In last month's column, I introduced you to a new videotape series by Robert Acland of the University of Louisville. His discussion of the muscles of respiration is fascinating and revealing, particularly because the function of respiration is often ignored clinically when in fact it is one of the most important perpetuating factors of repetitive strain to the cervical or lumbar spine. Treating the rib dysfunction and myofascial component is bound to fail if the real problem is in faulty respiration. Overactivation of the scalenes during inspiration results in upper-rib dysfunction and trigger points.
Management is incomplete unless normal diaphragmatic breathing is re-educated.
Acland shows how inhalation occurs when the diaphragm contracts and moves inferiorly, thus increasing the volume of the pleural cavity. The lungs expand to fill the available space. Normal, quiet inspiration is visualized by the abdominal wall slightly protruding out as the abdominal contents are pushed forward to make room for the diaphragm. The rectus abdominus, transverse abdominus, internal oblique, and external oblique muscles are all involved in forced exhalation, such as with coughing or sneezing. Faulty respiration not only leads to cervical problems, but compromises a patient's ability to stabilize their low back during lifting tasks.