Guest Lecture

Breathing Evaluation and Retraining as an Adjunct to Manual Therapy

Laurie McLaughlin PT, DSc, FCAMT, CMAG

Back and neck pain are extremely common health problems comprising a substantial portion of patients seeking manual therapy treatment. Meta Analyses regarding spinal pain management state that best practice includes manual therapy, education and exercise but suggests there is substantial room for improvement. Epidemiological evidence supports a link between breathing difficulties and back pain. Since trunk muscles perform both postural and breathing functions, it is theorized that disruption in one function can negatively impact the other. Altered breathing mechanics can change respiratory chemistry and therefore pH causing smooth muscle constriction, altered electrolyte balance and decreased tissue oxygenation. These changes can profoundly impact any body system leading to a wide range of possible symptoms. Increased excitability in the muscular and nervous systems may be most relevant to a manual therapist.

Respiratory function can be tested via capnography which measures CO2 at the end of exhale known as End Tidal CO2 or ETCO2. ETCO2 closely reflects arterial CO2 in people with normal cardiopulmonary function. Capnography is used in critical care settings and is considered an accurate, time sensitive arterial CO2 measure.

To investigate breathing as a possible contributor to musculoskeletal pain a pilot study was undertaken. A case series of twenty nine outpatients with neck or back pain who had plateaued with manual therapy and exercise were identified to determine whether poor respiratory chemistry was present and whether biofeedback training could improve chemistry, pain and function. All were found to have low ETCO2. Breathing retraining improved ETCO2, pain and function in all patients with 93% achieving a clinically important change in at least one of the measures of pain or function.

Screening for breathing dysfunction using capnography can be easily integrated into a manual therapy approach providing access to this very relevant physiological information. Incorporating breathing management may improve patient outcomes in those patients where manual therapy, exercise and education do not provide full resolution of symptoms.

Guest Lecture

Breathing Evaluation and Retraining as an Adjunct to Manual Therapy

Laurie McLaughlin PT, DSc, FCAMT, CMAG

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