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Season 1, Episode 24: Downregulation to Decrease Pain with Jen Esquer, DPT

By Jodi Cohen

Essential alchemy: the ancient art of healing naturally - join host jodi cohen, ntp, and guest jen esquer, dpt, on a podcast journey exploring downregulation techniques to enhance wellness.

With Jen Esquer, DPT, you’ll learn how to use breathwork to control your autonomic nervous system, how to manipulate your diaphragm to turn on downregulation, and how your vision affects your nervous system.

  • Using breathwork to control your autonomic nervous system
  • Manipulating the diaphragm to turn on downregulation
  • How your vision affects your nervous system

About Jen Esquer

Dr. Jen Esquer is a Doctor of Physical Therapy and the founder and creator of The Mobility Method and The Optimal Body programs that help you overcome your restrictions and optimize the way you move and feel. She empowers people through education into their own body and helping them understand there is no one single strategy, program, technique, or exercise that works for everyone.

If you’re enjoying the Essential Alchemy podcast, please leave Jodi a review on iTunes.

Jodi: Hi, it’s Jodi Cohen. And I’m super excited to be here with my friend, Jen Esquer, who is a Doctor of Physical Therapy, the founder and creator of The Mobility Method, and The Optimal Body programs that help you overcome your restrictions, and optimize the way you move and feel. She empowers people through education on their own body, helping them understand that there is no single strategy program, technique, or exercise that works for everyone. Thank you so much for joining me, Jen.

Dr. Jen Esquer: Thanks for having me. I’m honored to be here, because this is one of my favorite topics that, honestly, I always try to like steer conversations to, but I feel like people just like, “What’s mobility?”

Jodi: Yeah. Well, if you want to just start with that, kind of how the parasympathetic state plays into mobility and why it’s important?

Dr. Jen: Mobility is not going to open up for people, unless they understand how to tap into this parasympathetic system. And I think a lot of what people think, like we know mobility is the active portion of being able to open up into your body. But in order to hit that active portion, we have to have the body able to feel safe in those positions and safe in those ranges of motion. And that’s where the parasympathetic system really plays a role.

So your brain, which tells you whether it’s safe or not, or will guard you and protect you, is necessary to tap into first, so that you are allowing your body to feel like, “Oh, I can ease tension. I don’t have to be so tight. I don’t have to hold on to this tightness within my body.” Like, it’s the person who’s like, “Oh, well, I’ve been stretching, and doing foam rolling forever on my hamstrings, and yet nothing is changing.” And I’m like, “Because it’s not the fact of hammering into something. You need to actually pull back. You need to get your body to feel safe.”

And when we talk about tapping into this parasympathetic system, learning how to turn on that “off” switch, when we get people to do that, all of a sudden pain goes away. Mobility opens up, like you can get people to touch their toes in like five minutes who’ve never been able to touch the ground. And it’s not because of this tightness that we usually think within our body. It’s the freedom by tapping into that parasympathetic system first that allows you to create that mobility. And then that’s when you can start to build strength and power in those new ranges. But it has to come with that first step.

Jodi: That’s so beautifully put. And I mean, I was that “we can” warrior, that person who just kept pushing harder, and harder, and over exercising, and “no pain, no gain,” I can work through this. Can you speak a little bit about kind of the correlation between pain and the parasympathetic state?

Dr. Jen: Pain is a perception of the brain, ultimately. It’s the way that our body is perceiving that stimulus. And initially, yes, it could be physical, it’s what is being put onto the body that sends the signal up and announces that we have pain. But then eventually your body starts to get used to that signal. And sometimes it can send a signal back down, that even if there’s no tissue damage, it will alert you that there is pain in the area. So it’s not that it’s not real. It’s not that it’s not there. But at the same time, if we teach the body how to continue to signal in these signals of like, “Oh, this tightness represents pain. This movement means it’s bad. This exercise that I do is scary because I’ve gotten pain there before. This stress that I have in my life is going to cause pain in my back.”

So the more that we send these signals to the brain, without even really realizing it, we send it to the tissue. And then that’s how our body starts to perceive this level of pain. And then anytime we’re in a stressed out situation, anytime that we go into an exercise pattern that might’ve caused pain before, or that we’ve had surgery on or whatever it may be, your brain will then perceive that stimulus to be painful. And that’s when the tissues will start to lock up, and your body starts to guard, and present, and protect itself. Especially when we’re talking like back spasms, things like this. And we feel like we have that intensity, and that tightness. Think of that tightness like someone scared you and they go. And that initial response that you do when someone scares you, that’s what your body’s doing when it says, “Oh my God, I need to protect you, because we’ve been here before and it’s scary.” And so all that spasm is doing is your body’s way of protecting you, which is a beautiful response, and something I think we get to be grateful for rather than forcing like, “Oh, I need to smash it out. I need to attack it. I need to do something about it.” Because the more that we smash and attack, the more we’re just staying in that sympathetic state.

Jodi: That’s so beautifully put. And I know you help thousands of people work through this. What techniques, for the listeners that are like, “Oh my goodness, that’s me. What can I do?” How would you suggest people start with this?

Dr. Jen: So it really does go back to the breath. The breath is like one of the easiest ways that you can start to tap into this parasympathetic system, and literally take control of that autonomic system, that automatic system that tells us when we’re in that stress state. And when we’re in that relaxed state, and we need both within the body, it’s pertinent. It’s not a bad thing to have that stressful state, but we also get to address when that stressful state is becoming our automatic, is becoming the underlying factor that we can’t get out of anymore. And when we start to address that, that’s when we’ll start to create better balance within our system.

And so going back to the breath, if we just look at a basic breath cycle, and this is like the easiest way that I could break it down for people, is if we look at like how a breath cycle works, we have the inhalation phase, and we have the exhalation phase. Well, that inhalation phase is more of that sympathetic. So that is more of that, someone scares you and you go. And you take a breath in and you hold it, like, think about when someone scares you. The automatic response is to breathe in. So that is how you can think of that sympathetic state. Now think of going to get a massage. And it’s usually like, “Ah, I’m at a spa.” It’s a deep, slow exhale. That is that parasympathetic state.

So if we think of even that, at the smallest state, then we can say, “Okay, if I shorten my inhalation phase and I increase my exhalation phase, then I can automatically start to tap on and turn on that parasympathetic state more.” And when I have clients just start to do this, so even if it’s like, “Okay, just give me some breath work before you go to bed, like a four-second inhale and an eight-second exhale.” And obviously, we get them to think about where the breath is coming from, in different places within the rib cage, which we can get into. But even that small switch, automatically pain from like five years can go away. And automatically they can get into deeper sleep faster than they’ve ever gotten before. Stress can go away, panic attacks can go away. You know, even if we just started to switch and become more aware of our breath, it is the first step to taking back control of your system.

Jodi: I love that. And I love that you talked about engaging the diaphragm, which is so critical to all strength, stability, and everything. Can you speak to that a little bit more, and how the diaphragm plays a role in the downregulation of your sympathetic state?

Dr. Jen: And that’s where I go to the belly, I go to the rib cage with clients. And so when I start just gently massaging into the belly, and massaging underneath that rib cage, for some it’s painful because you’re not used to that stimulus there. But also, when we start to open up that restriction underneath the rib cage, so even just being able to take your fingers and kind of start to see, “What does it feel like underneath my rib cage? Can I even get my fingers underneath my rib cage?” I think that’s a huge thing that people forget, and they don’t have the access to even, because they’ve never felt it. And if we can start to just play around with these areas, we’ll notice that we can free up the way that that diaphragm moves. And the diaphragm rests right underneath the rib cage, and it needs to elevate and needs to drop.

So typically when we used to talk about diaphragmatic breathing, we were talking about belly breathing. And though, yes, I like to adjust it just a bit more instead of saying belly breathing. Because I used to get clients, who’d be like, “Oh, I’m working on belly breathing.” This thing that everyone’s talking about, and all they were doing is pushing their bellies in and out. And I’m like, “You’re missing the whole concept.”

Jodi: Really explain how to do it, and what the benefit is? That’s great.

Dr. Jen: Yeah. So really we need that low rib cage area to move. And this doesn’t mean that the chest is not going to move at all. Because think about it. Your rib cage even connects up to the chest. The point of belly chest breathing is that we just don’t want the chest to elevate.

So think of rising up to your shoulders, especially when we’re trying to get into a more parasympathetic state. We don’t want to increase all this pressure into our chest, and elevate. We want to expand, and when we can get a better expansion pattern, so from front, back, side to side, that’s when we start to free up the way that diaphragm will lift and fall, so that we get into being able to fill up those lungs all the way. The lungs fill up when I take a breath in and my diaphragm drops and that’s why that rib cage will expand. Right?

So I like to tell people, “Place your hands along your low rib cage here, try to relax your shoulders.” So whether you’re laying down, or you are sitting against a chair, and then give it a little squeeze, because this also is feedback for the system to know where to pull into. And so when you take a breath in, right before you take a breath in, give it a little squeeze, and then feel your hands kind of separate in that inhale, and then feel them come together as you nice and slow exhale.

And when you start to just become aware of the breath, because again, it’s not just front to back in that belly. The belly, yes, we want it to relax, but we want that rib cage to expand laterally too. And it’s so incredibly important to get that full expansion. So now we’re freeing up the diaphragm. Now we’re getting it to work the way we want it to. And we’re not using all these accessory muscles by the neck that we only need to be using when we’re running, or when we’re working out, or when we are in a stressed situation. That’s the only time we want these neck muscles to actually be working.

So if you notice that you get a lot of tension headaches, that you get a lot of pressure up here, you might be elevating the chest as you’re breathing and doing more inhalation phase, rather than a longer exhalation phase, or breathing in and out through your nose, and relaxing through that rib cage. So if even if you made that small switch one, it could take away back pain, take away neck pain. Any of these chronic issues that honestly come up, it can relieve nerve tension. I mean, it’s not going to be the magic fix for everything, that’s it, but it’s going to be a start. And it’s a foundation that I think we all get to go back into for our body. And when we start to address this, then we can start to open up a whole other place.

Jodi: Well, and even if you think about the organs that are located near the diaphragm, the liver, the gallbladder, the pancreas. I’ve had bodyworkers tell me that a tight diaphragm kind of compresses those organs. And so just giving them more room allows them to perform better. So there are no magic bullets, but this is something that’s usually helpful for most people. So how often would you have, how many repetitions, how many times a day, what do you find gets the best results?

Dr. Jen: So I would say there’s no one size fits all. I think just starting to address the body, and address the way that your breath is moving, is step one. Address the way that your rib cage is moving, because this automatically kind of steps us into a meditative state without even meaning to as well. Because all of a sudden I’m focused on my breath. I’m focused on my body. I’m not focused on the stressors that I have in life. I’m not focused on the outside world. I bring it into my body. And so automatically it kind of gets you into this more meditative state of, “What is my rib cage doing? Where am I expanding? Oh, maybe I expand more on my left, but I don’t expand as well into my right. So maybe I can put a little bit more pressure onto there.” And that’s why I say, at least give me like five minutes every night before you go to bed, at least start here, or you don’t even have to time it, you could say, “I’m going to do 30 breaths before I fall asleep tonight.” And it could be that simple.

And then I want you to start tapping it into other places. While I’m sitting in traffic, I’m going to come back to my breath. If I feel like I’ve been working a lot, I’m going to set a timer, and every hour I’m going to say, “What is my breath doing?” If I feel like my boss is yelling at me, and I’m getting stressed out, I’m going to see how I can come back. And the more that we can kind of remind the brain where to come back to in the body, how to respond, it can literally, I mean, tapping into this parasympathetic is just everything, right? Because if we can tap into a calmer place, then we change the emotional response that we have to anything as well. So we can change our reactions to people. We can change our reactions in stressful states to our significant others, to our children when they’re screaming and yelling. So it’s like, it opens up so much for us when we can do this.

And another trick that I like to use, if the hands is a little too hard to get onto that rib cage, is just like wringing a towel, or a blanket, and kind of wrapping it around, and giving it a little squeeze. And again, you could do it laying down, you could do it sitting up, and just start to feel that expansion in that low rib cage, on the sides, and on the front and back.

I like to do it in child’s pose sometimes, like bring your legs underneath you, so that you can feel where the belly is going to expand into. You could do it laying on your side, and put your hand onto your low rib cage again, and feel that expansion coming up to the sky, by doing that lateral breathing on your side.

So there’s so many different ways. And I would say, just start with about a four to six second inhale, nice and slow, through the nose. And to strengthen the diaphragm, I talk about doing about six to eight seconds out through your mouth, but pursed lips, like you’re blowing through a straw, so that helps to increase the strength of the diaphragm. But eventually I like to bring people back to just nasal breathing, because that’s another way to tap into that parasympathetic state.

Jodi: And I just want to say, that you and your fiancé have some examples of this on Instagram, that people can follow along with if they’re confused, or aren’t quite sure how to start.

Dr. Jen: Yeah. So him and I do breathwork together all the time. We even started through Face Time, when we didn’t live in the same state. And it was a super grounding thing to even say, “Okay, we’re going to do a four second inhale, a two second hold, a six second exhale, and a two second hold.” And when we would sync our breath pattern like that, all of a sudden it was just like this incredible connection, that it’s something that continues to ground us, and we do on a regular practice.

Jodi: Yeah. And I’ve had parents tell me that they do that with their children. It’s a really great way to establish connection and safety. And also, you were talking about vision and just kind of when you’re in that safety state. You know, if you’re turned around from a predator, you really only need to know what’s my next step. You can’t see the whole picture. So can you speak to how vision plays into this?

Dr. Jen: Vision is so awesome because, and it’s the easiest way again, to explain it is if I’m looking at a phone or if I’m looking at a screen, I’m putting my vision into a narrow place, and I’m automatically more sympathetic. But imagine looking at a sunset, looking at a sunrise, like who’s ever upset looking at a sunset? Usually not.

It usually taps you into that parasympathetic state because we’re now increasing a panoramic view. And so it’s not about looking everywhere. It’s about looking one place, and allowing yourself to take in the entire scenery. So even if you were locked inside, how can I get myself off of my computer screen, and look up, and take in the whole room? So if automatically, just increasing from a sympathetic, a narrow view point to a more panoramic, automatically switches your state.

So especially if we’re trying to tap into this rest, relax, digest, is better to digest if we’re not looking at a screen, if we’re not looking at our phone, and if we could just be sitting ideally outside, and you’re sitting and taking in the scene. But if you can’t, just at least turn off the devices for a minute so that you can actually let the nutrients absorb the way they need to in your body. And you’re in a more relaxed state so that you can actually digest things.

Jodi: This is so fantastic, because I mean, you’ve given like the most accessible takeaways, like focus on the exhale, focus on belly breathing, just looking outside, and expanding your view. Is there any other tip that you’ve found has really been helpful with your clients that you want our listeners to know about?

Dr. Jen: Yeah. I think the more that we could just start to become aware of how often you’re closing your mouth throughout the day is so important, because when we breathe in and out through our nose more, we increase the release of nitric oxide. And nitric oxide helps to open up those blood vessels, which will help to decrease blood pressure, which will help to move fluids through their body.

So again, if we’re talking about moving lymph, getting rid of toxins, getting more oxygen through the body, getting oxygen to the brain, and being more focused, then we’re talking about nasal breathing. And it’s even good to start doing this when you’re going for a walk, if you’re doing some light exercise, it’s obviously harder to keep your mouth closed when you’re doing exercise. But even if we can start to build it in, it is a way to start to practice with the body. Because what that does is it keeps more carbon dioxide within our body. And when we’re not expelling it out and breathing through the mouth all the time, what we actually end up doing is being able to respond to stress better within our body, because we’re holding more carbon dioxide in, and then that’s going to respond with our hemoglobin. Our hemoglobin is what releases the oxygen throughout our body.

I’ve even done it when, and I don’t suggest it unless you do this during the day and see that you’re okay, but I’ve put a tape vertically across my mouth like that, duct tape or anything, the tape that can come off.

But when I put it across my mouth, as I go to sleep, especially if I’m feeling like I might be coming down with something, or I’m feeling more exhausted, or I feel like I might be getting a cold. When I do this, I automatically help to increase the way that I’m breathing through my nose. And I wake up feeling so much more refreshed. And I mean, I could probably explain it in more detail. So I have a tape here, a tape across the nose, kind of like you’re opening up the bridge.

Jodi: Oh yeah, I’ve seen this.

Dr. Jen: A tape like across, right between your eyebrows as well. And if you do those three places, especially when you start to feel like sinus pressure or anything, you wake up feeling so much better.

Jodi: I love these kind of like low hanging fruit tips. Like anyone can listen to this, and go do those four things immediately. You are so amazing. I love when you work with people, you notice what you continually see. We haven’t even talked about how amazing you are helping people emotionally, but how can people find out more about you, and work with you?

Dr. Jen: Most of what I do is on Instagram, @docjenfit, but I do have longer videos on YouTube as well, docjenfit there. And specifically some videos on the breath too, to kind of again, address how inflammation is responding to our body, our nerves, our pain levels. It’s just one of my favorite things, because I’ve seen dramatic, and I’m talking dramatic, changes within people who have this chronic pain and it suddenly goes away. And I guarantee it’s not because of anything I did. It’s just how I’m getting them into the body. I just hope everyone really takes in all the tips that you’re providing, Jodi, throughout this entire summit, because I think it’s so needed.

Jodi: Well, it’s the easiest thing. You know, you and I have both talked about how you can’t control your external circumstances, but you can control how you respond. And if you can put yourself into that “I feel safe” space, all of a sudden, it’s much easier to see way more options, and to be able to respond in a way that when you think back on it, you’re like, “Oh, I really like that I made that choice.”

Dr. Jen: Exactly.

Jodi: So thank you. This was super helpful. I really appreciate it.

Dr. Jen: Of course, thank you so much for having me here.

Jodi: Thank you.

About The Author

Jodi Cohen

Jodi Sternoff Cohen is the founder of Vibrant Blue Oils. An author, speaker, nutritional therapist, and a leading international authority on essential oils, Jodi has helped over 50,000 individuals support their health with essential oils.