Breathing - Part 2

Breathing and the nervous system

The nervous system and the musculoskeletal system work in tandem to create movement. If we have dysfunction with one system, it may manifest in the other system. Therefore, respiratory dysfunction in the nervous system may present as a musculoskeletal problem.

The control of breathing is balanced between the central nervous system (brain and spinal cord) and the peripheral nervous system (somatic nervous system and autonomic nervous system). The autonomic division of the peripheral nervous system is of particular interest to us here. The autonomic nervous system is divided into the sympathetic nervous system, the parasympathetic nervous system, and the enteric nervous system. Here we will focus on the sympathetic and the parasympathetic divisions of the autonomic nervous system.

When we experience emotions, pain, fear, and stress, our sympathetic and parasympathetic nervous systems respond by adjusting blood pressure and heart rate (among other variables). Generally speaking, parasympathetic activity is associated with a relaxation response and sympathetic activity is associated with a heightened response.

A slow diaphragmatic breath with prolonged exhalation will increase parasympathetic activity and result in relaxation. On the other hand, rapid chest breathing with prolonged inhalation will increase sympathetic activity and result in a stress response.

When we operate mainly through the sympathetic nervous system, we are living in a state of heightened arousal. This state is known as up-regulation. Up-regulation negatively alters our breathing patterns and changes the respiratory muscles we recruit for breathing. These changes can alter motor control patterns and result in musculoskeletal pain. Therefore, we should be assessing and treating breathing in physical therapy.

Dual role of the diaphragm

In early development, the diaphragm acts primarily as a respiratory muscle. However, at 6 months, the diaphragm takes on a dual role as a respiratory muscle and postural muscle. Both of these roles must be intact in order to achieve lumbopelvic stability and optimal movement patterns.

The diaphragm initiates cores stability through its influence on intra-abdominal pressure. It works with the transverse abdominis, multifidus, and pelvic floor muscles to provide support to the spine. Proper diaphragmatic function not only allows us to breathe, but also provides us with the postural stability that is required for complex movements.

When breathing demands increase, there is competition between the two roles of the diaphragm. Breathing will always win this competition (after all, we need it to live). As a result, the diaphragm's contribution to postural stability declines.

When individuals exhibit breathing pattern dysfunction, meaning they cannot diaphragmatically breathe, or they are too dependent on accessory respiratory muscles, their bodies become hyper-focused on the demands of breathing. They will overuse other respiratory muscles and the diaphragm will be unable to perform its stabilizing role. Consequently, posture and movement patterns will suffer.

We must remember that the diaphragm is a muscle. It is critical that we involve breathing in physical therapy treatments - we have to train the diaphragm too!

In many adults, we see breathing move away from the stomach and higher into the chest. These individuals are not taking full advantage of the diaphragm. The longer they under-recruit this breathing muscle, the harder it is to normalize breathing patterns and the more likely they are to develop musculoskeletal issues.

End of part 2

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..

Training Around Pain

“The pain will go away on its own”

“If I just stop going to the gym, it will get better”

“No pain, no gain” “Pain is weakness leaving the body”

At On the Go Physical Therapy, we hear statements like these from friends, family, CrossFit athletes and clients all the time. Maybe you’ve been thinking this yourself.

The Body Is Resiliant

Our bodies have an amazing ability to heal.  Have you ever had a callous rip during a workout? Within a week, it is usually all healed up, right? Does that stop you from coming into the gym and working out the next day. Nope, you just slap some tape on it, put on your grips and move on. When it comes down to it there really isn’t much difference at the cellular level between a callous and the muscles, tendons, ligaments, bones and cartilage in the rest of your body. Our bodies are continuously repairing and healing, just at different rates depending on the extent of the injury and the tissue or bone affected. 

“So you are saying the pain will go away on its own?”

Maybe yes, maybe no. The injured tissue will heal over time, but often it can be more sensitive or weakened if not properly loaded during this healing period. This could potentially lead to pain lasting even after the tissue issue has been resolved. A skilled physical therapist can help you learn how to modify your workouts, load the tissue early and progressively and prevent complications down the road when you try to jump back into CrossFit, running, or any other activity you enjoy. This means that you can come back from your injury stronger than you were prior to your injury.

“What if I just stop going to the gym or doing the activity that aggravates my injury?”

There is nothing inherently bad about the activity that is aggravating your injury. Our bodies are meant to do all kinds of activities and be in all types of postures/positions. Sure it may be helpful to pause an activity that is making symptoms worse, but only for a limited time so that you avoid overloading the injured tissue. This does not mean stop being active. It is way more important that you continue being active for your CARDIOVASCULAR HEALTH and in order to stave off chronic disease.  Not a single person is dying from low back pain or shoulder pain, but shockingly 70% of the world IS DYING FROM CHRONIC DISEASE. A skilled physical therapist can help put the fire out on your pain all while keeping you active in doing the things you love. Be wary of doctors and other medical professionals that tell you to stop doing an activity or tell you that you WILL NEVER or SHOULD NEVER do “xyz” again. That’s usually bad advice and most of us wouldn’t listen to them anyway.

“No pain, no gain” “Pain is weakness leaving the body”

Should you avoid all pain no matter what? No, current research shows that there can be some benefit to painful exercise, but when we get into these painful episodes we need to identify what is off and what got you into this predicament in the first place.  Usually it is one of two things. You are doing TOO MUCH TOO SOON and your body has not adapted to that activity. You are essentially OVERLOADING your tissues and tissues do not like that. The other factor can be your lifestyle habits are off: poor sleep, diet, high stress levels, overall body inflammation.  These things need to be discovered and addressed or you just keep adding fuel to the fire.  If a change isn’t made, you run the risk of further injury or you end up turning this acute episode of pain (short period of pain) into chronic pain (long period of pain). 

Contact Travis or call/text (781)691-4378 to learn more about how you can put out the fire on your pain and stay active through injury.

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!

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.