resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
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.