Episode 67: Who would benefit from a breathing assessment?

The goal is to learn , inspire and bring Cardiopulm to the forefront of conversation . Thanks for joining me today and let's get after it . Hello , hello and welcome to today's episode of Talking All Things Cardiopulm . I am your host , Dr . Rachele Burriesci .

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I think today's going to be a quick episode , but I wanted to talk a little bit about paradoxical breathing and just talk about an interaction that I had with a young athlete . So I was home a few weeks ago and my niece's basketball team was at the beach house and the brothers and sisters and family were all with them and there was this one young guy .

He was probably 17 years old , a wrestler was . He was a wrestler and he was actually awaiting D1 calls that night , so high level athlete , very fit , and he was having a lot of back pain . So we were just chatting .

He was talking about how they love therapy and that they love their PT and all these things , and I'm not really sure how it happened , but all of a sudden I'm assessing this kid's diaphragm . I think they were talking about back pain and some conversation happened with you know , do you do anything related to breathing exercises ? And the answer was no .

So I just did a quick assessment of his diaphragm and , just , you know , cued him to breathe into his diaphragm and on first assessment we had paradoxical breathing pattern . I was like , wow , all right , here we are , 17 year old male , fit , active , high level athlete . We have paradoxical breathing .

So first of all , just kind of put some definition behind paradoxical . Paradoxical basically means that the muscle is moving in the wrong direction . So if we have a paradoxical diaphragm , that means that instead of the diaphragm moving inferiorly on inhale , pushing the stomach out , it's actually sucking in and up , so it's going in the wrong direction .

When you talk about paradoxical breathing you can also say upper paradoxical breathing pattern and in that situation the diaphragm would move aggressively in the correct direction and the upper chest , the anterior chest wall , would actually suck in on inhale . So normal breathing pattern when we inhale our diaphragm should move inferiorly .

Our lateral costals should move laterally , superiorly and posteriorly . Our anterior chest should move superiorly and anteriorly right . Everything should be moving up and out on inhale and down and in on exhale . Just a normal breathing mechanic , breathing mechanic .

Typically , when you see paradoxical breathing , for instance maybe in the hospital setting , you might have a spinal cord injury . It's very common that patients with spinal cord injury have an upper paradoxical breathing pattern pending level of injury .

You might see paradoxical breathing after a patient has been on mechanical vent and they're just like very asynchronous and not moving in the correct direction . Sometimes you see it with patients who are easily fatigued , like if they have a neuromuscular disorder commonly seen in , like MS Guillain-Barre , als . You're going to see that asynchronous type movement .

And then emphysema is another one where you can start to see paradoxical breathing . Once they've had a lot of rib cage changes where they have that horizontal rib , horizontal diaphragm , they're typically using more accessory muscles .

They might start to use abdominals inappropriately on inhale versus exhale , and so there's just some you know common diagnoses that you might see paradoxical breathing with . This gentleman has no underlying history , but it was very interesting to see this asynchrony .

So the first thing we really had to do to get him to start to activate diaphragm was not even sniffing . When he was sniffing he was paradoxical of sucking in . So the first thing we had to do was actually relax the abdomen . We had to relax the abdominals and you know it's very common that we might be tensing our abs for , maybe , visual appearance .

Maybe we're tensing our abs because we feel it gives stability , but it is like a chronic hold right and it's not meant to be in that pattern . So once he was able to let go of his abs like not hold back his abdominals tight at rest , we were starting to get movement of diaphragm with sniffing technique . So it's a it's .

It's going to take time for him to really activate diaphragm naturally , because in his resting state he's paradoxical . He has this abdominal contraction just holding tight . So it's going to be an unlearning process and I honestly I think sometimes that's the hardest thing to do . But the reason why I wanted to talk about this number one is breathing exercises .

Breathing assessments should not only be done in patients who have lung disease . It should not be considered like a geriatric assessment tool or a lung disease assessment tool . The diaphragm is a primary muscle of breathing and has many attachment points Rib eight laterally . We're at the T-spine at level 10 , right .

So we have a lot of correlation between our ribs and our T-spine and stability . If you are someone who is lifting heavy , there are tons of breathing techniques that can help you stabilize . There are tons of breathing techniques that can help you stabilize and there are breathing techniques that might actually create more asynchrony .

So being able to activate your diaphragm appropriately , even understand what your diaphragm is right Like . That was the first thing we did . We just had a conversation that we have this muscle that helps us breathe and this is how it moves , and when we're able to move our diaphragm , we can take a bigger breath .

And when we're able to move our diaphragm , we're able to actually stabilize our core and we start having this like anatomical conversation .

It's not like a bicep or a hamstring where people are really well versed in it , but in my opinion , this is something that we should be teaching earlier and earlier , because there's so much benefit to understand how to activate your breathing , use your breathing for stress management , nervous system hygiene , correct strength techniques and also coordinating it with

movement . So , thinking about someone who is a wrestler , you're going to be doing like high intensity burst type movements and I would put my money on it that if we could get you to pair your breath with your movement , you're going to have a more powerful move with each breath .

So just very interesting to see young , healthy , fit , unable to activate diaphragm appropriately . Now is the person at risk ? No , but there is asynchrony and my guess is we didn't really get into a lot of details that he probably gets gassed with most things right .

There's probably a level of shortness of breath and he's really suffering from a lot of back pain , likely using diaphragm to help stabilize versus appropriately a activating diaphragm and then appropriately strengthening back muscles . So lots of different things that can be tied in here .

But my point to this very short conversation is do not be afraid to assess breathing in your outpatient patients , in your young patients , because not only is the assessment important , but so are the interventions that are going to be attached to that assessment right . Just teaching diaphragmatic breathing can have a laundry list of benefit for that client .

So let's start making it a habit to assess breathing and to incorporate breathing interventions to help maximize that person in that moment in their sport and long term right .

And also give strategies , because if you can learn how to control your breath , you're going to be able to pace more appropriately , you're going to be able to brace more appropriately , you're going to be able to control stress when you need to control stress . So there's just like so many different aspects of this , that you can tackle .

But starts with assessment . If I didn't look , you know , look at diaphragm assessment . No one would ever know that he has a paradoxical breathing pattern . Likely that might be driving some of his other issues that he's dealing with chronically . You tap into that one piece , it could really open things up for that client .

So breathing exercises , breathing assessment is across the board All populations , all injuries , all post-surgical patients . There's just so much benefit to breathing that I just wanted to make a quick point that it's not just for one specific diagnosis . It is literally probably one of the most beneficial things you can teach across the board in any age period .

All right , this was a short one today . I hope this was helpful . If you have any questions , please reach out to me on Instagram , shoot me a text . If you found this beneficial , please drop me some stars . Write a great review is 100% appreciated . All right , I hope you all have a wonderful day and whatever you have to do , I get after it .