Why Breathing is the Foundation of Your Playing
How posture, position, and hypermobility shape your breath — and your sound
You probably think about breathing most if you sing or play a wind or brass instrument. But here's the thing: breathing mechanics matter for every musician. Whether you're a violinist, a pianist, a guitarist, or a percussionist, how you breathe while you play directly affects your tone, your endurance, your tension levels, and your injury risk.
And yet, breathing mechanics are almost never taught explicitly in music education. Most musicians don't realize there's an issue until something else starts hurting — the shoulders, the neck, the lower back — and a physical therapist starts asking questions about how they sit and stand.
This post is about giving you a foundation that often gets missed: what healthy breathing mechanics actually look like in three dimensions, how sitting versus standing changes everything, and why hypermobility throws a particular wrench into the picture for many musicians.
The Anatomy of a Good Breath
Before we talk about posture, it helps to understand what your body is actually doing when you breathe well.
The diaphragm is the primary muscle of breathing. It's a dome-shaped muscle that sits at the base of your ribcage, separating your chest cavity from your abdomen. When you inhale, the diaphragm contracts and flattens downward, creating a pressure drop that draws air into the lungs. The lower ribcage expands in three directions simultaneously — laterally (the classic "bucket handle" motion, where the ribs lift and flare outward to the sides), anteriorly (forward, which is the belly rise most people are familiar with), and posteriorly (into your back, which is the one most people forget entirely) causing your belly to rise.¹⁻² On the exhale, the diaphragm relaxes and recoils upward, and the ribcage returns to its resting position letting the belly fall.
Most musicians I work with actually have some awareness of diaphragmatic breathing — it comes up in applied lessons, particularly for wind players. But the mental model tends to be incomplete. The common understanding is that a good breath means the belly moves forward. That's true, but it's only part of the picture. If you're only expanding anteriorly, you're leaving a significant portion of your lung capacity on the table, and you're likely still recruiting accessory muscles — the neck, the upper traps, the scalenes — to compensate for the volume you're not getting through full three-dimensional expansion.
The goal is a breath that expands the lower ribcage in all directions: laterally, anteriorly, and posteriorly. When you achieve that, the breath is deeper, more efficient, and the neck and shoulder muscles can stay out of it.¹
Sitting vs. Standing: It's Not the Same Breath
Your breathing mechanics change meaningfully depending on whether you're seated or standing, and most musicians spend time in both positions.
Sitting
Sitting compresses the space your diaphragm has to move. When you're in a chair, if your lumbar spine isn't well-supported by your postural muscles or your pelvis tips back into a posterior tilt, your ribcage drops — which mechanically restricts diaphragm excursion before you've played a single note.³⁻⁴
The ideal seated position for breathing starts at the pelvis. You want your weight shifted slightly forward onto the front edge of your sit bones, with a gentle anterior pelvic tilt that places you over your pelvic floor rather than sitting on the “tips” of the ischial tuberosities (sit bones) directly. This matters more than it might sound — sitting directly on the ischial tuberosities with a flat or posteriorly tilted pelvis for hours at a time is uncomfortable and can reinforce a lumbar flexion posture that undermines everything above it.⁴ From there:
• Spine stacked in its natural curves — lumbar lordosis preserved, not flattened
• Neutral ribcage stacked over a neutral pelvis — not excessively flared or lifted, not collapsed toward the lap
• Head balanced over the shoulders, not jutting forward or poking the chin out
For orchestral musicians especially, chair height matters enormously. If your chair is too low, your hips drop below your knees, your pelvis tips back, and your lumbar spine rounds — a setup that makes all of the above nearly impossible and significantly increases lower back load.⁴
Standing
Standing gives your diaphragm more room to work, but introduces its own postural challenges. Many musicians in standing position subtly lean forward from the hips, hike one shoulder to support their instrument, or lock their knees — all of which interfere with the free movement of the ribcage and pelvis.
In standing, watch for:
• Knees soft, not locked
• Weight balanced evenly through both feet, with a base of support wide enough to feel stable without effort
• Pelvis neutral — not tucked under or overarched
• Neutral ribcage stacked over a neutral pelvis — same principle as sitting
• Shoulders relaxed and level (as much as instrument demands allow)
• Chin parallel to the floor
One thing I see frequently with standing musicians: feet positioned too close together. This creates a narrow base of support that requires constant low-level muscular effort to maintain balance — effort that travels up the chain and ends up as tension in the thorax and neck, directly limiting how freely the ribcage can move with each breath.
When Hypermobility Enters the Picture
Hypermobility — having joints that move beyond the typical range of motion — is more common among musicians than in the general population. Research dating back to a landmark 1993 study in the New England Journal of Medicine found that joint hypermobility was prevalent in a cohort of 660 musicians, and that its effects were context-dependent: hypermobility in the joints most used for playing was often an asset, while hypermobility in supporting joints could be a liability.⁸ A 2025 scoping review further confirmed that joint hypermobility is a recognized risk factor for playing-related musculoskeletal problems, though research gaps remain.⁹
But hypermobility has a significant downside when it comes to breathing mechanics specifically, and it's one that rarely gets addressed.
🎻 Fun Fact: Paganini and EDS
Niccolò Paganini (1782–1840) is widely considered the greatest violinist who ever lived — and many medical historians believe his extraordinary technique was at least partly explained by Ehlers-Danlos Syndrome (EDS). Contemporary accounts describe his ability to bend his fingers and wrists far beyond normal range, effortlessly span intervals that left other violinists baffled, and perform feats on the instrument that audiences assumed required supernatural ability (earning him the nickname "the Devil's Violinist"). His body build and joint laxity are now cited in medical literature as consistent with EDS phenotypic traits.¹³
The same connective tissue laxity that may have made him the most technically gifted violinist of his era also likely came with real physical costs — a tradeoff that will feel familiar to many hypermobile musicians today.
The Stability Problem
In a hypermobile body, the passive stabilizers — ligaments, joint capsules, connective tissue — provide less inherent stability than usual. To compensate, the nervous system often recruits muscles to do that job instead. The diaphragm, in particular, serves a dual role: it is both a respiratory muscle and a postural stabilizer that contributes to intra-abdominal pressure and trunk control.⁶⁻⁷ When the system is already working hard to stabilize hypermobile joints, that dual role becomes harder to coordinate.
The muscles that tend to get recruited for stability in the trunk are exactly the ones that should be relaxed during efficient breathing: the superficial abdominals, the hip flexors, the neck musculature. The result is a pattern that looks like this: the hypermobile musician braces their trunk to feel stable enough to play, that bracing inhibits diaphragm movement, they lose access to full three-dimensional ribcage expansion, and the neck and shoulder muscles become chronically overloaded. They often present with what looks like tension and overuse, but the root cause is a stability deficit driving a compensatory breathing pattern.
If you have hypermobility, the goal is not to stretch more — it's to build the active stability your connective tissue isn't providing passively.
This changes the entire clinical approach to breathing retraining.
Respiratory Symptoms in Hypermobility
Respiratory symptoms are well-documented in hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD). A 2021 narrative review found that dyspnea, respiratory muscle weakness, and altered breathing patterns are commonly reported in this population.¹⁰ Inspiratory muscle strength training has shown promise as an intervention in randomized controlled trials.¹¹
A particularly interesting 2024 study in Scientific Reports found that people with hEDS had significantly impaired lung volume perception compared to controls — they were less accurate at sensing how full their lungs were, particularly at moderate lung volumes. The researchers attributed this to reduced proprioception, which also altered their breathing control during cognitive tasks.¹² For musicians whose playing demands precise breath management alongside intense cognitive engagement, this is a clinically meaningful finding.
What Hypermobile Musicians Can Do
The approach for a hypermobile musician is different from standard breathing retraining. A few principles I work from clinically:
• Prioritize deep core stability — transverse abdominis, pelvic floor, deep spinal stabilizers — before focusing on breath expansion. You need the container to be stable before you ask it to expand.⁶⁻⁷
• Avoid cues that encourage "letting everything go" or maximal ribcage expansion, which can feel destabilizing rather than freeing
• Work on proprioceptive awareness — knowing where your ribcage and pelvis actually are in space — since hypermobile musicians often have reduced positional sense¹²
• Consider whether your instrument position is asking your body to stabilize more than it can handle comfortably, and whether that's contributing to the bracing pattern
A Quick Self-Check
You don't need a physical therapist in the room to get a basic read on your breathing pattern. Try this:
Sit in your playing position. Place one hand on your upper chest and one hand on your lower belly. Take a few normal breaths without trying to change anything. Notice which hand moves first and most.
In healthy diaphragmatic breathing, the lower hand moves first and the upper hand stays relatively quiet. Then try adding awareness to the sides and back of your lower ribcage — can you feel any expansion there, or is all the movement happening anteriorly? That lateral and posterior expansion is often the missing piece.¹⁻²
Repeat in your standing position and note whether the pattern changes. It often does, and that difference can be informative about whether the issue is more posture-based or habit-based.
Try this during your next practice session: pick one moment — a long note, a rest, a fermata — and check in with your breath. Are you holding? Bracing? Breathing only into the front of your belly?
Awareness is the first intervention.
When to See a Physical Therapist
Breathing retraining is well within the scope of physical therapy, and it's something I address regularly with musicians — often as part of treating something that looks completely unrelated. Neck pain, shoulder tension, rib pain, thoracic tightness, and even some aspects of performance anxiety frequently have breathing mechanics as a contributing factor.
Signs that a PT evaluation focused on breathing might be particularly useful for you:
• You have a diagnosis of hypermobility spectrum disorder or Ehlers-Danlos Syndrome (hEDS)
• You experience rib pain or a "catching" sensation with deep breathing
• You notice you hold your breath during technically demanding passages
• You have chronic neck or upper shoulder tension that doesn't respond to stretching or massage
• You feel winded or fatigued faster than expected during long rehearsals or performances
At Hampton Physiotherapy, I work specifically with musicians and approach treatment with an understanding of what your instrument actually demands from your body. Breathing assessment is part of how I look at the whole picture — not just where it hurts, but why.
The Bottom Line
Breathing is not just something that happens in the background while you play. It's a foundational movement pattern that influences your tone production, your endurance, your tension levels, and your injury risk. And for most musicians, the gap isn't a lack of awareness that breathing matters — it's an incomplete picture of what full, three-dimensional breathing actually feels like.
The good news: breathing mechanics can be retrained. It takes some directed attention, a willingness to slow down and notice what's happening, and sometimes professional guidance — but it is one of the highest-leverage things you can work on as a performing musician.
Your instrument deserves a body that breathes well. So do you.
References
1. De Troyer A, Kirkwood PA, Wilson TA. Respiratory action of the intercostal muscles. Physiol Rev. 2005;85(2):717-756. doi:10.1152/physrev.00007.2004
2. Bastir M, García-Martínez D, Torres-Tamayo N, et al. In vivo 3D analysis of thoracic kinematics: changes in size and shape during breathing and their implications for respiratory function in recent humans and fossil hominins. Anat Rec. 2017;300(2):255-264. doi:10.1002/ar.23503
3. Albarrati AM, Alghwiri AA, Nazer RI. Effect of upright and slouched sitting postures on the respiratory muscle strength in healthy young males. BioMed Res Int. 2018;2018:3058970. doi:10.1155/2018/3058970
4. Lin F, Parthasarathy S, Taylor SJ, et al. Effect of different sitting postures on lung capacity, expiratory flow, and lumbar lordosis. Arch Phys Med Rehabil. 2006;87(4):504-509. doi:10.1016/j.apmr.2005.11.031
5. Moseley AM, Adams R, Sherrington C. Changes in head-neck posture on the respiratory function in healthy males. J Phys Ther Sci. 2018;30(6):795-799. doi:10.1589/jpts.30.795
6. Hodges PW, Gandevia SC. Activation of the human diaphragm during a repetitive postural task. J Physiol. 2000;522(Pt 1):165-175. doi:10.1111/j.1469-7793.2000.t01-1-00165.x
7. Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89(3):967-976. doi:10.1152/jappl.2000.89.3.967
8. Larsson LG, Baum J, Mudholkar GS, Kollia GD. Benefits and disadvantages of joint hypermobility among musicians. N Engl J Med. 1993;329(15):1079-1082. doi:10.1056/NEJM199310073291504
9. King ML. Hypermobility and injury among instrumental musicians: a scoping review. medRxiv. 2025. doi:10.1101/2025.08.13.25333390
10. Chohan K, Mittal N, McGillis L, et al. A review of respiratory manifestations and their management in Ehlers-Danlos syndromes and hypermobility spectrum disorders. Chron Respir Dis. 2021;18:14799731211025313. doi:10.1177/14799731211025313
11. Reychler G, Liistro G, Pieters T, et al. Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers-Danlos syndrome: a randomized controlled trial. Am J Med Genet A. 2019;179(3):356-364. doi:10.1002/ajmg.a.61026
12. Baeza-Velasco C, Bourdon C, Reychler G, et al. Impairment of lung volume perception and breathing control in hypermobile Ehlers-Danlos syndrome. Sci Rep. 2024;14(1):7981. doi:10.1038/s41598-024-58890-2
13. Parapia LA, Jackson C. Ehlers-Danlos syndrome — a historical review. Br J Haematol. 2008;141(1):32-35. doi:10.1111/j.1365-2141.2008.06994.x