We all know the feeling of tightness in the chest, that out-of-breath sensation after a difficult interval repeat, or even coughing and becoming light-headed at the end of a big workout. For some runners, however, these symptoms begin cropping up workout after workout, and even into recovery runs.

When presented with these symptoms, some doctors are quick to diagnose asthma and prescribe inhalers. Because the breathing problems might be accompanied by allergies or respiratory sickness, medications or time off might also be prescribed. But for some runners, their symptoms don’t go away, leading to frustration and that much more stress about their breathing.

What if the answer were something else entirely? You could be dealing with paradoxical vocal fold motion disorder (PVFMD) or, more generally, vocal fold dysfunction (VFD). Here’s how to know if your breathing problems while running might stem from VFD, and what to do if that’s the case.

What Is Vocal Cord Dysfunction?

VFD occurs when, instead of the vocal cords opening freely during inhalation, they remain tightened or closed off. This is why runners with VFD will often wheeze when breathing in, unlike in asthma when the wheeze is often heard while breathing out. Once the natural pattern of vocal cords opening and closing becomes uncoordinated, it can become a pattern.

While the incidence of VFD remains difficult to pinpoint, owing to the difficulties in diagnosis, it’s estimated that at least 5 percent of elite endurance athletes experience VFD, with a higher percentage for recreational and younger athletes. Women and academic high achievers seem to be more susceptible than the general population. In the general public, one study out of Copenhagen discovered exercise-induced laryngeal obstruction in 7.5 percent of randomly selected participants.

Endurance athletes are more likely to experience VFD because exercise is a trigger for the symptoms to arise and prolonged activity results in acute awareness of bad breathing. Without stopping and allowing the vocal folds to reset and resume their natural relaxed pattern, the disrupted pattern will continue until exercise has stopped. Unlike other sports, running doesn’t allow for breaks to recalibrate breathing and for the body to reset, so the effects of dysfunction can build over the course of a run.

Stress

Stress, either physical or emotional, can exacerbate the problem. When you’re experiencing a sustained period of stress, most of your muscles become tighter. This includes the muscles in the neck and those surrounding the voice box. This will directly lead to the vocal folds becoming tighter or closed. Other physical triggers include changes in weather (especially breathing in cold air), coincident conditions such as seasonal allergies or asthma, and acid reflux, all of which runners tend to encounter. If your neck and nearby muscles remain in tightened for too long, that tightness can become your norm.

This disorder has been noticed to occur more frequently in runners who are making a step up, be it fighting for a scholarship in their final seasons of high school, joining a collegiate team, or beginning to make a big jump in performance. Whether they can feel it or not, carrying added perceived pressure can result in physical tightness and changes in the body.

Because runners are typically high achievers, they might continue to push through instances of labored breathing, exacerbating the problem. When their breathing feels out of control, they might start to panic, and their breathing might become even shorter and shallower. Teammates and coaches might hear a difference in breathing, the athlete might no longer keep up in workouts, and their performances might slip. If an athlete feels alienated from their group or worried about what’s going on, the problem can worsen.

All of these factors can contribute to a negative feedback loop and emotional stress. Once a pattern is established, even showing up to practice might trigger breathing changes.

Breathe Easy

The best current treatment for vocal cord dysfunction involves a multidisciplinary approach. You can seek diagnosis and treatment from a speech and language pathologist who has experience in the topic, an ear, nose, and throat doctor/otolaryngologist, a psychologist, and other specialists in the field.

Be open and honest about your symptoms. It often helps to take notes and share what you’re feeling, when you feel it, and what you’ve already tried in terms of changes or medications.

After diagnosis, learning about the breathing system anatomy can be a first step in treatment for many athletes. Doing diaphragmatic or “belly” breathing as often as possible, as opposed to high or chest breathing, will be important in resetting the vocal fold pattern. Successful treatment often includes relaxing and retraining the vocal cords, such as Laryngeal Control Therapy. Throat massage including manipulation of the adam’s apple can also help.

Treatments

Because VFD is often considered a sensory-motor disorder, increasing your sensation accuracy and self-awareness of the vocal cords can also be useful. Many athletes cite picturing and visualising their vocal folds blowing open with a relaxed throat posture during inhalation as an important turning point.

To make this your norm, start practicing diaphragmatic breathing during a rest state while picturing and trying to feel your vocal folds opening. Once this becomes more natural, try it while walking, then slow jogging, and so on until you can use these techniques during all of your runs.

Current treatments gaining popularity involve small cameras placed in the throat that can show the athlete’s vocal folds opening and closing during exercise for maximum visual feedback. Eventually, the athlete will feel the difference without needing to use the camera.

Practice breathing, relaxation, and warm up techniques daily. Being willing to slow down and take breaks as necessary can shorten the length of disorder. As many as 80 percent of treated athletes no longer had to use asthma medications after going through such treatments.

If mental stress seems to be a major culprit to onset of symptoms, seeking a sports psychiatrist may be an integral asset to breaking this cycle. Without uncovering and treating any mental triggers you may have, the symptoms are at risk to start up again in a similar stress environment.

Lastly, remember you’re not alone. Many high level athletes have dealt with and received help for VFD. With a more efficient breathing pattern, you can come out of treatment faster and smoother than ever before!

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