Breathing - Part 1

This is Part 1 of a series about the mechanics of breathing, and how breathing relates to pain, physical therapy, and performance

Breathing

On any given day, we take anywhere from 17,000-30,000 breaths. Like blinking and swallowing, breathing is not something we have to actively think about. If you are healthy, you likely view breathing as a natural and involuntary activity. But have you ever given thought to the quality of your breathing? Conscious attention to breathing can provide insight into both your physical and emotional states.

The role of respiration in overall health should be of particular interest to physical therapists. As clinicians who pride ourselves on a whole-body approach, it is our responsibility to consider the role of breathing in physical therapy. After all, breathing is the basis for everything we do.

Why should physical therapists worry about breathing?

In our stressful and fast-paced society, many people are susceptible to developing breathing dysfunctions. These dysfunctions can feed into the functional impairments we see in the PT clinic. Breathing pattern disorders may contribute to musculoskeletal conditions by impairing motor control and compromising trunk stability.

Many athletes and patients display dysfunctional breathing patterns, limiting performance and increasing vulnerability to injury, therefore as movement experts physical therapists are the ideal experts in assessing and treating dysfunctional breathing

Mechanics of respiration

Let's briefly review the mechanics of respiration:

Inhalation, also known as inspiration, is an active process during which air enters the lungs. The diaphragm contracts and flattens and the ribs move upwards and outwards. As the dome of the diaphragm lowers, the overall size of the thoracic cavity increases. The volume of the pleural cavity increases as well. This expansion of the lungs is associated with a fall in intrapleural pressure.

Exhalation, also known as expiration, is typically a passive process, during which no muscular contractions are needed. At the end of inspiration, the respiratory muscles will relax and the chest wall and lungs elastically recoil. The dome of the diaphragm moves superiorly and the ribs depress. This results in a decrease in the volume of the thoracic cavity and a decrease in lung volume. This change in volume is associated with an increase in intrapleural pressure.

While expiration is primarily a passive process, it does become active during forceful breathing. For example, expiration is active when playing a wind instrument or during exercise. During forced expiration, the anterior abdominal muscles and internal intercostals contract, increasing the pressure in the abdominal wall and thorax.

End of Part 1..

Painful squats? Look at your ankles!

The squat is an essential movement pattern that can be useful for building strength, speed, endurance, and decreasing risk for injury. Many times, athletes will complain of a tightness in the front of their hip at the bottom of the squat.

Often athletes will go and stretch their hip flexor to help to alleviate that tightness. Then, they go and squat again, but the tightness is only temporarily relieved or there has been absolutely no change whatsoever.

Then they keep trying to stretch it, squat through it, or try some other remedy.

You can also check to see if you have full hip flexion mobility. To do that, lie on your back and place one foot flat on the ground. Then bring the other knee up to your chest while keeping your back flat on the ground.

If you cannot bring your thigh to your ribs, you may be limited in your hip flexion mobility. Even if you can and you feel the pinch in your hip, tissues may be irritated.

But if you can do that test and you are still experiencing the same hip pinch, we need to look elsewhere.

It may not be the hip/lumbopelvic complex that is contributing to that pinching sensation.

So let’s take a look at the ankle.

A quick and easy test to see if you have adequate ankle mobility for squatting is the Knee to Wall Ankle Mobility Test.

Key Points:

-Start with your 1st toe 4 inches away from the wall.

-Make sure not to overpronate.

-Try to touch your knee to the wall without letting your heel come off the ground.

If you can touch the wall, you have adequate ankle mobility for squatting.

If you can’t, you may have ankle mobility issues.

The reason that ankle mobility is so important if a hip pinch is present is that if the ankle can’t go into dorsiflexion adequately, another joint in the body has to move more to descend into the squat.

Enter the hip! If there is limited ankle dorsiflexion, the hip may have to flex more in order to get to depth in the squat. The hip may have full mobility when assessed passively, but if the ankle is not moving properly, the hip may have to go into unavailable ranges of motion and in turn causing a pinch in the front of the hip.

So, if you are dealing with a hip pinch with squatting, contact me today to schedule an evaluation!

When is the best time to get physical therapy?

Ideally as soon as possible! The sooner we can assess and begin treating the pain and restrictions that are present, the faster you will get better! This is especially important if the pain is not only affecting your workouts but also activities performed outside of the gym.

Discomfort that is present with movement can be quite complex. With a physical therapy evaluation we assess for limitations or impairments in strength, stability, joint mobility, flexibility, coordination, and much more.

Get back to the activities that your love and schedule an appointment today!

What is Dry Needling?

What is Dry Needling (DN)?

Dry needling is a treatment technique in which small filament type needles are inserted into myofascial trigger points (known as painful knots in muscles), tendons, ligaments, or near nerves in order to stimulate a healing response with the goal of permanently reducing pain and dysfunction.  It has been shown that our bodies can develop areas of hypersensitivity and tightness as a response to various stresses i.e. postural, repetitive movements, psychological, emotional etc.  These areas are most likely to develop along tissues that are dysfunctional due to interruption of the nerves that innervate them.  This can be caused from nerve compression in a limb or in the spine from such things as disc injuries, facet joint dysfunction, vascular compression, metabolic stress or biomechanical stress.  When trigger points are present they can cause the muscles to neurologically tighten, further disrupts the normal functioning of that muscle due to increased pain and local compression of vascular structures and nerves.  Dry needling can help to effectively treat acute and chronic orthopedic and neuromusculoskeletal conditions.

Are dry needling and acupuncture the same thing? 

DN is not acupuncture or Oriental Medicine.  DN is a treatment that uses solid filament, disposable acupuncture needles, but that is where the similarity to acupuncture ends.  Dry Needling is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine in which the purpose is to alter the flow of energy ("Qi") along traditional Chinese meridians for the treatment of diseases.  The theoretical backgrounds for the two treatments are very different.  In fact, DN is a modern, science-based intervention for the treatment of pain and dysfunction in musculoskeletal conditions throughout the body. 

How does dry needling work?

• Local Mechanical Effects

  • Winding, tenting or needle grasp to deform and disrupt fibroblasts within the neighboring collagen tissue resulting in increased opioid mediated response

  • Local twitch response causing decreased muscle contraction and improved range of motion, mobilizing collagen restrictions within the muscle and fascia

• Electrophysiological Effects

  • Decreased spontaneous electrical activity (SEA) at the active trigger point, improved neuromuscular activation and timing

• Neurophysiological Effects

  • Increased pressure pain thresholds

  • Stimulation and decreased inhibition of the descending sensory pain pathways

  • Activation of central mediated systems including activation of areas in the brain involved in pain processing and the emotion of pain

• Chemical/Cellular Effects

  • Improved blood flow to nerves, tissues due to a decrease in vascular compression

  • Inflammatory and immune system responses initiated.

To schedule an appointment with Dr. Travis LeDoyt, PT, DPT, CF-L1 please go directly to https://www.onthegophysicaltherapy.com/ or click the button below. Self scheduling is easy referrals/doctors scripts are not required.