Low Back Pain and Breathing Pattern Disorders: Difference between revisions
No edit summary |
No edit summary |
||
| Line 12: | Line 12: | ||
== Definition/Description == | == Definition/Description == | ||
A breathing pattern disorder is defined as hyperventilation or over-breathing that does not occur as a result of an underlying pathology. a level 2B study<ref>Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother 2006;52:11–6.</ref> has shown that the presence of respiratory disease such as a breathing pattern disorders is a strong predictor for lower back pain. Stronger than other established risk factors | A breathing pattern disorder is defined as hyperventilation or over-breathing that does not occur as a result of an underlying pathology. a level 2B study<ref name="smith et al">Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother 2006;52:11–6.</ref> has shown that the presence of respiratory disease such as a breathing pattern disorders is a strong predictor for lower back pain. Stronger than other established risk factors | ||
What is defined as a normal breathing pattern:<br>• Abdominal, not chest breathing should initiate inhalation, which then expand outwards during inhalation.<br>• Lifting the chest up while breathing is faulty<br>• Lack of or a upwards lateral lifting pattern is faulty<br>• Paradoxical breathing is faulty<br>• Breathing that has no clavicular grooving formed by chronic chest lifting<br><br> | What is defined as a normal breathing pattern:<br>• Abdominal, not chest breathing should initiate inhalation, which then expand outwards during inhalation.<br>• Lifting the chest up while breathing is faulty<br>• Lack of or a upwards lateral lifting pattern is faulty<br>• Paradoxical breathing is faulty<br>• Breathing that has no clavicular grooving formed by chronic chest lifting<br><br> | ||
Revision as of 21:40, 27 January 2011
Original Editors - Verwichte Jeroen
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
Databases Searched: PubMed
Keywords Searched: breathing pattern disorders, hyperventilation syndrome, low back pain, respiratory alkalosis, diaphragm
Definition/Description[edit | edit source]
A breathing pattern disorder is defined as hyperventilation or over-breathing that does not occur as a result of an underlying pathology. a level 2B study[1] has shown that the presence of respiratory disease such as a breathing pattern disorders is a strong predictor for lower back pain. Stronger than other established risk factors
What is defined as a normal breathing pattern:
• Abdominal, not chest breathing should initiate inhalation, which then expand outwards during inhalation.
• Lifting the chest up while breathing is faulty
• Lack of or a upwards lateral lifting pattern is faulty
• Paradoxical breathing is faulty
• Breathing that has no clavicular grooving formed by chronic chest lifting
Clinically Relevant Anatomy[edit | edit source]
add text here
Epidemiology /Etiology[edit | edit source]
Breathing pattern disorders are because of hormonal influences (progesterone stimulates respiration) female dominated with a female to male ratio ranging from 2:1 to 7:1
Currently, there isn’t a consensus as to the scale of breathing pattern disorders in the general population, but a pilot study [2] examined the relationship between BPD and musceloskeletal pain and showed that 75% of those examined showed faulty breathing patterns. Although interesting, this study has several limitations. It was not designed or intended to be a reliability study. Its methods have no proven reliability. Future research is needed to validate the inter-examiner reliability of the methods of assessing breathing mechanics and the criteria of normal and faulty patterns of respiration. But if this numbers reflect to the general population, there is a 3 in 4 chance that your patient will have faulty breathing patterns.
Biochemical and neurological changes because of BPD.
[edit | edit source]
the biochemical effects of BPD (such as hyperventilation) will lead to systemic respiratory alkalosis. This is characterized by the decrease in CO2 and an increase in pH. This induces vascular constriction, decreasing blood flow, as well as inhibiting transfer from hemoglobin of oxygen, to tissue cells (due to the Bohr Effect). Also there is found to be an altering of the magnesium, calcium and potassium balance. Muscle cells affected in this way will show an interfering with the motor control, normal muscular function and the pain perception.
A study [3]revealed that with Moderate hyperventilation, there will be loss of CO2 ions from neurons which stimulates neuronal activity. This causes for an increase in sensory and motor discharges, muscular tensions and spasms, speeding of spinal reflexes and other sensory disorders.
Research from Seyal et al [4] demonstrated that hyperventilation increased the excitability of the human corticospinal system
Biomechanical effects of BPD and the effects on the low back
[edit | edit source]
Spinal instability occurs when either passive or active stiffness is disturbed.
Muscle behavior alters in conditions of respiratory alkalosis and the bohr effect ensures that both hypoxia and ischemia are more likely. chronic hypoxemia reduces muscle force generation by skeletal muscles and their ability to endure fatigue. It also affects not only the metabolic paths but also changes the gain of sensorimotor reflex loops. Another study [5] found that reoxygenation improved the muscles performance but reduced motor unit recruitment. This all suggests that spinal stability is likely to be compromised by the effects of overbreathing.
BPD also affects the diaphragm wich muscle contraction produces (with participation of the back and abdominal muscles) the intra abdominal pressure that augments the stability of the back during tasks of heavy lifting or extraordinary demands. When a challenge occurs that demands the stabilizing function of the diaphragm at the same time of extraordinary respiratory demands, the diaphragm will choose the respiratory factor over the stabilizing factor, wich compromises the spinal stability.
Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
BPD is diagnosed using physical assessment, a validated questionnaire (the Nijmegen) and a capnometer (measures respiratory Co2 levels)
- Nijmegen questionnaire provides a non-invasive test of high sensitivity (up to 91%) and specificity (up to 95%). a score of 23 out of 64 on the test suggest a positive diagnose of hyperventilation syndrome.
- Capnography have been shown to have a good concurrent validity when compared to arterial CO2 measures and can provide acces to this very important physiological information[6]
Because previous studies of breathing therapy have not included capnography in their research, it’s difficult to say anything about the validity of the device in function of therapy
[7]
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
add text here
Key Research[edit | edit source]
One level 1B RCT [8] studied the effects of breathing therapy on chronic low back patients. Patients improved significantly with breathing therapy. The changes in standard low back pain measures of pain and disability were comparable to those resulting from high-quality, extended physical therapy
There is also a review that describes the relationship between low back pain and breathing pattern disorders[9]. The review states that there is evidence of a weak but statistically significant positive correlation between LBP and respiratory problems. All the studies in this review were cross sectional 2A level cohort studies.
In one case serie [10] of 24 patient with low back or pelvic pain, they all showed an altered respiratory chemistry. Breathing dramatically improved with breathing retraining (all but one reached normal ETCO2 values). 75% of the patients reported improvements in pain, 50% reported improvements in functional activity. These results were both clinically important and statistically significant.
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother 2006;52:11–6.
- ↑ Perri MA, Halford E. Pain and faulty breathing: a pilot study. J Bodyw Mov Ther 2004;8:297–306
- ↑ Lum L. Hyperventilation Syndromes. In: Timmons B, Ley R. (eds) Behavioral and Psychological Approaches to Breathing Disorders. New York: Plenum Press; 1994.
- ↑ Seyal M, Mull B, Gage B. Increased excitability of the human corticospinal system with hyperventilation. Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1998;109(3):263-267
- ↑ Y. Jammes, M. C. Zattara-Hartmann and M. Badier .Functional Consequences of Acute and Chronic Hypoxia on Respiratory and Skeletal Muscles in Mammals. Comparative Biochemistry and Physiology Part A: Physiology, Volume 118, Issue 1, September 1997, Pages 15-22
- ↑ Laurie McLaughlin, Charlie H. Goldsmith, Kimberly Coleman. Breathing evaluation and retraining as an adjunct to manual therapy. Manual therapy, volume 16, Issue 1, pages 51-52
- ↑ J. S. Gravenstein,Michael B. Jaffe,David A. Paulus. Capnography: clinical aspects : carbon dioxide over time and volume. Br. J. Anaesth. (May 2005) 94 (5): 695-696. doi: 10.1093/bja/aei539
- ↑ Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomized, controlled trial of breath therapy for patients with chronic low-back pain, Alternative Therapies in Health and Medicine 2005 Jul-Aug;11(4):44-52
- ↑ Lise Hestbaek, DC,a Charlotte Leboeuf-Yde, DC, MPH, PhD,b and Claus Manniche, DrMedScc . IS LOW BACK PAIN PART OF A GENERAL HEALTH PATTERN OR s IT A SEPARATE AND DISTINCTIVE ENTITY?A CRITICAL LITERATURE REVIEw OF COMORBIDITY WITH LOW BACK PAIN. J Manipulative Physiol Ther. 2003 May;26(4):243-52.
- ↑ Laurie McLaughlin, Charlie H. Goldsmith, Kimberly Coleman. Breathing evaluation and retraining as an adjunct to manual therapy. Manual therapy, volume 16, Issue 1, pages 51-52
