resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
December, 2005, Vol. 05, Issue 12
Understanding and Rehabilitating Unbalanced Breathing
By Leon Chaitow, ND, DO
In the October issue of Massage Today,1 I outlined some of the symptoms that can be created or aggravated by Breathing Pattern Disorders (BPD) such as hyperventilation.The response to this has been remarkable. I honestly can say that in the many years I have written articles and books, I have never had such a rapid and insistent response asking for more information. This follow-up article goes a small way toward meeting those requests.
This article contains information focusing on three overlapping areas: the background to BPDs, how to recognize BPD in a new client and how to begin rehabilitation. More detailed information can be found in my co-authored book published by Elsevier, Multidisciplinary Approaches to Breathing Pattern Disorders (Chaitow, Bradley & Gilbert 2002).
Back pain research and breathing rehabilitation2
A very recent research paper has been published that demonstrates another aspect of the benefit of breathing rehabilitation improvement in chronic low back pain! In this randomized, controlled study, patients with moderate chronic low back pain, of average 1-year duration, improved significantly (both pain and function) whether they were treated with either Breathing Rehabilitation or what was described as "Gold Standard" Physical Therapy. Both groups received one introductory evaluation session of 60 minutes, and 12 individual therapy sessions of equal duration of 45 minutes, over six to eight weeks.
Summary of some of the main BPD effects:3
Excessive carbon-dioxide loss causes blood pH to rise, creating respiratory alkalosis. This induces increased sympathetic arousal, altering nerve function (including motor control). It also encourages a sense of apprehension and anxiety which affects balance. Calcium and Magnesium ions are lost as the kidneys attempt to restore pH balance by excreting bicarbonate. This enhances neural sensitization, encouraging spasm and reducing pain threshold. Smooth muscle cells constrict, leading to vasoconstriction (and possibly altering fascial tone). Smooth muscle constriction can lead to colon spasm and pseudo-angina. Due to alkalinity, the so-called Bohr effect reduces oxygen release to the cells because haemoglobin retains oxygen more effectively in an alkaline environment, thus affecting tissues and the brain, encouraging ischemia, fatigue and pain. Ischemia encourages the evolution of myofascial trigger points. Overbreathing creates biomechanical overuse stresses, particularly on the accessory breathing muscles (scalenes, sternomastoid, upper trapezius, etc), as well as compromising core stability and posture.
Breathing Pattern Disorders commonly are habitual, easily recognizedand usually capable of being improved or eliminated.
Background and Definition of Breathing Pattern Disorders
The extreme of a BPD is hyperventilation, which is defined as breathing in excess of metabolic requirements. A client might show an odd arrhythmic breathing pattern and not be hyperventilating, and perhaps more importantly, might look as if they are breathing okay, but actually be hyperventilating even if apparently fit with good lung function.
About 10% of all patients attending general internal medicine practice in the U.S. are estimated to be suffering from chronic hyperventilation.4 My own clinical experience with this sort of problem suggests that a large patient population exists with BPDs who don't meet the criteria for hyperventilation, but whose breathing patterns contribute greatly to their symptom picture.
What are the Symptoms?
The vast majority of patients who chronically overbreathe in this way present with symptoms such as: fatigue, widespread pain (such as fibromyalgia), irritable bowel symptoms, chronic bladder problems, anxiety, allergies, chemical sensitivities, headaches, premenstrual syndromes, photophobia and hyperacusis. In many such conditions, BPDs rarely are causal (except perhaps where anxiety is a major feature), but they almost always are contributory, and sometimes have become a major obstacle to recovery.
As will become clear, the effects of BPDs are global, affecting all systems, having profound neurological, psychological, digestive and circulatory influences. BPDs commonly are habitual, and with a cooperative patient, usually are capable of significant improvement and are sometimes curable over a three to six month time-frame. Chronic HVS can present with respiratory, cardiac, neurological or GI symptoms, without any clinically apparent overbreathing by the patient.5
BPDs More Common in Women
HVS/BPD is female dominated, ranging from a ratio of 2:1 to 7:1 (peak ages 15-55 years). Women are more at risk possibly because progesterone is a respiratory accelerator. This also can have implications for women on hormone replacement therapy. During the post-ovulation phase, carbon dioxide levels drop about 25% and additional stress then "increases ventilation at a time when CO2 levels are already low."6
Blood Sugar and BPD
Feelings of faintness, cold sweats, weakness and disturbed consciousness are common to both hyperventilation and low blood sugar, and symptoms are far worse when both situations are present at the same time.
It also has been found that fluctuating blood glucose levels, even when these stay within normal limits, can trigger hyperventilation/BPD symptoms. People affected in this way are recommended to eat breakfast (including protein) and to avoid going without food for more than three hours or following a little-and-often, or grazing pattern of eating. This particularly is important to patients who experience panic attacks or seizures.9
Perspective of a Cardiologist
Peter Nixon a leading UK-based cardiologist reported: "When dysfunctional thoracic breathing predominates, a shift occurs towards excessive arousal, which as a catabolic state predisposes the soma towards pathology."10 Someone suffering from BPD could experience catabolic changes; protein, fat and carbohydrate synthesis halted; energy mobilized from increased breakdown of protein, fat and carbohydrates; blood levels of glucose, LDL and cholesterol increase; decrease in repair and replacement of bone; decrease in repair and replacement of skin and gut cells; decreased production of immune cells (thymus shrinks, less WBCs); decreased sexual function; increased blood pressure; and increased salt and fluid retention.
Why do people breathe this way? One of the major medical researchers into BPD, Claude Lum, discussed the reasons for people becoming hyperventilators, "Neurological considerations leave little doubt that habitually unstable breathing is the prime cause of symptoms. Why people breathe in this way must be a matter for speculation, but manifestly the salient characteristics are pure habit."11
Although an absolute diagnosis only can be made with CO2 monitoring using a capnograph that monitors carbon dioxide levels in exhaled air, a simple questionnaire (Nijmegen Questionnaire) is internationally accepted as being over 90% accurate in suggesting that hyperventilation exists as a contributory feature of person's symptom picture. This non-invasive test is a simple and accurate indicator of acute and chronic hyperventilation.12, 13
What Patient Signs MightAlert You to BPD?
Possible Treatment Sequence for HVS/BPD
Note: The sequence outlined below is one I have evolved for my own practice and is not a recommendation for others. It does however contain the elements I feel are necessary for a successful restoration of breathing. Treatment and retraining commonly involves eight to 12 weekly sessions, followed by treatment every two to three weeks, for approximately six months. An educational component should be included at each session.
First Two Treatments: (Not less than weekly): release and/or stretch of upper fixators of the shoulders/accessory breathing muscle (upper traps, levator, scalenes/SCS, pecs, lats) as well as attention to trigger points in these; soft tissue (NMT, MET, PRT, etc) attention to the diaphragm area (anterior intercostals, sternum, abdominal attachments costal margin, quadratus lumborum/psoas), as well as attention to trigger points in these. Retraining: pursed lip breathing, as well as guidance as to restricting shoulder rise during inhalation. Give an introduction of the capnograph biofeedback method.
Sessions (Weeks) Three and Four: As above, plus mobilization of thoracic spine and ribs (as well as lymphatic pump/drainage methods), plus address fascial and osseous links (cranial, pelvic, limbs). Retraining: anti-arousal breathing, plus specific relaxation methods, stress management, autogenic training, visualisation, meditation, counselling. Sessions of capnograph biofeedback training as required.
Sessions (Weeks) Five to Twelve: As above, plus focus on other body influences (ergonomics, posture). Retraining: additional exercises as appropriate.
Sessions (Weeks) 13 to 26: Review and treat residual dysfunctional patterns/tissues. Throughout: as indicated nutrition, psychotherapy and adjunctive methods, such as hydrotherapy, tai chi, yoga, Pilates, massage, acupuncture, etc.
Successful breathing retraining
There have been many reports and studies showing the value of breathing rehabilitation.14 Lum 15 reported on a study in which more than 1000 anxious and phobic patients were treated using breathing retraining, physical therapy and relaxation. Symptoms were usually abolished in one to six months with some younger patients requiring only a few weeks. At 12 months, 75% were free of all symptoms and 20% had only mild symptoms however, about one patient in twenty had "intractable symptoms."
Instructions for Anti-Arousal/Pursed Lip Breathing 16 17 18 19
Place yourself in a comfortable (seated-or reclining) position, and exhaleslowly and fully through pursed lips (as though you are blowing through a drinking straw), with your lips just barely separated. Imagine that a candle flame is about 10 inches from your mouth and exhale (blowing a thin stream of air) in such a way as to not blow this out, but to just make it flicker. When you have exhaled fully, without strain, close your lips and pause for a count of one and then inhale through your nose. The complete exhalation will have created a "coiled spring" so you do not have to try to control how you inhale. Then, without pausing to hold the breath, exhale fully and slowly through pursed lips once again, blowing the air in a thin stream until you feel the need to inhale. Close your lips, pause for a count of one, and then inhale freely through the nose again. Repeat the inhalation and the exhalation for not less than 30 cycles of in and out. Practice this exercise morning and evening. You might feel light headed after the 30 cycles, so rest for a few minutes before resuming normal activities.
Methods need to be taught to encourage the restraining of shoulder movement (accessory muscle activation) during breathing using one of a variety of methods. For example: The patient is seated at the edge of a chair with arms hanging down, palms facing forward. On inhalation, the patient gently turns the arms so the thumbs point slightly backwards, and on exhalation this is released and relaxed. The rhythmic breathing pattern, along with this gentle restraint of accessory breathing muscles, starts the process of separating the act of inhalation from their over-activity.
The information in this short article has focused on the background, appearance, assessment and rehabilitation of breathing pattern disorders these are not pathologies any more than poor posture is a pathology but they can profoundly influence emotions, chemistry and structure. I sincerely hope you can use the essential features of this message to benefit your clients and perhaps yourself.
Click here for more information about Leon Chaitow, ND, DO.
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