CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation. connections 31 insplratory and expiratory muder, 31 Restoration of normal function requires Gait influences 32 restoration of adequate mobility to the structural component and, self-evidently, maintenance of Upper thoracic muscles 33 Thoracic musculature 34 any degree of restored biomechanical integrity NOTES ON SPECIFIC MUSCLES 35 requires that function (how the individual Spinalis thoracis 35 breathes) should be normalized through re- Semispinalis thoracis 35 education and training. Multifidi 35 Rotatores longus and brevis 35 Spinal musculature: implications for thoracic function 36 MULTIPLE INFLUENCES: Muttifidus and the abdominals 36 Serratus posterior superior 36 BIOMECHANICAL, BIOCHEMICAL, Serratus posterior inferior 36 AND PSYCHOLOGICAL Levatores costarum iongus and brevis 37 lntercostals 37 The area of respiration is one in which the inter- Interior thorax 38 action between biochemical, biomechanical, and Transversus thoracis 39 psychosocial features is dramatically evident 1 2 MULTtDISCIPLINARY APPROACHES TO BREATHING PATTERN DISORDERS Other catalysts which may impact on breathing function include environmental factors (altitude, humidity, etc.). Even factors such as where an individual is born may contribute to subsequent breathing imbalances: 'People who are born at high altitude have a diminished ventilatory response to hypoxia that is only slowly corrected by subsequent residence at sea level. Conversely, those born at sea level who move to high altitudes retain their hypoxic response intact for a long time. Apparently therefore ventilatory response is determined very early in life' (West 2000). How we breathe and how we feel are inti- mately conjoined in a two-way loop. Feeling anxious produces a distinctive pattern of upper- chest breathing which modifies blood chemistry, leading to a chain reaction of effects, inducing anxiety, and so reinforcing the pattern which pro- duced the dysfunctional pattern of breathing in the first place. Even when an altered pattern of breathing is the result of emotional distress, it will eventually produce the structural, biomechanical changes which are described below. This suggests that when attempting to restore normal breathing - by means of re-education and exercise for example - both the psychological initiating factors and the structural compensation patterns Figure 1.1 A Homeostasis. B Heterostasis. (Reproduced need to be addressed. (The psychological effects with kind permission from Chaitow 1999.) of breathing dysfunction are covered in greater detail in Chapter 5.) (Fig. 1.1A, 1.1B). Inappropriate breathing can result directly from structural, biomechanical causes, Homeostasis and heterostasis such as a restricted thoracic spine or rib immobility or shortness of key respiratory muscles. The body is a self-healing mechanism. Broken Causes of breathing dysfunction can also have bones mend and cuts usually heal, and most a more biochemical etiology, possibly involving health disturbances - from infections to digestive an allergy or infection which triggers narrowing upsets - get better with or without treatment of breathing passages and subsequent asthmatic- (often faster without!), and, in a healthy state, type responses. Acidosis resulting from condi- there exists a constant process for normalization tions such as kidney failure will also directly alter and health promotion. This is called homeostasis. breathing function as the body attempts to However, the homeostatic functions (which reduce acid levels via elimination of C02through include the immune system) can become over- the means of hyperventilation. whelmed by too many tasks and demands as a The link between psychological distress and result of any, or all, of a selection of negative breathing makes this another primary cause of impacts, including nutritional deficiencies, accu- many manifestations of dysfunctional respir- mulated toxins (environmental pollution, either ation. Indeed, it is hard to imagine examining a as food or inhaled, in medication, previous or person suffering from anxiety or depression current use of drugs, etc.), emotional stress, without breathing dysfunction being noted. recurrent or current infections, allergies, modi- THE STRuefilRE AND FUNCTION OF BREATHING 3 fied functional ability due to age, or inborn the pressure off the defense mechanisms while factors, or acquired habits involving poor the body focuses on its current repair needs. posture, breathing imbalances and/or sleep 2. Enhancing, improving, modulating the disturbances, and so on and on ... (Fig. 1.2). defense and repair processes by a variety of At a certain point in time the adaptive homeo- means, sometimes via specific intervention static mechanisms break down, and frank illness and sometimes involving non-specific, - disease - appears. At this time the situation has constitutional methods. modified from homeostasis to heterostusis, and at 3. Treating the symptoms while making sure that this time the body needs help - treatment. nothing is being done to add further to the Treatment can take a number of forms, which are burden of the defense mechanisms. usually classifiable as involving one of three Not all available therapeutic measures need broad strategies: to be employed, because once the load on the 1. Reducing the load impacting the body by adaptation and repair processes has reduced taking away as many of the undesirable adap- sufficiently, a degree of normal homeostatic tive factors as possible (by avoiding allergens, self-regulating function is automatically restored, improving posture and breathing, learning and the healing process commences. stress coping tactics, improving diet, using supplements if called for, helping normalize Therapy as a stress factor sleep and circulatory function, introducing a detoxification program if needed, dealing A corollary to the perspective of therapy being with infections) and generally trying to keep aimed at the 'removal of obstacles to self-healing' pesticides, etc. heavy metals Possible nutrient petrochemicals deficiencies: self-generated Lifestyle factors: vitamins via infection poor sleep patterns conditions minerals iaterogenic inadequate or excessive EFAs influences, etc. exercise Neural and/or limbic i alcohol, tobacco usage I svstem malfunction h\ / /I I social and medical drugs I bacterial I \U fungal viral personality traits parasitic, etc. powerlessness L- anxiety Genetically interpersonal issues inherited tendencies: hypermobility genetic inscription influences on hormonal function Endocrine imbalance Multiple current symptoms: Functional problems: \' pain, fatigue, insomnia, IBS, - hyperventilation digestive, allergic, recurrent - digestive enzyme Trauma - physical and/or infections, genitourinary, etc. deficit, etc. psychological When homeostatic adaptive capacity is exhausted treatment calls for: 1. Restoration of immune competence, enhancement of defence capabilities, support of repair functions 2. Reduction of as many of the multiple interacting stressors impacting the individual as possible 3. Attention to symptoms (ideally without creating new problems). Figure 1.2 Multiple stressors in fibromyalgia. (Reproduced with kind permission from Chaitow 1999.) 4 MULTIDISCIPLINARY APPROACHES TO BREATHING PATTERN DISORDERS is that, since almost any form of ’treatment’ been established. This commonly requires the involves further adaptive demands, therapeutic removal of causative factors, if identifiable, interventions need to be tailored to the ability of and, if possible, the rehabilitation of habitual, the individual to respond to the treatment. acquired dysfunctional breathing patterns, and, Excessive adaptive demands