Asthma is an inflammatory condition of the lungs and is usually characterised by a cough, wheeze, chest tightness and difficulty in breathing. It is often put down to an over sensitivity of the airways to a range of stimuli, including dust, dust-mites, pollen, fungal spores, pollutants, vapours and fumes, cold air, exercise and sometimes emotional upset.
The role of the musculoskeletal system in maintaining and exacerbating this condition is not often talked about, but can also be an important factor. Effective breathing relies on having full movement in the area known as the thoracic cage or thorax.
The bony thorax is made up of:
• the twelve pairs of ribs
• the twelve thoracic vertebrae, which form the backbone of the midback
• the breast bone (or sternum), which joins the upper ribs together at the front of the chest
When put together these components form a cage shape. The joints between the ribs and the thoracic vertebrae at the back, and between the ribs and the breast bone at the front, must be able to move freely within their normal range in order to allow maximum chest expansion when we breathe.
When we take a breath, we do so using the intercostal muscles between the ribs and the large, dome shaped diaphragm muscle, which fills the entire space at the floor of the thoracic cage. But we also recruit a large number of other muscles in our chest, back, abdomen and especially in the neck and shoulder region.
People with asthma often overuse the muscles in their neck, back and shoulder regions as they struggle to take a deep breath. If they are continually overused, these muscles can become tight and shortened and in turn they can restrict the movements of the bony thorax. As everything gets tighter the work of breathing increases, requiring even more effort to breathe. What is more, as the respiratory muscles shorten they are thought to send signals to the brain, which increase the sense of breathlessness. Factors such as stress, excessive computer use, driving and drinking too much caffeine can also shorten these muscles, compounding the situation for the individual.
If expansion of the rib cage is restricted over time, breathing can tend to become shallow and concentrated in the area of the upper chest, and this in turns means the breathing rate has to increase to compensate. When we shallow breathe quickly we may blow off excessive amounts of carbon dioxide, which can make the lung tissues excessively alkaline and lead to earlier exhaustion of our breathing muscles.
It therefore becomes clear that having a mobile bony thorax, and long, elastic and well functioning respiratory muscles is essential to all of us if we are to breathe efficiently. For asthmatics, this is even more crucial in order to prevent musculoskeletal restrictions from exacerbating and prolonging their condition.
- aims to improve the mobility of the bony thorax through gentle articulation and stretching of the ribs and thoracic spine
- relases specific joint restriction
- relaxes the diaphragm and lengthens the other respiratory muscles to improve their function
- aims to improve compliance or "stretchability" of the chest wall to reduce the workload of breathing
The osteopath will also offer advice and breathing exercises which can help to manage the condition in the long term. Treatment can be adapted for patients of any age, from very young children showing first signs of asthma, to frail and elderly patients experiencing breathing difficulties.
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