The average adult breathes 12-20x/minute, which accounts to over 20,000 breaths/day. Ideally, the diaphragm is the major muscle of inspiration. When abnormal breathing patterns develop, accessory muscles (scalenes, SCM, upper trapezius, pectorals) are forced to be used more. In other words, these muscles have the potential to be used improperly >20,000x/day. Scary right?!
While various breathing pattern abnormalities exist, a commonly seen pattern is the "chest breather." The chest breather does not fully engage his/her diaphragm and often has decreased lung volumes. These patients often incorporates their anterior accessory muscles of inspiration which can pull them into a forward head and rounded shoulder posturing: a posture we see in many of our clients. Their imbalances go deeper than what is seen by observation alone. Because the chest breather has decreased lung volumes, he/she may be in a constant sympathetic state to supply sufficient oxygen to the bodies tissues. Consequently, they may have increased muscle tone, anxiety, and a variety of other PNS and CNS symptoms. In a post written by Mike Reinold in late April, he highlights two studies that show the importance of proper breathing. One study interestingly discovered increased EMG activity of the scalene and trapezius muscles while typing. As students, who spend most of their day at a computer, this is something to consider. This could be contributing to neck pain and stiffness that so many students have. Additionally, breathing exercises maybe a good place to start for your sedentary office worker with chronic neck pain.
Reinold also mentions several treatment strategies to initially assess breathing technique:
1. Breath Holding Test. Decreased breath holding my demonstrate an intolerance to CO2 build-up.
2. Belly/Chest Test. Have the patient place one hand at their naval and their second hand at the sternum. Assess which hands moves further. Is there a change is sitting vs. supine? With a deep breath, ~90% of motion should come from the lower hand, indicating good diaphragmatic breathing. This test can later be used as an intervention. It is a simple way to provide external cueing to the patient to activate their diaphragm.
3. Seated Lateral Expansion. Have the patient place a hand on either side of their thorax. Take a deep breath in and feel for rib movement symmetry. Again, if one side is moving differently than the other, hand cueing + manual facilitation can act as a good treatment intervention early in the POC.
Below is a basic video demonstrating diaphragmatic breathing:
Here are 2 other good resources we found off Dr. E's website (The Manual Therapist) on breathing:
1. 5 Techniques to try with Diaphragmatic breathing
2. Assessment and Treatment for Diaphragmatic Breathing by: SPT Fred Charles
Thanks Mike Reinold and Dr. E for the great posts!
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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