Persistent Pain

Howard Knudsen has been providing provo physical therapy in a professional setting since 1998, and integrates several modalities for a unique treatment that is individualized to each client's needs. He provides therapeutic treatments by appointment in his Provo, Utah office: 801-310-0851.

A Provo Physical Therapy Clinic


Jan 2011 Newsletter

Advanced Spine And Pain Solutions

Howard KnudsenFrom: Dr. Howard Knudsen
A Provo Physical Therapy Clinic Owner
Saturday, January ??, 2011 at 4:19 PM

"What is the truth about methods
to relieve persistent pain?"


A Free Newsletter for the Friends and Patients of:
Dr. Howard Knudsen

pain relief


Thank you for reading the first installment of my newsletter.

When I set out on a quest to find the "perfect strategy" to relieve my patients' pain I found a cure for my persistent back pain. I hope you can, too!

The theme of this Issue is Breath is Life

pain relief Photo of the Month: North Rim of the Grand Canyon

pain relief Thought of the Day: Riding Waves

pain relief Health & Wellness Tip: Breath Is LIFE!

pain relief This issue's Perfect Strategy: Synchronized-moving-and-breathing while maintaining inner-body-awareness

pain relief Introducing: "The X-Files"

pain relief This Issues X-File Investigation: BreathWalk ®

back to toppain

January Photo

Photo of the Month for January 2011

north rim

Photograph taken while camping at the North Rim of the Grand Canyon. I woke up early before sunrise to take this photo.

back to toppain

Thought of the Day

For your health!


"We are all riding waves from ripples in the pond of life! So throw gratitude rocks... gems of enthusiasm... boulders of strength... zen stones of balance ... pearls of wisdom... diamonds of abundance... and rubies of health and healing."

Howard A. Knudsen

back to toppain

Health and Wellness Tip

Breath is LIFE!

conscious breathing exercises

You've probably heard the saying: "Breath is Life!"

Is this really true?

Well, the research is in... and the answer is undeniably... YES!

Andrew Weil, MD"The simplest and most powerful technique for protecting your health is absolutely free -- and literally right under your nose."

(From Breathing: The Master Key to Self-Healing by Andrew Weil, MD)

Oxygen is the most basic requirement for human life. If your brain goes without it for five minutes you die.

Yet how often do you pay attention to your breathing?

lungsUnless you practice yoga or have respiratory problems (like asthma or emphesema), then I bet it is probably RARE for you to consciously change your breath pattern or observe how you breathe.

The fact is, an astonishing number of physical ailments and chronic diseases are rooted in poor breathing and oxygen deficits.

Even chronic pain conditions, like fibromyalgia, back pain, neck pain, headaches, and muscle pain are strongly associated with breathing problems and lack of oxygen.

persistent pain

Why are physical ailments and chronic diseases rooted in poor breathing and oxygen deficits?

A massive study (of over 5000 male subject spanning 30 years) shows that lung capacity determines longevity.

Al Sears, MD says:

"It's a little-known fact that your lungs determine whether you live or die. Doctors involved in the Framingham Heart Study discovered that lung health predicts how long a person will live -- even before developing a serious disease."

The doctors learned that they could predict how long you will live by measuring how well you breathe with a simple test.

The study also concluded that lung capacity declined at the rate of 9% to 27% per decade.

Why does this matter?

The lungs cleanse your blood, and blood chemistry determines the health of your cells... in your nerves... your muscles... your fascia... your organs... your whole body.

Biologist Dr. Bruce H. Lipton says that your cells can only be as healthy as the environment in which they reside.

Since your cells are bathed in blood, your blood chemistry (the environment of your cells) determines the health of your cells.

An incredible finding by Lipton! He reports that he was able to remove unhealthy cells from a person with a disease and place the cells in a petri dish. When he created a healthy environment in the petri dish those diseased cells became healthy.

He suggests that the unhealthy environment of the body (bad blood chemistry) caused the cells to be unhealthy, never healing like they normally should.

How do we "clean-up" your blood chemistry so your body heals?

To cure our bodies of tissue toxicity we need to detox, we need to remove the poisons from our bodies and oxygenate the cells.

There are three main objectives to work on:

1. Conscious breathing (Doing breathwork or exercising your lungs will improve your blood chemistry; respiration takes in more oxygen and eliminates carbon dioxide; it also causes a change in brain activity to decrease stress-hormone release).

2. Improve blood circulation (Stimulate remodeling of hardened soft tissue with manual therapy tools; moving to promote return of blood to heart; learn to relax "tensing" muscles.)

3. Change brain activity (neural network pattern-breaking to change state to a "relaxation" -- instead of "stress" -- response which allows your organs to go into a healing mode to work on cleansing your blood and healing your cells).

In what specific ways are breathing problems associated with back pain?

There is a growing body of evidence that shows that if you have a breathing problem, then there is a higher chance you will also experience back pain. In fact, it's a much higher chance than if you are over-weight or because of your physical activity level.

Why is there an association?

Dr. Paul Hodges, PT, PhD, has proposed that the association between back pain and poor breathing is because we share the same muscles for two different responsibilities. Muscles of respiration (diaphragm and transversus abdominis) are also simultaneously used to control the posture of your torso.

Another well known reason for the association is that insufficient-oxygen delivery (anoxia) to any muscle causes pain.

Myositis syndrome can be treated with manual therapy tools and techniques.

When anoxia persists your muscles become unhealthy and myositis syndrome may develop.

In myositis syndrome the nerves, muscles, and fascia get inflammed and extremely pain-sensitive. Another part of this syndrome is that your body lays down more fibrous tissue as a response to insufficient oxygen levels.

There are two reasons that our bodies remodel this way.

First, fibrous tissue consumes less oxygen than muscle. Second, fibrous tissue is used to stitch up and scar down an injured area.

Unfortunately, excessive fibrosis within and around the muscles just causes more problems with oxygen delivery to the cells.

astym instrumentsThis is why I use ASTYM, guasha, and Chinese suction cups to break up excess fibrous tissue that clogs up the capillary blood vessels. These modalities increase delivery of oxygen and nutrients and promote removal of cellular waste and congestion.

astym gua sha

Dr. Knudsen's insight from using rehabilitative ultrasound imaging for back pain.

What I've uncovered with ultrasound imaging is that most people with back pain consistently breathe wrong. Many of the patients I scan with ultrasound habitually "brace" with their abdominal and back muscles, even when lying down to rest.

This muscle-bracing inhibits a normal relaxed breathing pattern (expanding out and recoiling back the lower ribcage along with diaphragm movement).

What results is shallow, tense breathing in the upper chest wall, while breathing is severely restricted in the mid to lower lungs. This means less oxygen to the cells and more accumulation of waste... because the lungs are not as efficient in filtering and detoxifying the blood.

transversus ultrasound

With ultrasound imaging biofeedback, I can show you how to breath properly to promote relaxation and break the cycle of habitually bracing with back and abdominal muscles. For many, this has led to pain relief.

relaxation breathing

Just to make it clear... because many of my patients have been trained to habitually brace with the back and abdominal muscles... bracing causes insufficient oxygen levels in two ways:

1. Restricted air flow into the mid to lower lungs because the lower ribs cannot expand against tight muscles.

2. Continuous muscle tensing restricts blood flow in the torso muscles and anoxia causes pain.

Stress and inflammation

There is another way that breathing problems are associated with back pain and other persistant pain conditions.

Do you hold your breath during stress events?

When something is identified as a "threat" the primitive brain triggers the pain response alarms, your breath changes, typically to shallow breathing, hyperventilation or holding your breath.

If you want to calm the stress and pain, consciously change your breathing to a relaxed pattern.

It will increase oxygen delivery to cells and organs in your body and remove carbon dioxide.

You will learn to eliminate stress-hormones and also decrease episodes of stress.

Your body and brain connection will improve and so will your health and ability to self-heal.

And, there is good evidence that your inflammation response to stressful events will decrease and likewise so will your pain sensitivity.

Inflammation is triggered when the lining of your blood vessels is irritated or injured. It's a major cause of chronic disease. Bad blood chemistry irritates or weakens the lining of the blood vessels which makes you have an inflammatory response to stressful encounters.

Inflammation appears to be a key risk factor for many chronic diseases, so practicing "synchronized-moving-and-breathing" while maintaining inner-body-awareness might be a great way to stay healthy.

What has been largely overlooked by most health care providers is the fact that lung capacity can be maintained or increased, even in severe cases of chronic obstructive pulmonary disease (COPD).

A new study from Ohio State University showed that practicing conscious moving and breathing activities will reduce the inflammatory response to real stress, like doing hard math problems in their heads with their feet in cold water.

I have asked numerous patients with breathing problems what kind of pulmonary (lung) rehabilitation they have done. The typical response is: "I was told there is nothing that can be done..."

My answer is that there surely is something that can be done. In fact, your health and reclaiming your body's natural ability to heal your chronic pain condition depends on it.

Opera teachers know that breathing volume can be increased. Yet activities such as singing and sports do not necessarily lead to optimal breathing.

Unlike all the other involuntary functions of the body, breathing becomes voluntary as soon as you make a conscious effort to breathe differently.

We offer a variety of techniques and moving and breathing activities that help restore natural, healthy breathing patterns.

back to toppain

Wellness Philosophy

Dr. Knudsen's Philosophy for
Relieving Persistent Pain

The following questions will help to summarize what I've learned on my quest to find the "perfect strategy." The perfect strategy begins with knowing...

What is the key to long-lasting pain relief?

Promote health and natural self-healing.


Create an optimal environment inside your body for your cells.

What do you mean by environment?

First, our cells are bathed in blood. Therefore, blood chemistry is one key to promoting health and reclaiming our body's natural ability to heal at the cellular level. The other factor is the energy state of the affected region of the body.

Please understand the following rule of health and natural self-healing:

The health of the cell is only as healthy as its environment.

What is required to promote a better environment?

1. Stop releasing stress-hormones into your bloodstream. This process is regulated by the brain. When stress-hormones are released too frequently this will create a toxic environment for your cells and organs.

2. Improve lung function: Every cell requires oxygen for metabolism and renewal. We also need to filter out waste (carbon dioxide) to cleanse the blood.

What actions are required to stop stress-hormone release?

Discover brain states that promote relaxation.  

Correct mis-alignments of the spine and pelvic bones.

Stimulate myofascia remodeling to neutralize trigger points and other pain amplifiers with ASTYM, guasha, etc.

Inner body awareness to more precisely connect mind and body

Be present.  Believe.  Take responsibility.  
Breathe right.  Sleep right.  Eat/drink right.  
Align.  Neutralize.  Stimulate.  Stabilize.  Move.

How do you improve lung function?

A specialized program of Conscious Breathing exercises.

What is the overall theme of these actions?

Awakened doing.

What is the ultimate aim of changing brain activity?

Relax the nervous system (especially the primitive brain) to neutralize your pain sensitivity.

What went wrong to create conditions that promote persistent pain?

Chronic pain is maintained because nerve cells, muscle cells, collagan cells, neurons (brain cells), etc are in an unhealthy and toxic environment. In such an environment unhealthy cells stay unhealthy.  And, unhealthy patterns of brain activity along with a heightened state of nerve sensitivity are also maintained as a stress response.

In regards to blood chemistry and working towards wellness, I have uncovered an activity that works for both the brain and the lungs. It is part of my "perfect strategy" that I use everyday called breathwalking.

What I practice may be described as "synchronized-moving-and-breathing" while maintaining inner-body-awareness. See more details in the following section.

back to toppain

Perfect Strategy

Practicing inner-body-awareness with synchronized-moving-and-breathing

SUMMARY: Five years ago I discovered "conscious breathing" as a way to jog longer distances without getting fatigued.

This started me on a path to become a breathwalk instructor. But I have to admit, that the original version of Breathwalk (which is mixed with religious worship) is SPOOKY to me! So I teach a modified version.

In 2005 I decided to "get back in shape" by jogging on a treadmilltreadmill. At first I could only jog for about 5 minutes before feeling a strong desire to quit. I didn't improve much over the next couple weeks (I was only up to 7 minutes).

Then something remarkable happened! I decided to check my oxygen saturation with a pulse oximeter while jogging.

I noticed my oxygen level was dropping below 88% at the time that I had a strong urge to quit.

A thought came to me: "What if I consciously breathe more to keep the percentage higher?" pulse oximeter

I attempted to consciously breathe to keep my oxygen-level above 96%. Soon I figured out the best breathing pattern for jogging.

By breathing more effectively I was able to jog longer distances. In fact, the duration jumped from 7 minutes to more than 35 minutes, almost from one day to the next. What's more... the only reason I stopped at 35 minutes was because I had an appointment to get to, not because of an urge to stop.

Three years later, my brother let me borrow an audio program he owned and I discovered another way to consciously breathe while walking.

Anthony Robins Version: Breathwalking
get the edge Tony RobbinsTop-selling author and success guru Anthony Robbins, calls it "breathwalking" on his Get The Edge audio program. He has already eliminated all the "spooky" features as he knew they would not be palatable to his audience.

I learned "breathwalking" from Tony while I was staying at a beach house in Mission Beach, San Diego. The best place to do these synchronized moving and breathing exercises is when you are surrounded by the wonders of nature; what more do you need for inspiration!

Listening to Tony's instructions, I walked along the beach, trying not to worry that someone would see me and think I was crazy. It might look strange at first glance as you "sniff" in and "puff" out segmentally in 4-parts each ("sniff... sniff... sniff... sniff" (on the inhale) then, "puff... puff... puff.. puff" (on the exhale) as you synchronize the footsteps with each unit of breath.


He also taught me to recite "incantations" (as an alternative to the "puffs" during exhalation), like:

"Everyday, in every way...

I'm getting better and better, yes!"

I have been doing a modified version of the Anthony Robins' "breathwalking" exercises for 2 or 3 years almost every day and I have to say I am getting profound results. It is the foundation of my exercise program and I wouldn't want to start a work day without it.

As a previous "strongman" on a Junior College football team that is saying a lot. When I was at Snow College I bench pressed 235-pounds for 27 repetitions. I refer to this only to suggest that walking -- as an exercise -- was not something I would do if I didn't see profound results.

When I got home from my week-long vacation in San Diego, I googled breathwalking and found a website of the yogis who developed the program.

One week later, I was at a workshop in Salt Lake City at the University of Utah, along with seven other attendees (one was a professor of psychology and another was a physical therapist) to become a certified Breathwalk ® instructor.

back to topprovo physical therapist

What is an X-File?

Intro to this section

You may be wondering: "Why the reference to The X-Files in this issue?"  

I am devoting a section of each issue to an investigation of alternative methods of pain relief.  It will be under the section heading: "X-File."  Please read below and watch the movie trailer to better understand the reference.

What are X-Files?
mulderIn the 1990's David Duchovny and Gillian Anderson starred in the television series called The X-Files. In the series, FBI agents Fox Mulder and Dana Scully are the investigators of X-Files: marginalized, unsolved cases involving paranormal phenomena.

Mulder is a believer of the paranormal (aliens, conspiracy theories, and the supernatural). He is passionately motivated to find the truth.

His partner, Scully was assigned as his partner to make scientific analyses of Mulder's discoveries. She is a medical doctor and a skeptic of all things paranormal.

Like FBI agent Fox Mulder, I want to believe "THE TRUTH IS OUT THERE"... and if I searched passionately enough I could uncover the perfect strategy to cure my persistent pain and also find solutions for my patients.

scullyTwo different belief systems.
To me the most compelling aspect of the show is how each has a different explanation for the "mystery" they are attempting to solve. Their investigation always turns up with two different reports because each embraces a different belief system.

As I investigate alternative treatment strategies I see myself using "science as my guiding light," like Dana Scully, M.D.  I have been "assigned" to uncover the scientific reason or practical explanation for treatment benefits that people are reporting.

The "spooky" versus scientific reason or practical explanation.
The developers of these alternative treament techniques commonly have a different belief system than mine. They may accept concepts from a different culture, religious adherence, and even at times the "supernatural."


In many ways the concepts and explanantions seem... "spooky." ("Spooky" is the nickname given to Fox Mulder because of his belief in the paranormal).

So, I will do a scientific analyses of treatment concepts and the "spooky" explanations of why they work. Then I will give my practical explanation with scientific evidence of the benefits, like Dana Scully would in The X-Files.

In this first issue I investigate an extremely beneficial exercise that I teach to my patients that I describe as:

  • Practicing inner-body-awareness while performing synchronized-moving-and-breathing exercises.

But the original version called Breathwalk ® deserves an X-File investigation.

back to topprovo physical therapist

X-File: Breathwalk ®

Dr. Knudsen's Investigation
of Breathwalk ®


Why is Breathwalk ® an X-File?

To me, Breathwalk ® seems like an x-file because it is mixed with Sikh and Hindu religious worship practice.

Breathwalk bookThe authors of the program insist that their version of religious worship must be followed without variation for Breathwalk practice to be effective (efficacious).

The fact is the Breathwalk is based on kundalini yoga and the concept of kundalini awakening of energy centers called chakras is not recognized by western medicine or science.

The Yoga Journal states:

"Whereas breathing is a simple biological process, pranayama (a.k.a. yoga breathing) has complex spiritual implications."

(Pranayama is defined as: learning to control the energy associated with breath, or controling that which brings forth breath.)

breathwalk author"Spiritual implications" are part of yoga practice, but maybe more so with Kundalini Yoga. The person who introduced K.Y. to North American (who also co-authored the book and developed the BreathWalk ® program) is recognized as the Sikh religious leader in the Western Hemisphere. He is Yogi Bhajan (see picture on right).

To his disciples or followers, Kundalini is a way to reach spiritual enlightenment through religious worship.

Of course, Mulder would "want to believe!" But Sculley would say: "I can prove through modern science that we do not need to include their religious worship practices to gain the health benefits."

What was "spooky" to me about Breathwalk ®?

breathwalkI was looking for more detailed information on an exercise I thought would be good to teach my patients, but instead found that I was being taught to worship in the ways of a foreign religion. The health benefits received by performing breathwalk are outstanding, but there is no question in my mind that finding converts is the goal of bringing Kundalini Yoga to the western hemisphere. In the breathwalk certification workshopI attended, I thought the following were spooky:

d The concept of kundalini is not accepted by western medicine or science.
kundalini"Kundalini" is a Sanskrit word that means coiled, like a snake. It is mentioned extensively in the literature of Yoga and Tantra (both Buddhist and Hindu).

It is said to be a dormant energy (represented by a serpent) that resides coiled up at the base of the spine. Yoga and other forms of mystical spiritual practice are used to awaken or uncoil kundalini energy.

In kundalini yoga, it is taught that through the guidance of a guru or spiritual teacher techniques may be used to concentrate all life force and raise the coiled Kundalini energy along the spine and activate seven energy centers known as chakras. This spiritual development is said to bring about physical effects as well as spiritual enlightenment.

d Belief in seven chakras, each with their own residing diety.

chakrasThose who choose to go further into learning kundalini yoga are taught how to pray to and worship the Hindu goddess Shakti (the residing diety of the lowest chakra) and Lord Shiva (the residing diety of the highest chakra).

In this way, the divine mother Shakti, in the form of Kundalini, can find union with her beloved, the supreme Shiva, who resides in eternal bliss at the top of the skull.

shakti"Watch out, if you move that way you'll disrupt your chakra!"

When I attended the instructor training program I was told not to move my arms through certain energy fields or I would disrupt my chakras and this would cause poor health.

As a doctor of physical therapy I can positively say there is no scientific basis for her assertion.

d Chanting religious mantras, like "Satanama" and "Wahey Guru" is a form of religious worship. We were instructed to use "Sa-Ta-Na-Ma" and "Wa-Hey-Gu-Ru" to coincide with the synchronized footsteps and segmented breaths during a breathwalk.

Here is an exerpt written by a yoga expert who just finished a kundalini yoga treacher's training program. He reports on his website that after the training, some devotees gathered at a camp to sing hymns. He describes the following experience regarding what he calls the "Wahey Guru prayer":

"My wife volunteered to sing a serenity prayer, and a fellow yogi provided the music using a one string instrument (Ektara). She sang for us all the Wahey Guru hymm, and the atmosphere it created was marvelously tranquil, prayerful and joyful. This prayer uses the Wahey Guru mantra, which essentially means Ecstasy Beyond Words, and it is a key mantra in Kundalini Yoga and the Sikh faith."

by Anmol Mehta at

Youtube is filled with videos of this religious hymn. Below is an example.

d Wearing turbans and other religious attire.
New converts to kundalini yoga are also expected to wear religious attire (white clothing and turbans) at advanced kundalini workshops. 

d We must strictly follow the guru as disciples.
I was also told not to change anything about the program when I taught others to perform breathwalk and that I must follow the strict guidelines. Or in other words we must "worship" by the strict dictates set forth by Yogi Bhajan.

Our workshop instructor likewise stated that if I made any handouts for my patients/clients or had them listen to music during a breathwalk I must receive approval from Gurucharan S. Khalsa, Ph.D (the co-author of Breathwalk).

Needless to say, I do not practice kundalini yoga or Breathwalk.

back to toporem physical therapy