resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
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.
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