Altered Breathing Pattern/Hyperventilation Syndrome

[alophysio]

Hmmm,

Bikelet, read at the end of this post please...

Neuromuscular, i am sorry for not responding to this and other correspondence but i have been away lecturing.

My impression, and this is obviously and opinion, is that you have developed theories and models based on your clinical experience.

As you say, you are a clinician (and so am i BTW ).

For myself, whenever i try to explain what i think is happening clinically, i try to understand what the 'experts' say happens and what other explanations are out there. I also try to ensure i don't fall into the trap of scoffing at other theories but rather, i try to understand them (like i have been with your APAS theory).

From your language, it would seem you have very definite ideas of what is going on and i often want to challenge those ideas - not because it doesn't work but because it may not be theoretically correct - am i making sense?

In this particular instance, i have attached a PDF from Netter's Anatomy and this link from Wikipedia which is taken from Gray's Anatomy... Serratus posterior inferior muscle - Wikipedia, the free encyclopedia.

1. To my way of thinking, internal oblique is in a much better position to flare the ribs. It is larger than Serr Post Inf

2. Lats and the LDF intimately blend into it, making the mm a likely synergist. Also, to generate torque, you would think that it would have a stronger attachment than a thin aponeurosis to the SP and supraspinous ligamanet.

3. I have personally felt dissections of this area - the muscle is TINY compared to the obliques and lats.

Therefore, your strong, confident comments do not seem to me to be well researched... which led me to ask how you were so certain that it was serr post inf.

Looking at the anatomy pictures, there are so many muscles in the same area, you could have treated lats, IO, EO, TrAb, even erector spinae.

To call lats a synergyst may be a misnomer - perhaps dysfunction or overactive but lats are a forced expiratory muscle - which is why people hold on tight when puffing - for the forced inspiration (scalenes etc) and forced expiration (abdo mm and lats etc)

Can you reference the trial at winnipeg hospital please? Just so i can check the facts of the trial.

Also, your assessment methods are subjective (unfortunately) - i too am more concerned by the results than the theory but if we are to propose why something works, i would be a little more careful...it would have been very easy for someone to just dismiss your theories as being unfounded.

However, people do it to me without thinking about what i am trying to say which is why i try to ask you lots of questions to glean what is going on (compared to what you think is going on).

I hope i am making sense...

Your thoughts on the matter are more than welcome of course!

Bikelet,

belly breathing is usually a sign that the person has locked their ribs down and so you seen the belly moving in and out because the rib cage is not moving - the pressure has to go somewhere.

Normal breathing is seen as the chest and the abdo moving equally

cheers

[sharileedahl]

I've been away from this site for a while so I'm joining in on this topic a month after its start but... a few thoughts.

I was first introduced to the thought that changes in breathing pattern can affect chonic pain (and other msk pain...not just in the thorax) a couple years ago. The researcher / clinician that was presenting the material referred to their use of capnometry to measure changes in breathing patterns but also to assist in retraining clients' breathing patterns. They found positive effects on their pain / dysfunction. My thought at that time was that this was a relatively new concept in the world of physiotherapy (other than the Tsp and ribs move with inspiration and expiration) and looked forward to hearing more.

So it is interesting to read Esther's comments regarding her previous work experience in the 70-80s. I guess sometimes our new concepts aren't all that new after all??

Regarding the link between the diaphragm, pelvic floor, TrA, Multifidus etc there is definitely a link that continues to proven in research over the last many years. I heard Paul Hodges speak a couple years ago and based on that I jumped at the chance to take one of his courses when he was recently in Canada. My little brain is now jammed with little factoids and graphs. (Anyone who has met him probably knows what I'm talking about!) Very cool research but as the years go by I start to wonder something....

As physios (researchers and clinicians) we are breaking things down in to minute pieces (i.e. we train folks to contract TrA, multifidus......we train people to change their breathing pattern.....we train folks to do pelvic floor exercises etc etc). I guess the theory is that if our clients can get these little pieces working properly again that they will work properly as we introduce more functional exercise and they return to normal ADL / sport / work...
The reason I find this very interesting is that I have been dabbling in yoga of the past number of years. As I learn more about physiotherapy research, I realize how much of what we teach has been stressed in something like yoga that has been around for a very long time. It would be interesting to see research on yoga postures and practice compared to motor control training as researched by Hodges and the likes.

So back to Esther's comments....it would be interesting to note where that rehab process came from in the 70s and 80s when the present physiotherapy research is presenting the link with msk pain and breathing as a new concept.

Any thoughts??

[alophysio]

Hi sharileedahl,

i am not sure that msk pain and breathing is a new concept. I suppose researchers might emphasise the *findings* as new but as you say, the concept is older. As for Esther's research, perhaps the findings were in Dutch??

I too would be interested in the findings/reference for the research.

Cheers