resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Another Step Forward for Chiropractic
Chiropractic is now available to 86,000-plus Latter-Day Saints missionaries and you are invited to become a provider. LDS membership in not required; our only concern is that our missionaries get the best quality care available.
Five Branches University Has First Hospital TCM Residency
Established in 1984, Five Branches University (FBU) has campuses in Santa Cruz and San Jose, Calif., which serve the communities of Santa Cruz, the Monterey Bay, and Silicon Valley.
The Case Report: A Valuable Tool
Case reports are a valuable form of descriptive research. The most basic form of practice-based research, a case report is a detailed account of the history, presenting symptoms, assessment, observations, treatment and follow-up of an individual patient, discussed in the context of prior and potential future research.
We Get Letters & Email
Our Country Needs Us Between Elections, Too; Continuing Care: We Aren't There Yet; Our Associations Need to Do More.
News in Brief
Updated Neck Pain & Whiplash Guideline; Attention, IHS DCs; New VP of Institutional Advancement At Palmer; N.J. DC Interns At U.S. Olympic Training Center; Chiropractic Society Of R.I. On The Front Lines.
Nutrition for Menopause: Front-Line Therapy for All Phases
Of all the changes women experience during their reproductive life, there is no doubt the most dreaded are the three phases of menopause. This is not surprising since all of the symptoms associated with menopause are replete with unpleasantness.
Low Back Pain in Running Athletes
After 7 million years of adapting to upright postures, the lumbar spine and pelvis have become remarkably adept at managing ground-reactive forces associated with running.
Let's Clear Up the Collection Confusion
This is an often-misunderstood practice swirling with misinformation. First, a few basics: Insurance is a contract between the patient and the insurance company. The insurance company is simply making a payment for services or care on behalf of the patient.
Crow Like the Rooster
As we welcome in the Year of the Rooster, we look at some of its major characteristics: confidence and communication, which suits the image we have of the Rooster...strutting in the farmyard, crowing to the others that it's time to wake up.
A New Year and Vision for the ACA
Inadequate pain management coupled with the epidemic of prescription opioid overuse and abuse has taken a severe toll on the lives of millions of people in the United States. Every day, more than 1,000 people are treated in the ER for misusing prescription opioids.
Scar Reduction With Acupuncture & Microneedling (Part 2)
Protocols and treatment Timing: A course of treatments should be performed over a period of 12 weeks if possible. Microneedling should be performed once every two weeks.
Prepare for the End, From the Beginning: Wealth Building and Retirement with the Tao
Yin and yang flow into and out from one another continually. Beginnings become endings and endings become beginnings again. Wholeness and cycles are the nature of Tao.
The winter season is upon us and offers unique challenges for the clinician and patient alike. To effectively navigate through the winter season there are two main TCM medicinals, Huang Qi and Gan Jiang, to consider, as well as two important formulas which feature these two TCM treasures.
Anti-Aging With Dr. Ping Zhang
Jennifer Waters, TCM practitioner and writer of the Acupuncture Today column, "Talking With the Masters" sat down with Dr. Ping Zhang to discuss aniti-aging with acupuncture.
Flirting With Alternative Therapies
There are about as many adjunct therapies being marketed to acupuncturists as there are acupuncturists. While some may remain purist in their application of traditional Chinese medicine, others choose to explore new horizons of treatment.
An Opportunity & a Responsibility
Nearly 80 Americans die from an opioid-related overdose every day, and spine-related pain is one of the principle drivers of opioid use. This unfortunate situation creates both an opportunity and a responsibility.
Acupuncture Points: Broadening Our Scope and Diagnostic Work
As every practitioner knows, the correct diagnosis is everything. Most healing disciplines rely on the use of symptomatology for their treatment implementation. Beyond symptomatology, we have clinical tests to provide more objective findings.
An Education in Gluten Sensitivity
A relatively new syndrome officially documented as non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS) was officially recognized and published in the new list of gluten-related disorders in 2012.
Qigong for Substance Abuse
It is commonly believed that substance abuse, in addition to harming one’s physiological state, hurts the spirit. There is also a belief that one’s spirit does not weaken due to substance abuse, but rather, the person finds solace in addiction due to an already weak spirit.
The Acupuncture Channel System (Part 1)
The earliest Chinese reference to channels is in the Mawangdui Medical Manuscripts,1 which are dated to the Warring States period of the Zhou Dynasty (475 BC-221 AD). The text presents 11 channels. There are no acupuncture points listed in those channels.
True Practice Mobility for the Chiropractic Profession
When natural disasters occur, chiropractors can literally travel to the other side of the world to offer humanitarian relief in less than a day. The chiropractor's license to legally practice, however, can't make it past the state line.
Shoulder Rehab: Start With the Scapula
The scapula is an incredible display of elegance and movement within the biomechanics of human motion. It's evolved for mobility and stability in the scapulo-thoracic region, giving us the ability to do things that are uniquely human, such as throwing with accuracy.
February, 2016, Vol. 16, Issue 02
A Bridge to Reducing Chronic Anxiety and Panic Attacks
By Dale G. Alexander, LMT, MA, PhD
One of the most important "aha's" in my career was developing an understanding of the paradoxical breathing reflex and discovering that re-calibrating this reflex was an effective therapeutic bridge for reducing the severity and frequency of chronic anxiety and panic attacks.
There are a range of definitions for paradoxical breathing.1 Here, I propose a description that comes from more than 35 years of empirical clinical experience: When the cervical muscles are initiating the breath wave instead of the diaphragm muscle initiating it, one is caught in the reflex of paradoxical breathing. This state of inefficient breathing is characterized by the SCM's and the scalenes unnecessarily lifting the thoracic cage. It is a complete reversal of the typical neuromuscular sequence involved in normal breathing, especially when the body is at rest. This proposed definition fits the description of "labored breathing" in some texts.2
Certainly, other soft tissues can be recruited beyond the SCM's and scalenes as part of a paradoxical breathing pattern. I am referring to this as a reflex because the client is unaware of it and is unable to restore a normal pattern without sensory guidance and tissue re-calibration. You will not find this listed as a reflex in medical textbooks.
Additionally, the reflex of paradoxical breathing has implications for co-perpetuating a plethora of chronic physical complaints such as neck pain, migraines, upper radicular syndromes, TMJ dysfunction and pain, etc. It is a very long list. I am selecting chronic anxiety and panic attacks simply because I have observed that these symptoms are much more common within our client population than many might think and I sense we, as a profession, can assist in resolving this patterned behavior once we comprehend the primary physical variables involved.
The five most common physical correlations to chronic anxiety and panic attacks include:
My experience with clients suggests that those with a history of highly emotionally charged events, whiplash, head trauma, asthma and respiratory allergies, or the many forms of lung dysfunctions or disease complications, most commonly experience physiological states that trip the neurological switch that activates this reflex.
Repeating for emphasis and clarity, the paradoxical breathing reflex is active when the client is initiating their breathing from their neck rather than from the diaphragm muscle. This is observable, yet, if one doesn't know that this reflex exists, it is easily missed amid the vocalized constellation of painful symptoms clients so often present to us. We often are swept up in our sincere desire to help, allowing the client to direct our therapeutic focus to where they hurt rather than to observe and assess them as a whole.
If a client presents with a chronic somatic dysfunction, then I encourage you to include paradoxical breathing as one of the usual suspects in your initial assessment. The first step is to observe the client while breathing as they sit on the side of your table. Observe them from the front and from both sides. If their chest is rising and lowering, up and down with the rhythm of the breath, it is a potential sign of paradoxical breathing. And, if in addition, their belly does not move with their breath, then there is a very high probability that they are experiencing the reflex of paradoxical breathing.
Is the pattern I am calling paradoxical breathing ever normal? Yes, it is! When you exercise and your heart rate rises, your cervical muscles will initiate the breath wave normally to increase the anterior to posterior dimension of your chest in order to increase your oxygen intake. It is characterized by the heavy breathing we all experience after exercising. Speaking of heavy breathing, another time that paradoxically breathing naturally occurs is when one approaches and experiences sexual climax. Then, as our heart rate lowers and our neural system shifts to parasympathetic tone, our breathing initiation returns to the more normal pattern of the inferior descent by the diaphragm creating the space for the lungs to expand. The third most common natural activation of this reflex is in the latter stages of pregnancy. The expansion of the uterus which then occupies so much space within the abdominal-pelvic cavity is the obvious stimulus for this shift of neuromuscular function. My description of this phenomena in an article written in the mid-90‘s, "Freeing the Breath Wave During Pregnancy," is the most often requested article I have written to date.3
Once paradoxical breathing has been assessed, the next step is to assist your client in re-normalizing their breathing pattern. Sit on the table next to them. Request they close their eyes. Place one of your client's hands on your upper abdomen and the other hand on their upper abdomen and request that they breath in tandem with you for 6 to 10 cycles while you embody a normal, diaphragmatically initiated breath pattern.
Then, move their hand from your belly to their upper chest while the other remains on their abdomen. Have them continue normal breathing for another 6 to 10 cycles directing their intention to notice which hand moves first. Even if they are unable to make a complete shift toward a normal pattern, most clients will register the distinction between whether they are initiating from above or from below.
This technique is using the principle of kinesthetic entrainment, and I have found that it is the quickest way to give your client a sensory experience of what is more normal. It also gives them the psychological and physical permission to release the tension of their abdomen.4
As the diaphragm descends, your abdomen will normally expand slightly forward, but many consciously or subconsciously restrict this motion. Yes, this is another reason that perpetuates this reversal of function: People don't want to be perceived as fat. Next, have your client lie supine, placing one hand on their upper chest and the other on their upper abdomen. Request that they intentionally initiate their breathing from their neck muscles for 2 to 3 cycles then switch back to diaphragmatic breathing for 3 to 5 cycles.
The key to this method of recalibrating the paradoxical breathing reflex is to consciously initiate the dysfunctional pattern "on purpose" so the nervous system develops a sensory recognition and discernment between the two. For many, a few rounds of feeling their diaphragmatic breathing restored and then intentionally initiating from their cervical muscles again will be enough to interrupt the reflexive cycle. For others with entrenched physical or psychological trauma, it will take a few or even many sessions to restore the normal neuromuscular sequencing of the breath cycle.
If deprived of air for 3 to 5 minutes, most of us would die. We all know this instinctively, so some breath is better than none, even if it is feeding our chronic anxiety or functions as a pre-disposition to our panic attacks. Most of our clients simply do not understand how their bodies really work. Identifying this dysfunctional pattern is one way that our profession can educate them, serving them at multiple levels with knowledge, touch, and compassion.
One caution: do not focus on the breath re-calibration process for more than about 10 to 12 minutes, especially if a client is not making progress. This doesn't occur very often, yet frustration fatigue can set in quite quickly for any of us. Instead, allow yourself to use other therapeutic tools you already possess to relax the additional structures identified earlier in the article. Or, if your context is principally to give a client a relaxing full body massage, trust that this will assist them. At the end of the session, you can ask them if their breathing feels more normal. You will be surprised just how many will say yes.
In a future article, I will expand on the other physical variables that have shown themselves to be associated with this paradoxical breathing reflex.
Click here for more information about Dale G. Alexander, LMT, MA, PhD.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.