8/19/12  

WAITING TO EXHALE

Midwest  Performance  Enhancement   Seminar  2012  

WAITING TO EXHALE “If  breathing  is  not  normalized  –  no  other  movement   pa7ern  can  be.”   -­‐Dr.  Karel  Lewit   “The  main  factors  which  determine  the  maintenance  of   the  abdominal  viscera  in  posi=on  are  the  diaphragm  and   the  abdominal  muscles,  both  of  which  are  relaxed  and   cease  to  support  in  faulty  posture.”   -­‐Joel  Goldthwaite   Body  Mechanics  and  Health,  1922   Midwest  Performance  Enhancement   Seminar  2012  

OBJECTIVES   •  •  •  • 

Normal  breathing  mechanics   Breathing  paHern  disorders   Compensatory  kineLc  chain  dysfuncLons   Strategies  

Midwest  Performance  Enhancement   Seminar  2012  

1  

8/19/12  

BREATHING ANATOMY   •  The  Diaphragm   –  Primary  breathing   muscle   –  Trigger  for  effecLve   stabilizaLon   –  Canopy  faces  pelvic  floor  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Diaphragm   –  Influenced  by  internal   organs   –  Results  in  asymmetrical   funcLon   –  Asymmetry  is  NORMAL  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Pelvic  Floor   –  ContracLon  coupled   with  IO  and  TVA   –  Strong  contracLon  of   pelvic  floor  =  more   efficient  co-­‐contracLon   of  abs   –  Voluntary  acLvity  of  abs   increases  pelvic  floor   muscle  acLvity   Midwest  Performance  Enhancement   Seminar  2012  

2  

8/19/12  

BREATHING ANATOMY   •  Diaphragm,  Psoas,  and   Quadratus  Lumborum  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Diaphragm,  Psoas,  and   Quadratus  Lumborum  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Fascial  ConnecLons  of   Diaphragm  

Midwest  Performance  Enhancement   Seminar  2012  

3  

8/19/12  

BREATHING ANATOMY   •   Internal  Oblique  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY      

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •   Transversus  Abdominis  

Midwest  Performance  Enhancement   Seminar  2012  

4  

8/19/12  

BREATHING ANATOMY   •  Diaphragm  and  TVA  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Deep  Cervical  Flexors   –  Part  of  deep  spinal   stabilizing  system   –  Inhibited  with  forward   head  posiLon   –  Rich  in  proprioceptors   –  Feed-­‐forward   stabilizaLon  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Accessory  Breathing   Muscles   –  Pec  major/minor   –  Erector  Spinae   –  Scalenes   –  Trapezius   –  Serratus  Anterior  

Midwest  Performance  Enhancement   Seminar  2012  

5  

8/19/12  

BREATHING ANATOMY   •  Upper  ribs  (1-­‐5)  pump   handle   •  Lower  ribs  (6-­‐10)  bucket   handle  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Posterior  torsion  with   extension   •  Anterior  torsion  with   flexion   •  Posterior  torsion  to   same  side  as  rotaLon   •  Anterior  torsion  on   opposite  side  of   rotaLon   Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY  

Midwest  Performance  Enhancement   Seminar  2012  

6  

8/19/12  

BREATHING ANATOMY   •  Diaphragm  flaHens  and   acts  against  abdominal   wall   •  Coordinated  effort  of   diaphragm,  abs,  pelvic   floor  control  IAP  and   stabilize  the  T/L   juncLon  and  L/S  spine   anteriorly     Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ANATOMY   •  Zone  of  ApposiLon   •  Controlled  by  the   abdominals   •  Abs  oppose  the  outward   protrusion  of  abdomen   anteriorly  and  laterally   during  diaphragmaLc   contracLon   •  DiaphragmaLc   mechanical  advantage  is   maintained   Midwest  Performance  Enhancement   Seminar  2012  

BAD BREATH   •  PosiLon  of  the  thorax  and  spine  determines   whether  ideal  synergy  between  diaphragm,   abs,  and  pelvic  floor  takes  place   •  If  the  thorax  is  in  an  inspiratory  posiLon  at  the   end  of  expiraLon/beginning  of  inspiraLon,  the   sternum  and  ribcage  posiLon  is  impaired,   extension  occurs  at  the  T/L  juncLon,  and   acLvity  of  the  diaphragm  is  impaired     •  Sub-­‐opLmal  Zone  of  ApposiLon   Midwest  Performance  Enhancement   Seminar  2012  

7  

8/19/12  

BAD BREATH  

Midwest  Performance  Enhancement   Seminar  2012  

BAD BREATH   •  Most  common  breathing  paHern  disorder  is   upper  chest/apical  breathing   •  Triggered  as  compensaLon  for  posture,  pain,   injury,  stress,  infecLon/pathology,  or  in  aHempt   to  maintain  blood  pH   •  Limited  ribcage  expansion/thoracic  rigidity   •  Accessory  muscles  recruited  to  lii  ribcage   •  Results  in  hypervenLlaLon/hyperinflaLon   •  Self-­‐perpetua+ng  once  it  starts   Midwest  Performance  Enhancement   Seminar  2012  

BAD BREATH   •  Consequences  of  Overbreathing/ HypervenLlaLon/HyperinflaLon   –  Reduced  CO2  resulLng  in  increased  Blood  pH   –  SympatheLc  dominance  (“flight  or  fight”)   –  Reduced  blood  flow  to  brain  (by  50%),  limbs,  and   heart   –  Reduced  oxygen  to  cells  (Bohr  Effect)   –  Increased  circulaLng  histamines   –  DepleLon  of  Ca  and  Mg   –  Reliance  on  Gylcolysis  (decondiLoned)   Midwest  Performance  Enhancement   Seminar  2012  

8  

8/19/12  

BAD BREATH Consequences  of  Overbreathing/Hyperven;la;on/ Hyperinfla;on   •  •  •  •  •  •  •  •  •  •  • 

Increased  Anxiety   Tiredness   Dizziness   ExhausLon   Tingling   Cramps   “brain  fog”/confusion   Panic  aHacks   Phobic  behavior   Weakness     Poor  core  stability/motor  control  

•  •  •  •  •  •  •  •  •  •  •  • 

Rapid  pulse   SweaLng   Cold  extremiLes   Increased  muscle  tension   Trigger  points   Muscle  twitching/spasm   Increased  swallowing  rate   BloaLng/indigesLon   Food  allergies   Shoulder/head/neck  pain   Increased  pain  percepLon   Strong  allergic  reacLons  

Midwest  Performance  Enhancement   Seminar  2012  

BAD BREATH

Midwest  Performance  Enhancement   Seminar  2012  

BAD BREATH Consequences  of  Overbreathing/Hyperven;la;on/ Hyperinfla;on  –  FEMALES   –  Breathing  paHern  disorders  more  common     •  2:1  to  7:1   –  Progesterone  is  a  respiratory  accelerator   –  CO2  drops  post-­‐ovulaLon  

Midwest  Performance  Enhancement   Seminar  2012  

9  

8/19/12  

BAD BREATH   •  Core  Stability  +  Poor  Breathing  PaHern  

–  Breathing  Challenge  +  Spinal  Load  Challenge  

•  Stability  loses   •  Reduced  diaphragmaLc  and  TVA  funcLon  toward  spinal   stability  

–  Loss  of  Punctum  Fixum  for  the  psoas  and  iliacus   –  Extension-­‐based  breathing  paHern   –  Loss  of  ICR/joint  centraLon   –  Loss  of  opLmal  joint  posiLon/muscle  imbalance/poor   motor  control   –  Unable  to  protect  passive  joint  structures  due  to   uneven  loading   Midwest  Performance  Enhancement   Seminar  2012  

BAD BREATH  

Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION   •  Facilitated/short   –  –  –  –  –  –  –  –  –  –  –  – 

Hip  flexors   Adductors   Hamstrings   Gastroc/Deep  posterior   Spinal  erectors   Quadratus  Lumborum   Piriformis   Upper  trap/levator   Pecs   SCM   Cervical  extensors   Upper  extremity  flexors  

•  Inhibited/weak   –  –  –  –  –  –  –  –  – 

Tibialis  anterior   VM   Glute  max   Glute  med/min   Abdominals   Lower/middle  trap   Serratus  anterior   Deep  cervical  flexors   Upper  extremity  extensors  

Midwest  Performance  Enhancement   Seminar  2012  

10  

8/19/12  

KINETIC CHAIN DYSFUNCTION   •  •  •  •  •  •  •  • 

Lower  Back  Pain   SI  joint/piriformis  syndrome   Groin  pain/FAI/Labrum   Hamstring  strain/sciaLca/ ITB   Knee  pain/Patellar   tendinosis/degeneraLve   changes   Achilles  tendinosis   Plantar  fasciiLs   Hallux  rigidus  

Trigger  point  development   Headaches   TMJ   Neck  pain   Thoracic  outlet  syndrome   Internal/external  shoulder   impingement   •  Periscapular/thoracic  pain   •  Medial/lateral  elbow   tendinosis   •  Peripheral  nerve   entrapments   •  •  •  •  •  • 

Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION   Lower  Body  Compensatory  Ac;vity  for   Func;onal  Asymmetry   •  Right  oriented  pelvis   •  Lumbar  spine  follows  the  pelvis   •  Lumbar  muscular  adaptaLons   •  Lei  hip  ER/right  hip  IR   •  Loss  of  lei  hip  IR  and  adducLon   •  Lower  extremity  muscular  adaptaLons   Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION   Upper  Body  Compensatory  Ac;vity  for   Func;onal  Asymmetry   •  Right  sternal/spinal  orientaLon   •  Lei  Scapula  elevated/ER/retracted   •  Lei  lat  facilitated/limited  GH  ER   •  Right  Scapula  abducted/depressed/IR/ protracted   Midwest  Performance  Enhancement   Seminar  2012  

11  

8/19/12  

KINETIC CHAIN DYSFUNCTION  

Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION  

Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION  

Midwest  Performance  Enhancement   Seminar  2012  

12  

8/19/12  

KINETIC CHAIN DYSFUNCTION  

Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION  

Midwest  Performance  Enhancement   Seminar  2012  

KINETIC CHAIN DYSFUNCTION  

Midwest  Performance  Enhancement   Seminar  2012  

13  

8/19/12  

BREATHING ASSESSMENT   •  •  •  •  •  •  •  •  •  • 

General  ObservaLon   Scapulothoracic  posiLoning/posture   Lumbopelvic  posture   Infrasternal  Angle/Abdominal  muscle  balance   Ribcage  symmetry/posiLon   Overhead  reach  test   Seated  Lateral  expansion  test   Seated  hip  flexion   Supine  deep  breath   Supine  Apical  Expansion   Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ASSESSMENT   •  General  ObservaLon   –  RespiraLon  rate   –  Obvious  muscle  tension   –  Swallowing  rate   –  Pupil  size   –  Body  Language  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ASSESSMENT   •  Scapulothoracic  posiLoning/posture   –  Shape  of  Thoracic  spine/kyphosis/flaHening     –  Scapulae  rest  evenly  on  ribcage   –  RelaLve  symmetry  of  scapular  posiLon   –  Elevated  or  depresses  scapulae   –  Rib  hump/Rib  flare  

Midwest  Performance  Enhancement   Seminar  2012  

14  

8/19/12  

BREATHING ASSESSMENT   •  Lumbopelvic  posture   –  Shape  of  lumbar  spine/lordosis/flaHened   –  Muscle  mass/tension   –  Symmetry  of  muscle  mass   –  Lateral  flexion/rotaLon  

Midwest  Performance  Enhancement   Seminar  2012  

BREATHING ASSESSMENT   Infrasternal  Angle/Abdominal   Muscle  Balance/Rib  Cage  Posi;on  

•  90  degree  opLmal   •  >90  sLff/short  internal   oblique   •