The Neurophysiology of Breathing

You know what 5 Con-Ed Goals of 2014 list I just published? Turns out I may not achieve any of those (other than PRI), as I just started a webinar program from betterphysiology.com.

A very well educated MDT Diplomat mentored at our clinic last year. She and I spoke a lot about the Capnotrainer, a device that measures CO2 output. She said that unless you have an actual objective measure of CO2 output you cannot just change everyone's breathing to diaphragmatic, slower breaths. This solution is like taking antibiotics for all problems.

I only took the first half of the webinar, entitled Behavioral Physiology 302, and is taught by the founder of the Behavioral Physiology Institute in New Mexico, Peter M. Litchfield, Ph.D.

Learning all about the neurochemistry of breathing was very interesting as well as looking at changing breathing as a behavior that is learned, and can also be changed. Looking at these things we take for granted through the eyes of a researcher who is a psychologist is very insightful. It fits in very well with modern pain science.

Here are some course highlights

breathing and respiration are 2 different things

respiration is what happens internally (diffusion), externally (mechanics)
breathing is a learned habit, and as such needs cognitive learning to change
cognitive learning: without motivation and true understanding, plus self assessment and treatment, the behavior will not change
the emphasis is placed on what the patient needs to do, rather than what the clinician does for them

Self-defeating learned breathing behaviors compromise physiology, psychology, health, and performance

Learned dysfunctional breathing has a major impact on multiple physiological systems, resulting in symptoms and deficits, usually attributed to other causes, by clients and their health practitioners, rather than to learned behaviors and responses that may account for them

when pH is off, it can lead to almost any unexplained complaint, from HA, to paraesthesia, to anxiety, pain, etc... because it effects ALL systems

behavior hypocapnea is the result of overbreathing behavior - excessive CO2 given off, resulting in higher pH

can cause problems in

emotional
behavioral
cognitive
physical

our primary objective is changing external respiration

pH= [HCO3-]/PCO2 - H-H equation
takes kidneys 4-5 days to effect HCO3
CO2 level regulated by breathing
breathing can be changed in seconds, hence pH can be changed in seconds
this is able to be monitored with capnograph
measuring with a capnograph tells whether or not someone is over breathing, which is common, under breathing is either very rare or nonexistent
over breathing leads to restriction of bronchioles, which decreases CO2 levels, feel as if you cannot breathe, deeper breaths are attempted, which worsens the condition
pt then tends to breath deeper wihch further decreases CO2, contributing to the problem
this is why deep abdominal breathing is not the solution for all!

since breathing is a habit, it is state context dependent, like anything learned

this is a very interesting (for me) reason why someone may have their symptoms only lying in bed, at work, on the field, etc...
the threat of any of these positions, times, places may cause their breathing pattern to recur, decreasing CO2 levels, increasing pH and leading to any "unexplainable symptoms"
extinction of a behavior is not getting rid of the response, it is unlearning the response

Case examples from the MDT Diplomat training for FAAOMPT

Woman scheduled for cervical surgery for paraesthesia, cervical pain and canal stenosis

had some improvements with flexion, worse in extension
Sx worse in lying
capnograph showed she was overbreathing
instructed on underbreathing, paraethesia and pain improved rapidly
pt instructed on overbreathing to reproduce her complaints for cause and effect
pt still did not believe PT
PT then had her perform, underbreathing while lying in cervical flexion, and cervical extension to effect it mechanically
pt was able to completely relieve her complaints while in cervical extension, which as a position, was previously reproducing her complaints and making them worse
only after showing cause and effect and that patient was able to control her symptoms with her breathing, independent of head/neck position, did the lightbulb come on
surgery was cancelled!

Olympic Gold Medalist Figure Skater

not able to perform as well as she and her trainer/PT thought she could (not sure if there were more symptoms)
breathing and CO2 levels WNL in all positions/places except when on the ice
her PT used a capnograph while she was skating to regulate her breathing habits within this state context
this gold medalist attributes her edge over the other olympians to her breathing training with her PT on the ice

Needless to say, I am psyched to get the refreshers on the psychology of learning and habits in the context of physiology and breathing. The founder of the Behavioral Physiology Institute believes that PTs as a profession are in a prime position to help bring the use of capnographs into mainstream healthcare. I also ordered a Capnotrainer and am excited to start using it on everyone from centrally sensitized chronic pain patients to athletes.

I will keep you updated on the courses and my trial and error with the Capnotrainer!

Keeping it Eclectic....