BREATHING PATTERN DISORDERS

Breathing pattern disorders (BPD) and hyperventilation syndromes (HVS) can lead to a myriad of responses in the human body. A lack of oxygen to the cells and brain can cause a “wide variety of emotional, perceptual, cognitive, attention, behavioural and physical deficits that can seriously impact health and performance” (11). Detrimental changes of breath influence health by changing blood chemistry, reducing the amount of oxygen reaching the brain, altering neuronal function and depleting calcium and magnesium ions (8,12). Low levels of carbon dioxide (respiratory alkalosis or hypocapnia) influence not only the physiology of the body but also emotions – inducing fear, anxiety and stress. Anger, memory loss, loss of posture, muscle cramping and chronic fatigue are just a few of the possible outcomes for athletes who over- breathe (hypocapnia) as shown in Box 3. It is not surprising that anxiety and fear start to impact on an athlete’s training regimen and mental clarity, as well their relationships with people around them, and ultimately therefore on their performance. Hyperventilation syndrome (HVS) stems from the hypocapnia caused when a person hyperventilates. Symptoms include palpitations, shortness of breath, light-headedness, sweating, tingling sensations, and sometimes fainting. HVS can occur both acutely and chronically. Athletes regularly move their respiration into a so-called low-HVS state which Chaitow (10) describes as a blood gas profile that does not meet the mark of true hyperventilation, but which has a noticeably elevated level of breathing rate. In both true HSV and low HSV states the individual exceeds the metabolic respiratory demands of his or her body, and this excess of breathing leads to a change in physiology. HVS is a vicious cycle similar to the pain–spasm–pain cycle of chronic pain conditions, whereby the pain and the spasm feed into each other and perpetuate the associated feelings, pain and mental challenges.

ASSESSING BREATH RESTRICTIONS We are often taught to look clearly at musculoskeletal patterns, pathologies

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BOX 3: EFFECTS OF HYPOCAPNIA (OVER- BREATHING) IN ATHLETES

Symptoms can be: n Emotional n Perceptual n Cognitive n Attentional n Behavioural n Physical

Consequences might include: n Decreased coordination n Decreased reaction time n Anxiety n Disturbed sleep patterns n Cramping n Muscle fatigue n Repeat injuries and strains n Loss of focus

and pain control without paying any specific attention to the movement of the body’s breath. Routine assessment of athlete’s breath in treating injury and postural dysfunction does not seem to happen, despite its significant role in the body and performance. Perhaps we need to develop a specific interest in the role of the breath and its relationship to the thorax, abdomen and pelvis, rather than just pass by it with a perfunctory glance and modest assessment of the movements of the rib cage, stomach and shoulders. By learning to spend time with every athlete in our care, exploring their breath, we are opening up a whole new world of possibilities with respect to their health and performance. The Hi–Lo test (Box 4 and Figures

Figure 4: The patient places the right hand on the middle of the abdomen and the left on the middle of the sternum

Figure 5: Watch the movement of both hands during inhalation and exhalation

BOX 4: THE HI–LO TEST

This is the simplest test to start assessment with. 1. Have your patient lie supine on a treatment table. 2. Ask them to place their right hand over the centre of their abdomen and their left hand over the middle of their sternum (Figure 6). 3. Once they are relaxed, follow their breath. Watch the movement of both their hands during the inhalation and exhalation phase (Figure 7). The breath should start with a downward movement of the diaphragm into the abdomen, with their right hand moving upwards and their left hand remaining steady.

4. If the during the inhalation the left hand moves upwards and away from the chest cavity before any movement of the abdomen, it suggests that the patient is breathing paradoxically. 5. Repeat the above with the patient taking long, deep breaths. This will exaggerate any breathing patterns they have.

4–5) provides an immediate insight into how the diaphragm and rib cage moves during inhalation. Thoracic breathing draws air into the lungs when the shoulders, clavicle and upper ribs move upwards. This produces a very shallow breath because the first movement of the diaphragm descending downward into the abdomen (and creating more space in the thorax) is not activated. This is also known as paradoxical breathing – when the stomach should be moving outwards along with the ribs on inhalation, the upper chest moves out instead, the shoulders rise and the capacity of oxygen intake into the thorax is reduced. We need to think about the whole torso as the apparatus of breath – it is afterall an interdependent dialogue through the diaphragm. Start by examining the breath in the lower pelvic region (Figure 6), moving into the lower back and abdomen (Figure 7) then the transition between the abdomen and the ribs (Figure 8), checking the elasticity (spring) and position at each stage before moving into the upper extremities, shoulder girdle and cervico- occipital junction. Examining the tone, form and movement of these different structures (as well as checking for trigger point development and postural adaptations in the skeletal system) provides a broad and valuable picture of the health of our clients.

TREATING BREATH RESTRICTIONS Treatment is as much about education as it is about manual therapy. For clients who have HVS or BPD, Chaitow

sportEX dynamics 2010;23(Jan):21-26