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What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
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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