Top 5 Fridays: 5 Ways to Instruct Breathing on Difficult Cases | Modern Manual Therapy Blog

Top 5 Fridays: 5 Ways to Instruct Breathing on Difficult Cases


Sometimes any movement, positional, or manual therapy based input is not enough on a patient with a very sensitized nervous system. This is often a good time to get back to basics.
Other than rest, hydration, and nutrition, breathing is one of the basics that we can influence and make rapid changes due to neurophysiology. Here are 5 ways I instruct breathing patterns

1) Tactile Cues
  • supine lying - patient has one hand on sternum and the other on the belly
  • emphasize belly breathing primarily and initially with inhale, try to make it 70 belly, 30 sternum
  • for patients that cannot initiate without excessive sternal breathing, try prone, so they have tactile input from the table or mat and can feel their ribs expand as well
  • place your hands on their lateral ribs and ask for expansion once they get belly breathing down
  • ask them to remember what this breathing pattern feels like in this position, as they must replicate it later in their threatened movement pattern or position
2) In a relaxed atmosphere
  • even though I work in a gym, if a patient is wound up, I take them into a quieter area that does not sound like a night club
  • get them in an exam room, turn off overhead lights, and have them close their eyes
  • if you are promoting relaxation, make the atmosphere match
3) Emphasize exhalation
  • I tell patients that inhalation increases tension, exhalation decrease tension
  • even though they should take a deep breath in, the exhalation, should be emphasized and slower than the inhale
  • not necessarily through pursed lips, as this causes unnecessary facial tension
  • before starting this, find a tender point related to the area in complaint (maybe QL, upper trap, etc)
  • palpate lightly and ask if it is tight/tender, if so, have them do a few good and longer exhales and ask them if it is still as tight/tender, often they will notice significant decrease in both or either
4) Time to Move - Move into the barrier
  • check out this Quick Case from earlier this week for an example of this
  • have the patient move into the perceived position or movement of tightness or pain
  • at their limit, have them perform the same breathing pattern from supine or prone
  • ask them to picture and feel the same pattern as they were in lying 
  • 3-4 good exhales should get them through the barrier
  • you can use some PNF if they are not touch adverse to help speed this along with some hold relax
5) Show Cause and Effect
  • If you were able to get to step 4 session, congrats! Time to show cause and effect
  • get the patient to sternal breath, with their normal breathing pattern (probably a bit faster and with aborted exhalation)
  • palpate the tender area, and have them move into the barrier - if there still is one
  • showing increases in tension/tenderness or increasing discomfort to movement or position with one breathing pattern and decreases/elimination using another is learning, showing them they can control their symptoms
Want a review on the neurophysiology of breathing? Click here! Here are 5 Techniques to Assist with Breathing. Have any cases to share where breathing made a difference in your outcomes? Share below or on the facebook page!

Interested in live cases where I apply this approach and integrate it with manual therapy and repeated motions? Check it out on The OMPT Channel!

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