The Neurophysiology of Breathing | Modern Manual Therapy Blog

The Neurophysiology of Breathing


You know what 5 Con-Ed Goals of 2014 list I just published? Turns out I may not achieve any of those (other than PRI), as I just started a webinar program from betterphysiology.com.


A very well educated MDT Diplomat mentored at our clinic last year. She and I spoke a lot about the Capnotrainer, a device that measures CO2 output. She said that unless you have an actual objective measure of CO2 output you cannot just change everyone's breathing to diaphragmatic, slower breaths. This solution is like taking antibiotics for all problems.

I only took the first half of the webinar, entitled Behavioral Physiology 302, and is taught by the founder of the Behavioral Physiology Institute in New Mexico, Peter M. Litchfield, Ph.D.

Learning all about the neurochemistry of breathing was very interesting as well as looking at changing breathing as a behavior that is learned, and can also be changed. Looking at these things we take for granted through the eyes of a researcher who is a psychologist is very insightful. It fits in very well with modern pain science.



Here are some course highlights
  • breathing and respiration are 2 different things
    • respiration is what happens internally (diffusion), externally (mechanics)
    • breathing is a learned habit, and as such needs cognitive learning to change
    • cognitive learning: without motivation and true understanding, plus self assessment and treatment, the behavior will not change
    • the emphasis is placed on what the patient needs to do, rather than what the clinician does for them

  • Self-defeating learned breathing behaviors compromise physiology, psychology, health, and performance
  • Learned dysfunctional breathing has a major impact on multiple physiological systems, resulting in symptoms and deficits, usually attributed to other causes, by clients and their health practitioners, rather than to learned behaviors and responses that may account for them
    • when pH is off, it can lead to almost any unexplained complaint, from HA, to paraesthesia, to anxiety, pain, etc... because it effects ALL systems



  • behavior hypocapnea is the result of overbreathing behavior - excessive CO2 given off, resulting in higher pH
    • can cause problems in
      • emotional
      • behavioral
      • cognitive
      • physical
  • our primary objective is changing external respiration
    • pH= [HCO3-]/PCO2 - H-H equation 
    • takes kidneys 4-5 days to effect HCO3 
    • CO2 level regulated by breathing 
    • breathing can be changed in seconds, hence pH can be changed in seconds 
    • this is able to be monitored with capnograph 
    • measuring with a capnograph tells whether or not someone is over breathing, which is common, under breathing is either very rare or nonexistent
    • over breathing leads to restriction of bronchioles, which decreases CO2 levels, feel as if you cannot breathe, deeper breaths are attempted, which worsens the condition
    • pt then tends to breath deeper wihch further decreases CO2, contributing to the problem
    • this is why deep abdominal breathing is not the solution for all!
  • since breathing is a habit, it is state context dependent, like anything learned
    • this is a very interesting (for me) reason why someone may have their symptoms only lying in bed, at work, on the field, etc...
    • the threat of any of these positions, times, places may cause their breathing pattern to recur, decreasing CO2 levels, increasing pH and leading to any "unexplainable symptoms"
    • extinction of a behavior is not getting rid of the response, it is unlearning the response
Case examples from the MDT Diplomat training for FAAOMPT

Woman scheduled for cervical surgery for paraesthesia, cervical pain and canal stenosis
  • had some improvements with flexion, worse in extension
  • Sx worse in lying
  • capnograph showed she was overbreathing
  • instructed on underbreathing, paraethesia and pain improved rapidly
  • pt instructed on overbreathing to reproduce her complaints for cause and effect
  • pt still did not believe PT
  • PT then had her perform, underbreathing while lying in cervical flexion, and cervical extension to effect it mechanically
  • pt was able to completely relieve her complaints while in cervical extension, which as a position, was previously reproducing her complaints and making them worse
  • only after showing cause and effect and that patient was able to control her symptoms with her breathing, independent of head/neck position, did the lightbulb come on
  • surgery was cancelled!
Olympic Gold Medalist Figure Skater
  • not able to perform as well as she and her trainer/PT thought she could (not sure if there were more symptoms)
  • breathing and CO2 levels WNL in all positions/places except when on the ice
  • her PT used a capnograph while she was skating to regulate her breathing habits within this state context
  • this gold medalist attributes her edge over the other olympians to her breathing training with her PT on the ice

Needless to say, I am psyched to get the refreshers on the psychology of learning and habits in the context of physiology and breathing. The founder of the Behavioral Physiology Institute believes that PTs as a profession are in a prime position to help bring the use of capnographs into mainstream healthcare. I also ordered a Capnotrainer and am excited to start using it on everyone from centrally sensitized chronic pain patients to athletes.

I will keep you updated on the courses and my trial and error with the Capnotrainer!

Keeping it Eclectic....

3 comments:

  1. Very interesting! When you mention "instructed on under breathing", I imagine this pertains to both breathing amplitude and frequency.. Do they recommend general guidelines for patient education with regards to breathing parameters even without using a capnograph? Is there too much variability from one person to another to make a general assumption that a specific breathing rate will assure proper CO2/pH balance?


    Thanks

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  2. Yeah, it is amplitude and frequency, sometimes diaphragmatic, sometimes not. It is always patient specific and based on the measures the capnograph is giving realtime feedback. So you don't know the type of breathing to instruct both to provoke and relieve the patient's complaints without the measure. You could try different types of breathing and see what happens.

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  3. Interesting metaphors there, and use of graded strength training. I'm sure it's more than that, we all know how comprehensive the media is. Good that it's an entire program and not just one PT here and there (like me in my area).

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