenon that I wanted to describe is if you do it with something very light, it actually makes it harder to find these core muscles that are supposed to help. It's only when you add a lot of weight that you're like, oh, there it is. Because the body's not going to step in with these supportive muscles. If it's so light, it's like, yeah, just keep using your arms and your traps because you're not lifting. You're not doing anything that requires the core step into support. And so by adding more weight, it becomes easier to actually get the results you want. It's not always doing something light that gives you a little amount of what you want. Sometimes you get none of what you want when you're too light. I think that this is one of those cases where because what we do with our upper body and our core together is so little, that the core is not really connected to the upper body. That's why I have things like hanging. And for coughing, I would say, I would say go a step further. (I just said that twice, I would say, I would say.) What's that bighorn comic of the big chicken or something? I say, I say, I say, yeah. All right, that was a non sequitur. Anyway, hang from a bar and then pull your knees up. Let your core musculature feel the weight of your lower body. It's going to be very challenging if you've never done it before. But I would put this into a getting cough strong, cough coordinated. Because there are plenty of people listening who probably lift heavier weights and they are used to upping the ante so much with their weight that all those parts come in and step in to help. But if you sort of eschew a lot of heavy, if you eschew labor and you don't lift heavy - you don't do anything that really challenges your body strength - you're going to be pretty weak between your pelvic floor, your core and your rib cage. So starting to pick up your legs and hold yourself is going to be really important for you. You don't have to go lift a heavy weight. You're a heavyweight.
JEANNETTE: Yes, yes.
KATY: You're going to lift yourself. And so if you already have that sort of light hanging practice, start pulling the knees up and holding them up and you're going to, I mean, that's spinal mobility, core strength. It's going to work on the pelvis and this coordination. It's kind of creating this upward coordination and that's what we really need with a cough.
JEANNETTE: Yeah, brilliant. And then when you're having a rest, I like to just stand and hold on my bar and practice rib breathing in that position.
KATY: Yes.
JEANNETTE: Because that's really good at getting some movement into the back. That's some expansion and different parts of your rib cage will experience some movement in that position.
KATY: For many people, they have difficulty breathing when they go to hang or put their arms overhead. And that has a lot to do with the core musculature being too weak in that position to move the ribs.
JEANNETTE: Right.
KATY: So that's why it's very hard to do. Because you're like, I'm not going to sit here and struggle breathing. But that's what's going on. That's a good indication that your core musculature is ... it's really too weak for your body. And it's challenging when you live...
KATY: We live in a time where society does not require very much physicality of us. So it's very hard to reconcile that our biological needs for us to be strong are what they are. Because when would the body dwell in a time where you could pretty much sit around most of the time? Never. Like this is a completely outlying scenario. And so we have to fake some of these strengths through exercise. If you're not going to transition into these much more difficult labor for those that aren't doing it, then you have to bring in labor intense movements. And so that's a really good one. And I just, I really, I want people to be able to cough well. Coughing well - let's talk about coughing well here for a second. You know, you already talked about the immediate need to clear in an instant. You're choking, right? Even choking.
JEANNETTE: Yes, you need a cough to click, just to get over the choke, to get it out.
KATY: It's giving yourself the Heimlich maneuver, essentially is what a cough is.
JEANNETTE: That's right. It is.
KATY: So a cough is like a Heimlich maneuver you do yourself.
JEANNETTE: Yes.
KATY: And in that absence, someone else is going to put their arms around the tube of toothpaste and they're going to squeeze and create an upward pressure to help you expel.
JEANNETTE: That's right. Or come and pat you on the back really hard, dislodge...
KATY: But these are ...
JEANNETTE: ...because you can't do it to yourself.
KATY: Because you can't do it yourself. And now obviously there are situations where something can just be wedged in beyond your strength, but many times we are just not strong. Our bodies are not strong enough to do a lot of these.
JEANNETTE: Right.
KATY: A lot of these things. And that's why core strength in babies, I think, is so important. Because then they can clear their own. They're much more susceptible for things like choking when they are just sort of weak babies early on. So that strength - that making a dynamic early on, again, is life-saving.
JEANNETTE: Yes.
KATY: It's life-saving. And then ... It's hard to think about things like pneumonia as related to strengths. And let's just say the movement diet of the whole body overall. Now you get a pathogen, you're going to react to it in the way that you're going to react to it. But I think that we underestimate how our sedentary lifestyles really interfere with... It's like calf hearts, which is a whole separate thing. We don't really see the fact that walking and ankle and leg mobility is so related to the function of the heart.
KATY: But your overall movements and strengths and mobilities and daily engagement with complex movement is part of your immune system - specifically in cleaning out the lungs. So like what's in the lungs? Let's talk about what's in the lungs.
JEANNETTE: Yeah. So in the lungs, you obviously have, the air goes into the lungs. But then lining the surface of the lungs, you have a surfactant, which is a chemical that reduces the surface tension.
KATY: Yes, let me just say what that is for people. Surfactant is also what's in your laundry soap. So water is very attracted to itself. You know, if you've ever filled a glass of water and then you keep filling it above the rim of the glass - you know, if everyone's done that little experience - water is so attracted to itself that it will even bind to itself in the absence of a container.
JEANNETTE: That's right.
KATY: So the alveolar sacs - the part in our lungs where this gas exchange is happening, (go back and listen to the lung podcast), it's so thin. It's like Kleenex. But it's almost like two pieces of Kleenex. And when they get too close to each other, they cling and they stick because the wetness is so attracted. And then now that alveolar sac is not functional because the sides are sticking to each other. So you regularly secrete surfactant like soap. So when you put your clothes into the wash, you add surfactant. And that breaks up water's attraction for itself, which frees up the oils and the dirt from your clothes. And that's what surfactant is doing in the lungs. So we are always secreting this sort of goo.
JEANNETTE: Stuff, yeah.
KATY: Stuff, stuff. This stuff, and it needs to be cleared. And that's one of the reasons breathing is so important: including deeper breathing, heavier breathing, cardiovascular exercise where you're changing the shape. That's part of how you get rid of this constant secretion of surfactant. This is not even - you don't even have anything right now. You have no pathogens.
JEANNETTE: That's right, yeah.
KATY: You're not making mucus. This is baseline clearing that needs to be happening. Okay, go ahead.
JEANNETTE: And then we've got mucus on top of that, which you just mentioned.
KATY: Right.
JEANNETTE: So then we also secrete mucus. Which when you don't have an infection, tends to be quite watery. And it's cleared by - we talk about these little hairs in the lung episode, they're not hairs, but they'll hair like projections - cilia, which ...
KATY: Cilium.
JEANNETTE: And they clear the lungs and actually it goes into your throat. You swallow it and you clear it that way. Because the lungs have what's called a blind end. Right? They have to go in and out the same way. But your gut can get rid of stuff.
KATY: Yeah.
JEANNETTE: So you swallow it and then you get rid of stuff. And mucus is there to trap viruses, particulates. So you have this continual clearing.
KATY: To get it out of your body. Because technically it's not in your body yet.
JEANNETTE: That's right.
KATY: Go back and listen to the last episode. Are Your Lungs Outside Your Body?
JEANNETTE: That's right. So it's gone. It's trying to get in and then your body's just getting it out. And then you might have ... more mucus might be produced in certain scenarios than others. When you've got an infection, if you've got lots of particulates, you have an increased production of mucus. And that's when the cough might come in. You actually need the cough to get more - when you've got a lot of mucus to clear it.
KATY: It's like supporting the tiny beading hairs. They can only do so much. Sometimes you're going to get a large amount out at once.
JEANNETTE: Yes, that's right. And the viscosity of the mucus - it's like its properties actually dictate how easy it is to clear. So for what we call an effective cough does is - it's really dependent on two things; the velocity of the air and the properties of the mucus.
KATY: Mm-hmm. Right. So we'll say your coordination and the strength of which you can squeeze that tube of toothpaste and then how sticky or tacky the mucus is.
JEANNETTE: That's right. Yeah.
KATY: The more viscous it is, the more it is like honey, the less viscous, it's like water. So if you’ve got honey mucus plus a weak cough, it's not going to go nearly as fast as if you had thinner mucus and a stronger cough.
JEANNETTE: Exactly right. And that's when you start to get these issues of concern with pneumonia. Because you're not getting stuff out.
KATY: That's right, and it's accumulating. And now you have fluid in your lungs.
JEANNETTE: It accumulates. That's right. Yeah. And lung collapse too, when you've got more fluid. So another thing to think about is things like smoking, which affect not only mucus - the properties of it tends to make it thicker so your cough is less effective. It also affects the cilia. So it's like a double whammy. Both your mechanisms are full clearing are affected basically.
KATY: Yeah. And all you have is a cough now.
JEANNETTE: Yes.
KATY: All you have is a cough. You've really reduced this low grade constant lung clearing.
JEANNETTE: That's right.
KATY: And now you've just sort of got to hack it out on your own all of the time. And it's more tar-like.
JEANNETTE: That's right.
KATY: The viscosity of it is so high.
JEANNETTE: Yeah. So yeah. Where were we going with? Oh, that was what was in the lungs. We were talking about that.
KATY: Yeah. So, again, I always like to tie seemingly unrelated concepts to people.
JEANNETTE: Yes.
KATY: Tie them together. So that if you are thinking about it, like what is going on right now, this is what's going on.
JEANNETTE: Because we always tend to think - here we have a phrase that pneumonia, it was an old phrase, but pneumonia is old man's friend.
KATY: Say that again.
JEANNETTE: Pneumonia is old man's friend.
KATY: Okay, sorry, I meant say more, but I'm glad you repeated it.
JEANNETTE: Oh, sorry, I'm sorry. Yeah, sorry. Yeah, I think there's two different interpretations, I think. One is that, someone said to me, they think it's because it's not a terrible passing...
KATY: Okay.
JEANNETTE: ...death by pneumonia. I actually thought it was for something else. It was essentially, it means you kind of, you're at the stage when it takes you out without too much. When you get to a certain age, it's something that just takes you out relatively calmly.
KATY: So my whole body recoils at that thought because struggling for breath might be ...
JEANNETTE: Yes. The most horrific.
KATY: ... the most horrific thing that I can imagine.
JEANNETTE: Well, that's what I, yeah. I'm now questioning, because it sounds to me like the most horrible way to go.
KATY: It's the opposite. I would rather, I mean, dropping dead.
JEANNETTE: Well, that would be everybody's.
KATY: That's what my in-laws are planning. They're like, we're just going to drop dead.
JEANNETTE: Yeah, I think it was just this idea that it was peaceful. And it didn't let them sort of have this degrading, where they became increasingly dependent. And it just, in the maybe 18th century.
KATY: Yeah. I would say, what year is it? Yeah, I feel like this is from like a whole different ...
JEANNETTE: Yeah, I think it's a different era for sure. But my point, which I diverted from, is that we think about it as being an old person's disease.
KATY: Right.
JEANNETTE: And it might be. But is it because it's really an old person's weakness? And we have more susceptibility. But we never really think about the fact that it actually could be just that we're weaker.
KATY: Well, weaker - so less mobile over all.
JEANNETTE: Yes.
KATY: Weaker and then more susceptible or fragile. And in other ways where maybe pathogens can come in more.
JEANNETTE: Take hold, yeah.
KATY: Yeah. You've lost other levels of defense. But anyway, coughing is a fitness program that you can train for.
JEANNETTE: That's right.
KATY: And that's my overarching message here is let us be more aware of what are things that are just happening in the body, not related to me or anything, and what is directly related to the larger choices at hand that society, like the way society is organizing itself. And then also our individual behaviors within it. So if this is an area where you're prone - like I think everyone's got different illnesses that tend to come up in the same way.
JEANNETTE: Yeah, for sure.
KATY: The weaker spots. For some people it's digestion. For some people it's in the lungs. So if you already know that this is an area for you that might need some reinforcement in our sort of sedentary landscape, then you can direct your movement plan towards that. So, I've got My Perfect Movement Plan. And maybe for you right now, coughing becomes a plan. I wanna strengthen my cough. Fitness goals don't have to all look like athletic feats or pursuits.
JEANNETTE: Right.
KATY: They can be quite practical. People I know are working on their bones. But I think that it's perfectly respectable to create a, "I'm trying to strengthen my breathing and my coughing", I keep saying apparatus ... to see your body as this thing that has this task to do. And if you are already seeing problems in this task, it's just like balance. "Wow, my balance is really poor. I want to work on my balance." "Wow, my coughing strength is really poor. I want to work on supporting my lungs in staying clear to the best of my ability." And there's so many things that are going on. There's air quality. You can definitely have compromised lungs from past viruses that have left.
JEANNETTE: And maybe your job. People who are in the building trade and things like that. So, particularly relevant to people like that.
KATY: That's right, that's right. You work in a coal mine.
JEANNETTE: Yeah.
KATY: (coughs) Okay, well, let's make our way out. But as we do, what do you go to in a cough? Do you have a remedy, a home remedy?
JEANNETTE: Yeah, so I definitely, I'm...
KATY: You're not a coffer, you're a sneezer. Tell me, what is that?
JEANNETTE: I'm not really. But yeah, I sneeze a lot. I think that's just, I don't know. I'm a very regular sneezer. Things irritate my nose. But coughing is not, not that I never cough. But if I have got a cough or a sore throat, definitely my mom's solution to every single thing was honey and lemon. Hot water with honey and lemon. And then I also have these sweets. I think it's Jakeman's, which I love. And that they're probably a weird British thing because they're black. And they have menthol and anise seed and eucalyptus oil.
KATY: Ooh, a real medicine cabinet drop.
JEANNETTE: Yes, and you have to be ... my kids hate them because they have a really strong flavor. But they're sweet, so it feels, you know...
KATY: Feels like you're getting a bit of a treat when you're down and out.
JEANNETTE: Yes, exactly, exactly. Yeah, so how about you?
KATY: Yeah, definitely when I grew up, I feel like cough syrup, Robitussin, you know. Or in my husband's Irish family, it was cough bottle. You know. Right? You get the cough bottle. It's sort of like Windex in my big, fat Greek wedding. Like, just this idea of this is the cure-all. "Take a sip of the cough bottle." Yes, I think another thing that we do a lot of is hot water, really hot water, lemon, honey, and whiskey.
JEANNETTE: Oh!
KATY: That's the Irish version, obviously.
JEANNETTE: Yes. Yes.
KATY: I just like a straight tablespoon of honey. You know, they're starting to really look at honey compared to cough syrups and seeing that it's really, you know, you've got to be over one. But that it's just as effective at really soothing and suppressing the coughing reflex. So it's a nighttime thing. In the daytime, I think I'll go with hot water and lemon and just soothing in that way. But at nighttime, just a spoonful of honey. And I've used it in dogs too, with coughs. And it works for them.
JEANNETTE: Interesting. And antimicrobial too.
KATY: It's antimicrobial, and that's why they think maybe it's not just ... I mean, is it working because it's coating? Or does it actually change the state of the tissue in some way that's allowing some healing? But either way, it's inexpensive and available and, you know, with no side effects. So that's pretty great.
JEANNETTE: Yeah, that's always good. Well, Katy, I hope your cough eases with your honey and...
KATY: I'm feeling good now. It's suddenly disruptive for a podcast. But other than that, yeah.
JEANNETTE: I think it's added. It has added to this one.
KATY: I mean, it is enhanced. It has enhanced. Yes, and I don't make very much mucus. And so sometimes I think it takes me a little bit longer. Because my mucus is just sort of ... I'm always dry in there. And then I feel like I'm trying to clear something out. And so maybe drink more water to either thin or add volume to the mucus to help.
JEANNETTE: Yes. Dehydration is definitely not a help for mucus.
KATY: Not a cougher's friend.
JEANNETTE: Okay.
KATY: All right, well, I hope everyone enjoyed this show and stays well this season.
JEANNETTE: Yes, absolutely.
KATY: All right, take it easy.
JEANNETTE: See you soon, bye.
KATY: Bye.
(Theme music)
Hey there. My name is Carla from Fredericksburg, Texas. This has been Move Your DNA with Katy Bowman, a podcast about movement. Hopefully you find the general information in this podcast informative and helpful, but it is not intended to replace medical advice and should not be used as such. Our theme music was performed by Dan MacCormack. This podcast is produced by Brock Armstrong. And the transcripts are done by Annette Yen. Find out more about Katy, her books and her movement programs at NutritiousMovement.com.
(Music ends)