The Science Behind Breathwork: Why It Matters in EDS, POTS, and MCAS

Breath is more than just a life-sustaining function — it’s a powerful gateway to the autonomic nervous system (ANS), which controls how your body responds to stress, regulates heart rate, digestion, and more. Conscious breathing, especially slow, diaphragmatic breathwork, has been shown to increase vagal tone, calm sympathetic overdrive, and promote balance across multiple body systems.

At Actify PT, we understand how crucial this is for individuals living with complex conditions like Ehlers-Danlos Syndrome (EDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS) — where the nervous system is often out of sync, contributing to symptoms and movement challenges.

How Breathwork Influences the Nervous System

The vagus nerve, a key player in parasympathetic regulation, connects the brain to nearly every major organ and controls the diaphragm through the phrenic nerve. When you breathe slowly and intentionally—especially focusing on a longer exhale—you activate afferent vagal fibers that send calming signals from your body to your brain. This “bottom-up” communication shifts your state from sympathetic (“fight or flight”) to parasympathetic (“rest and digest”).

For people with:

• EDS/HSD: Proprioceptive deficits and altered connective tissue tension make stability and coordination difficult.

• POTS: Autonomic dysfunction causes symptoms like tachycardia, dizziness, and exercise intolerance.

• MCAS: Increased sympathetic tone triggers histamine release and mast cell activation, leading to inflammation and allergic symptoms.

Breathwork offers real physiological benefits, including:

• Improved baroreceptor sensitivity, helping regulate blood pressure

• Increased heart rate variability (HRV), a key marker of autonomic resilience

• Enhanced interoceptive accuracy, improving how the brain senses internal body signals

• Better sensorimotor integration, coordinating sensory feedback with movement

A 2020 review in Frontiers in Human Neuroscience highlighted that paced breathing at six breaths per minute can significantly improve cognitive function, emotional regulation, and pain tolerance — all important for those managing hypermobility-related disorders.

Why Breathwork Should Be Part of Your Movement Practice

Integrating breathwork before movement primes the nervous system, activates the core stabilizers, and reduces fatigue and symptom flares. This prepares your body for more precise, effective, and sustainable movement.

5 Key Ways Breathwork Enhances Movement in EDS, POTS, and MCAS

1. Neurological Priming: Resetting the Brain-Body Connection

What happens: Slow, deliberate breathing boosts vagal tone and calms sympathetic nervous activity.Why it matters: Starting in a parasympathetic state enhances focus, motor learning, and movement quality. Many with EDS/POTS/MCAS develop protective movement patterns—like muscle bracing or co-contraction—due to pain or fatigue. Breathwork creates a safer internal environment that reduces these compensations. ➡ Think of breathwork as switching “on” the brain-body communication line before challenging the body

2. Improves Interoception and Movement Awareness

What happens: Breathwork directs attention inward, strengthening proprioceptive feedback.Why it matters: Those with connective tissue disorders often rely on visual cues because internal feedback is weakened. Breath helps reconnect with deep stabilizers and enhances the ability to “feel” alignment and effort before loading joints. ➡ Breathwork helps you tune in to your body’s signals rather than relying on external input.

3. Activates the Diaphragm and Deep Core Stabilizers

What happens: Diaphragmatic breathing recruits muscles like the transversus abdominis, pelvic floor, and multifidus.Why it matters: These muscles generate intra-abdominal pressure, protect joints from shear forces, and provide essential stability for hypermobile connective tissues. Breath-led core activation prevents overuse of larger, global muscles that can cause tension and pain. ➡ Engage your foundational stabilizers before adding strength or mobility work.

4. Restores Respiratory-Postural Coordination

What happens: Coordinated breathing synchronizes respiration with posture and movement.Why it matters: Breath-holding, rib flaring, and paradoxical breathing disrupt alignment and increase strain, often leading to fatigue and tension pain. Proper coordination improves endurance and reduces compensatory stress on joints. ➡ Breathe with your movement to maintain alignment and prevent early fatigue.

5. Reduces Symptom Flare-Ups During Movement

What happens: Breathwork regulates heart rate, blood pressure, and cerebral blood flow.Why it matters: For individuals with POTS, craniocervical instability (CCI)/atlantoaxial instability (AAI), or heightened sympathetic states, positional changes or exercise can trigger dizziness, brain fog, or MCAS flares. Breathwork helps moderate these responses, supporting longer, more effective rehab sessions. ➡ Breath control sets the stage for safer, more sustainable movement without interruptions.

How to Begin Breathwork in Your Rehab Sessions

At Actify PT, we start breathwork in a calm, supported position to optimize nervous system regulation:

• Position: Supine with head elevated ~15°, knees bent, bolster under legs

• Focus: Eyes gently closed or softly focused

• Guided cues:

  • Inhale through your nose for 4 seconds, feeling your ribs expand outward and down.

  • Exhale gently through pursed lips for 6 seconds, softening your belly and relaxing your shoulders.

Once comfortable, we progressively layer gentle movements such as pelvic rocking, foot awareness exercises, and small cervical nods—all synchronized with breath. This sequence wakes the deep core and prepares the body for dynamic movement.

Final Thoughts: Breathwork as the Foundation of Movement

Breath is not just an accessory to movement — it is the foundation for safe, effective rehabilitation in people with connective tissue and autonomic disorders. At Actify PT, breathwork is our entry point to reset the nervous system, engage stabilizers, and prevent symptom flares.

When practiced consistently, breathwork restores control, builds tolerance, and empowers you to move with confidence again.

If you’re managing EDS, POTS, or MCAS and want to learn how breathwork can be integrated into your rehab journey, reach out to Actify PT. Our personalized approach is designed to meet your unique needs and help you reclaim your active life.