Role of physiotherapy in dysfunctional breathing/ breathing problems
Case history: One of my patient came to me with difficulty in breathing which she was bearing since more than a year. But at this moment it was affecting her a lot. She was also worried to think about the cardiac problem and she consulted with physician in this regard and get done her ECG. But she had no cardiac problem. One day she consulted us (Rid of Pain Physiotherapy) and we found her muscles were affecting her. She was using her secondary muscles instead of primary breathing muscles. we just treated her kinetic chain and she got immediate relief in her problem.
Dysfunctional breathing and its affect:
Dysfunctional breathing can lead to or can be because of dysfunction of the kinetic chain.
Introduction. The importance of all systems in the body is to work synergistically. The cardiorespiratory system is a major support system for the kinetic chain and the kinetic chain also provides essential support for the cardiorespiratory system. Muscles, bones and the nervous system are all essential components oft he cardiorespiratory system that enable it to function optimally. If there is a dysfunction in the cardiorespiratory system, this can directly impact the
components of the kinetic chain. Alterations in breathing patterns are a prime example of this relationship.
Proper Breathing
Breathing is the actual process of moving air in and out of the body. It is divided into two phases, inspiratory (inhalation) and expiratory(exhalation).Inspiratory ventilation is active. Inspiratory ventilation occurs in two forms, normal resting state(quiet) breathing and/or heavy (deep, forced) breathing. Normal breathing requires the use of the primary respiratory muscles, which consist of the diaphragm and intercostals muscles. Heavy breathing requires theadditional use of the secondary respiratory muscles, including the upper trapezius, scalenes, sternocliedomastoid, levator scapulae and pectoralis minor. Expiratory ventilation can be both active and passive. During normal breathing, expiratory ventilation is passive as it results from the relaxation of the contracting primary inspiratory muscles. During heavy or forced breathing, the expiratory ventilation relies on the activity of expiratory muscles, such as the abdominals, to compress the thoracic cavity and force air out. The action of normal rested breathing is typically seen asdiaphragmatic, or “belly” breathing, where the abdominal region moves outward during inspiration and inward during expiration. As breathing becomes harder, breathing can be seen as “chest breathing”, where the secondary respiratory muscles are involved to help lift the rib cage to allow the lungs to expand further as more air is brought in. Dysfunctional Breathing and the Kinetic Chain Breathing dysfunction is a very common cause of kinetic chain dysfunction and is commonly associated with those who are chest breathers” during rested states of breathing. In these cases, individuals use their secondary respiratory muscles as their primary respiratory muscles, which can be a result of/lead to postural imbalances. For example, individuals who have upper cross syndrome (rounded shoulders, forward head) typically found tightness of the upper trapezius, scalenes, sternocliedomastoid, levator scapulae, and pectoralis minor (secondary respiratory muscles).These muscles can become overactive during normal breathing, leading to the action of chest breathing and furthering the postural dysfunction. Restricted breathing can also result due to the position of the rib cage in this posture.
This may force the secondary respiratory muscles todo more during rested breathing to help lift the rib cage to allow the lungs to expand. This, too, can lead to muscle imbalances and the postural distortion pattern. In addition, poor neuromuscular control of the intrinsic core stabilizers (which includes the diaphragm, a primary respiratory muscle)can force one to overuse their secondary respiratory muscles to assist inbreathing. This can lead to the development of the upper crossed syndrome. In this case individuals can experience difficulty in breathing, neck pain, shoulder pain, headaches and even dizziness or anxiety. Assessments and Solutions Assessing for dysfunctional breathing can be done very easily and quickly.
Assessing one’s static posture can be a first step in determining the possibility of dysfunctional breathing. If an individual has the upper crossed syndrome may indicate tightness in the secondary respiratory muscles. Second assessment option is simply instructing an individual to breathe normally and assess whether they breathe naturally through their belly or by lifting their chest. If they are chest breathers”, this may indicate overactivity of the secondary respiratory muscles. If either of the above problems exist, myofascial release and static stretching of the upper trapezius, scalenes, sternocliedomastoid, levator scapulae, and pectoralis minor as well as strengthening of the scapular retractors and deep cervical flexors would be warranted to address these imbalances. Also, simply teaching individuals how to breathe diaphragmatically can help encourage proper breathing action and improve neuromuscular control of the core.
This can be easily done by simply having the individual sit or stand upright while placing their hand on their abdomen. Then, instruct them to push their abdomen out into their hand during inspiration and pulling their abdomen back in, away from their hand, during expiration. This can help teach proper neuromuscular control of the diaphragm and could be a good first core-stabilization exercise. Instruct the individual to perform this exercise throughout the day to improve breathing awareness and neuromuscular efficiency. So Breathing is an action that can be easily taken for granted, but it can also play a major role in kinetic chain dysfunction. This dysfunction can come in the form of difficulty in breathing in resting position/running/walking, joint pain, headaches and dizziness. Thus, it becomes important for professionals to be aware of proper and improper breathing patterns as well as ways to address muscles imbalance that can be a result of/lead to kinetic chain dysfunction. Like many kinetic chain dysfunction, breathing action can be improved thought physiotherapy treatment to maintain flexibility, strengthening and neuromuscular control techniques.
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