BREATHING PERFORMANCE

(13) proposes a specific protocol consisting of 12 weekly treatment sessions, followed by one session every 2–3 weeks for approximately 6 months. The first 2 weeks of Chaitow’s protocol addresses upper fixator breathing muscles, the whole diaphragm area and release of trigger points. Retraining focuses on pursed lip-breathing and the tendency for the shoulders to rise with the thoracic breath. Weeks 3–4 address mobilisation of thoracic spine and ribs, pelvic and cranial restrictions, and specific relaxation methods (eg. conscious breathing and visualisation). Weeks 5–12 cover ergonomics and posture as well as return to work while

THINKING – A REAL PROBLEM FOR ATHLETES DURING A RACE OR EVENT

INEFFICIENT BREATHING, OR LOW-LEVEL HYPERVENTILATION, CAN LEAD TO CLOUDED

weeks 12–26 involve treating residual patterns of dysfunction as well as nutrition and stress management (eg. using massage and acupuncture). Many athletes experience reduced

Figure 6: Examining the breath in the lower pelvic region

thoracic breathing because they are using their accessory breathing muscles more than their diaphragm; the approach involves careful exploration of the fascial restrictions in the torso, correcting posture and providing kinaesthetic feedback to encourage more relaxed breathing patterns.

Figure 7: Examining the breath in the lower back and abdomen

Figure 8: Examining the breath at the transition between the abdomen and the ribs

www.sportEX.net

Fascia restrictions Breathing is limited not only by the movement of the thorax and abdomen but also by any fascial or membrane layer or other connective tissues (1). We must assess the superficial, middle and deep layers of fascia that surround the ribs, and have multidirectional planes of movement, as well those in the abdomen, pelvis and cranium. Any fascia restrictions of any type limit the vital capacity of the lungs. Peter Schwind’s excellent work (1) focuses on the fascia and membrane running through the torso. He found that the limitations of fascial movement in the torso below the diaphragm and into the abdominal cavity decrease the ability of the diaphragm to fully contract. The same occurs in the upper torso at the cervicothoracic junction. Here the connection of the endothoracic fascia with the transverse processes of the cervical vertebrae means that there are greater forces from the upper torso and chest cavity and these can impact on joint movements (1). As Schwind aptly phrased “certain conditions of the interior and exterior structure of the

torso must be guaranteed” in order that the process of inhalation and exhalation work fluidly (1). The first condition (or guarantee) is that the thoracic wall limits the capacity of the lungs; the second is that the movement of the thoracic wall is determined by the structure of the torso; and lastly, the intercostal membranes limit the movement of the ribs during inhalation (1). As therapists we need to think about the fascia constrictions in all planes of movement, and in the segments of the torso, as well as restriction of individual joints. We must think in 3-D! The fascia of the deep front line (stemming from the viscera and diaphragm) comes up from the diaphragm through the central tendon, through the pericardium to the parietal pleura of the lungs. It forms sheaths and a matrix around the whole lung system (14), therefore any restrictions here will constrict the respiratory system. Muscular tension through the intercostals, obliques and abdominal muscles must all be addressed by the therapist, and releasing the fascia from the pelvic floor – all the way through to the upper thorax and cervical spine – is a central focus of working with athletes. After working comprehensively through the fascial planes therapy must include deactivating diaphragm trigger points, increasing rib mobilisation and thoracic spine mobility and decreasing tension in the transverse thoracis.

Accessory muscle dysfunction The numerous accessory breathing muscles described in Box 1 all need to be tested for dysfunction. Experience shows, however, that once the fascia

25