Sometimes any movement, positional, or manual therapy based input is not enough on a patient with a very sensitized nervous system. This is often a good time to get back to basics.
1) Tactile Cues
- supine lying - patient has one hand on sternum and the other on the belly
- emphasize belly breathing primarily and initially with inhale, try to make it 70 belly, 30 sternum
- for patients that cannot initiate without excessive sternal breathing, try prone, so they have tactile input from the table or mat and can feel their ribs expand as well
- place your hands on their lateral ribs and ask for expansion once they get belly breathing down
- ask them to remember what this breathing pattern feels like in this position, as they must replicate it later in their threatened movement pattern or position
2) In a relaxed atmosphere
- even though I work in a gym, if a patient is wound up, I take them into a quieter area that does not sound like a night club
- get them in an exam room, turn off overhead lights, and have them close their eyes
- if you are promoting relaxation, make the atmosphere match
3) Emphasize exhalation
- I tell patients that inhalation increases tension, exhalation decrease tension
- even though they should take a deep breath in, the exhalation, should be emphasized and slower than the inhale
- not necessarily through pursed lips, as this causes unnecessary facial tension
- before starting this, find a tender point related to the area in complaint (maybe QL, upper trap, etc)
- palpate lightly and ask if it is tight/tender, if so, have them do a few good and longer exhales and ask them if it is still as tight/tender, often they will notice significant decrease in both or either
4) Time to Move - Move into the barrier
- check out this Quick Case from earlier this week for an example of this
- have the patient move into the perceived position or movement of tightness or pain
- at their limit, have them perform the same breathing pattern from supine or prone
- ask them to picture and feel the same pattern as they were in lying
- 3-4 good exhales should get them through the barrier
- you can use some PNF if they are not touch adverse to help speed this along with some hold relax
5) Show Cause and Effect
- If you were able to get to step 4 session, congrats! Time to show cause and effect
- get the patient to sternal breath, with their normal breathing pattern (probably a bit faster and with aborted exhalation)
- palpate the tender area, and have them move into the barrier - if there still is one
- showing increases in tension/tenderness or increasing discomfort to movement or position with one breathing pattern and decreases/elimination using another is learning, showing them they can control their symptoms
Want a review on the neurophysiology of breathing? Click here! Here are 5 Techniques to Assist with Breathing. Have any cases to share where breathing made a difference in your outcomes? Share below or on the facebook page!
Keeping it Eclectic...
Post a Comment
Post a Comment