resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
"Doctor ... Always Do the Right Thing"
So says "Da Mayor" in the iconic Spike Lee movie. As a fresh grad questioning in-network versus out-of-network, it struck me that some doctors have explicitly skirted the issue, while others have argued adamantly for the latter and "sticking it to the man."
Don't Trust What a Patient Says
When a patient presents to the office for care, they typically have a specific complaint in mind – lower back pain, whiplash, sinus congestion, sciatica, etc.
News in Brief
D'Youville Vet Program Gets High Praise; A Moment of Silence for Dr. Paul Reginald ("Reg") Hug.
Vibrational Medicine: Frequency Micro-Current and Color Acupuncture
Vibrational medicine involves the application of various forms of energy frequencies to the body for pain relief, healing and rejuvenation. Vibrational medicine will become a major growing trend in our medical systems for the following reasons:
We Get Letters & E-Mail
Imagine What More Could Be Achieved With Your Support; A Lesson in Hygiene: What Do You Do in Your Office? Open Letter to the Profession.
The Importance of Knowing Mainstream Lingo
There is a secret lingo within mainstream medicine of which the vast majority of acupuncturists and Chinese medical professionals are unaware.
Shared Mechanisms Between Computer-Assisted Mechanical Adjusting and Contemporary Acupuncture?
Can contemporary acupuncture provide clues to the mechanisms responsible for pain relief provided by computer-assisted mechanical adjusting instruments, and clarify whether certain mechanical frequency combinations are superior to others for modulation of acute peripheral pain?
The Boston Benevolent Chiropractic Clinic: Standing Up for the Needy
Our chiropractic assistant, Bridget, greeted an arriving patient at the Emmanuel Church in downtown Boston. She said, "Hi, Michael, good to see you. It's been awhile. Have a seat and Dr. Ken will see you soon."
Medial Knee Pain: 11 Potential Causes (and Corrections)
We have all seen patients with medial knee pain that either has no traumatic origin or lasts well beyond when it should be resolved. How can we help these patients? Here is an overview of clinical scenarios and how we can provide conservative care.
CRREW Rallies for Ongoing Acupuncture Relief Effort in the Philippines
On November 8, 2013, Typhoon Yolanda (Haiyan) made her way through the Philippine Islands, leaving in her wake at least 7,000 people dead, millions homeless and complete communities destroyed.
Home Sweet Medical Home
While the Affordable Care Act (ACA) has received its fair share of praise and criticism since its adoption, few question the value of its emphasis on collaborative, patient-centered health care.
Medical Qigong for the Heart: Part I
According to the Center for Disease Control and Prevention, heart disease is the leading cause of death in the United States, affecting people of all ages and backgrounds. Coronary heart disease, in just the United States alone, costs close to 109 billion dollars a year.
The Search for the Origin of the Wiggle Technique
When Bob had adjusted me previously, most of the time I knew what he was doing. But this time, he had me lie on the treatment table in the usual side-posture position, and he "wiggled" my sacroiliac with the fingers of both hands, while stabilizing my pelvis with his forearm.
New Leadership Era at the WFC
The World Federation of Chiropractic recently announced not only a new president, as is customary every two years, but also an incoming secretary-general, marking the first time since the WFC's inception in 1988 that someone other than David Chapman-Smith, Esq., will serve in that capacity.
Halt Allergies With Moxibustion Therapy
An allergy is an immune system disorder in which the body is hypersensitive to normally harmless substances in the environment.
Low Melatonin Linked to Risk of Advanced Prostate Cancer
Epidemiological and experimental studies suggest the hormone melatonin, which plays a role in regulating the sleep-wake cycle, may play a role in the development of prostate cancer, as lower melatonin levels have been associated with an increased risk of prostate (and breast) cancer.
Deciphering the New CMS-1500 Claim Form
Q: I am confused about how and when to use the new 1500 form, particularly block 14 and block 15. What is required and how do I properly fill out these fields? And do I actually have to use this new form or may I continue using the old version?
Employers Need Chiropractic First and Sooner
From the Journal of Occupational and Environmental Medicine comes a study that gives excellent direction to employers (and insurers) regarding the management of low back problems (LBP).
Replenishing and Restoring Jing
I learned an important principle from my great Taoist Master Sun Hak. He taught me that all people "leak" Jing, and that we can mitigate or stop this leaking, and as a result strengthen our life force, develop enhanced adaptability and lengthen our life.
News In Brief
Pacific College of Oriental Medicine obtains grant funding from NIH; Yo San University of Traditional Chinese Medicine Announces New President; Kentucky Gets Licensed; PCOM Receives Approval from WASC to Offer FPD.
Wellness: A New Buzzword at the Aging in America Conference
Aging in America is "the nation's largest gathering of a diverse, multidisciplinary community of professionals in healthcare, social service, government, business and philanthropy with expertise in providing services and products for older adults."
Changes in Herbal Medicines from Ancient Times to the Present
The classical literature of Chinese medicine remains highly relevant in the modern era, as many of the basic theories and herbal combinations emphasized in clinical practice were first established in texts that are nearly 2000 years old.
Don't Trust What Your Patients Say
When a patient presents to the office for care, they typically have a specific complaint – lower back pain, whiplash, sinus congestion, sciatica, etc. They are often not interested or engaged in what they consider "unrelated" personal health history.
Working With The Yuan-Source Level: Resonance and the Extraordinary Vessels
How do we stay fresh with our medicine? As healers, how do we balance our medical selves with creative artistry? Chinese Medicine is not a fixed dogmatic entity, but a living system, reliant on a mysterious force called "resonance."
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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