Top 5 Fridays! 5 Reasons Why Deep Diaphragmatic Breathing May Not Be the Right Prescription (yet) | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Reasons Why Deep Diaphragmatic Breathing May Not Be the Right Prescription (yet)

I am currently 1.5 courses in of a 3 course series on Behavioral Physiology in relation to breathing and learning. It is very fascinating and humbling to learn about breathing in a completely different context.

I had several questions from regular readers regarding the explanation behind why abdominal breathing may not be indicated. The problem I alluded to in my previous post is that between the various clinicians, not to mention any number of fitness professionals instructing on various forms of abdominal breathing, it's now the new stabilization.

Abdominal breathing may not be correct initially, but it is acknowledged that it is better from a mechanical and neurophysiologic standpoint. Here are 5 Reasons Why it May Not Be the Right Prescription (yet)

1) The patient already has low CO2 levels (over breathing)
  • lower CO2 levels increases pH, would could in turn, affect all systems in the body, since it affects blood, interstitial fluid, and CSF - 3 fluids found EVERYWHERE
  • the deep breathing further decreases CO2, causing a viscous cycle
  • I found that in times when I am normally fatigued (afternoon while driving, during mass/homily), I have to breath shorter, faster breaths, around 22 per minute, to reach levels of 43 mmHg
  • trying this during the times I normally struggle to keep awake, or times when I would normally have a second or third cup of coffee, I have been awake and alert to the point of describing it as vivid
  • the answer is not always faster/shorter breaths, the answer is a breathing pattern that raises CO2 levels, it may be deeper breathing, or may be faster shallow breaths
  • bottom line: it's different because each patient is different

2) Abdominal breathing may be threatening 
  • there are many different kinds of perceived threat
  • one of them may simply be due to constriction
    • think skinny jeans or a belt that is preventing anterior, lateral and posterior trunk expansion
  • bottom line: eliminate the threat, sometimes the restriction is physical, but external

3) The state context of breathing as a habit
  • hooking several patients up to the Capnotrainer this week showed very interesting results
  • one was a former PT who is a fitness competitor
  • she could not believe that her breathing rates would be off
  • I had to describe that the efficiency at which her muscles utilize oxygen has nothing to do with her breathing as a habit, or that in sitting and standing, her CO2 levels were much lower than the normal 35-45 mmHg
  • only upon lying supine with her eyes closed did she get to 35, and upon lying prone prior to IASTM, did she get well above 40, and consistently
  • she described that this was the position she relaxes in at night, and after a very stressful day at work, this is the position she wants prior to her kids getting home
  • the next is a chronic pain patient that I train more than I treat
  • she has chronic left pelvic pain and burning
  • she described being hooked up to the Capnotrainer as visual feedback for meditation
    • the waveform and goal of getting the wave to consistently be above the threshold of 35 mmHg was very useful and educational to her
  • upon closing her eyes and remembering a meditative state a friend taught her when pain prevented her from leaving the house, she was able to consistently reach 40 mmHg, up from her initial readings of 25 mmHg
  • after practicing the breathing pattern in several positions, we disconnected her and she started walking
  • her burning came back, but she was walking with her arms folded across her ribcage as she was cold
  • I told her to walk and swing her arms naturally and to remember her breathing patterns
  • after some concentration as the pattern is not yet a reinforced habit, she was able to significantly reduce her pain while she was still walking around the clinic
  • bottom line: appropriate breathing patterns to reduce Sx must be practiced until they are automatic, especially in states where the patient is most under threat

4) They are not ready for diaphragmatic breathing mechanically

  • eliminating possible skinny jeans/belt obstruction, the patient still requires mechanical competence to promote diaphramatic breathing
  • if they are overly tonic in one psoas versus the other, QL, and/or have significant limitations in thoracic and rib mobility, you're instructing a skill and setting them up to fail
  • bottom line: check the usual suspects to start, reduce tone in the accessory muscles, work on thoracic mobility, rib excursion, etc...
ok, so MOST people have a motivation

5) The patient has no motivation to learn a new habit
  • every patient has a motivation
  • telling someone they have to do this because it's good for them is often not enough
  • they have not only a true understanding of why, be shown cause and effect, and they have to buy in to your instruction
  • inquire: What do you want out of these sessions?
    • whatever the answer is: to feel better, to run, to golf, etc...
    • your response: If working on your breathing would help you attain that goal, and I taught you some ways to breathe better, would you practice it several times a day?
  • bottom line: learning occurs best with motivation and rehearsal
I am psyched for the remaining courses to get better acquainted with using the Capnotrainer and to assist patients with their breathing habits. 

Keeping it Eclectic...

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