Breathing retraining and manual therapy for long COVID – A literature review

Improvements in multi-dimensional measures of dysfunctional breathing in asthma patients after a combined manual therapy and breathing retraining protocol: a case series report

Purpose: Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Methods: Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n = 30) or breathing retraining plus MT (intervention; n = 30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. Results: At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p = 0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p = 0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (−1.1, 6.6) p = 0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance). Conclusion: Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.Implications for RehabilitationDysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources.Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB.However, the results of this study suggest that MT provides no further benefit and cannot be recommended in the clinical management of this condition.

The effect of osteopathic manual therapy with breathing retraining on cardiac autonomic measures and breathing symptoms scores: A randomised wait-list controlled trial

The effects on pulmonary function tests and exercise tolerance of resistive breathing training (RBT) were assessed in 16 subjects with stable chronic obstructive pulmonary disease (COPD) who had received no benefit from previous programs of breathing retraining (BR) and medical therapy (MT). 16 male patients with mild degree stable COPD underwent detailed evaluation of pulmonary function tests, blood gas analysis and exercise tolerance test before and after a monthly program of RBT. The patients had received no physiological effects from previous monthly programs of BR and MT. No change in pulmonary function tests, blood gas analysis and exercise tolerance test was observed after RBT. Only maximal static expiratory pressure increased significantly after RBT. We conclude that RBT does not improve pulmonary function tests in subjects who received no physiological benefit from BR.

Breathing pattern disorders (BPD) are frequently observed in adolescents, often resulting frompostural alterations. Suboptimal posture, particularly forward head posture, thoracic kyphosis, andmuscle imbalances, can impair normal respiratory mechanics, leading to dysfunctional breathingpatterns. This literature review examines the relationship between postural alterations and BPD inadolescents, synthesizing key research findings, assessment methodologies, and potentialinterventions. Studies indicate that postural education, breathing retraining, exercise-basedinterventions, and manual therapy can effectively ameliorate respiratory function and posturalalignment. Further research is warranted to develop standardized interventions for managing BPDin adolescents.

Nonpharmacological Interventions for Dysfunctional Breathing in Adults: A Systematic Review.

Hyperventilation (hv) is increasingly recognized as being significant in a number of psychological and medical conditions. The core of treatment for hv is breathing retraining, usually on an individual basis. This article describes a group therapy for breathing retraining for patients with hv-induced panic reactions. An analysis of group process suggests that such treatment is helpful in ways impossible for individual retraining and that further exploration of this modality is warranted.

Breathing evaluation and retraining as an adjunct to manual therapy

<b>Background:</b> Paradoxical vocal cord dysfunction (pVCD) is a debilitating condition caused by inappropriate vocal cord motion. Exercise testing with laryngoscopy followed by therapy is the accepted management of adults with pVCD but little evidence is available on the use of this method with children. <b>Aim:</b> To determine the efficacy of pre and post exercise flexible awake laryngoscopy in the diagnosis and treatment of children with paradoxical vocal cord dysfunction (pVCD). <b>Methods:</b> 10 boys and 5 girls with a provisional diagnosis of pVCD were assessed in a specialist multidisciplinary environment. Each child underwent an awake flexible fibreoptic laryngoscopy before and after a treadmill based exercise test to trigger an acute episode. Treatment involved breathing retraining and other associated techniques delivered by an experienced physiotherapist. <b>Results:</b> All patients tolerated the procedure well and 11 of the 15 children had abnormal cord motion post exercise (73%). 3 of these children also had abnormal cord motion at rest prior to exercise(27%). 12 chose to undertake a course of treatment. 7 children completed the course of treatment, 2 didn9t attend for treatment and 3 are on the waiting list. Using the PedsQL health related quality of life (QoL) measure, 80% of children and 100% of parents reported a significant improvement in QoL. Mean QoL scores for children and parents improved by 10 points. Post treatment, all children were either asymptomatic or experiencing minor symptoms which did not limit their activity. <b>Conclusion:</b> Exercise laryngoscopy is a well tolerated and effective means of diagnosing pVCD. When the diagnosis is made, response to breathing retraining therapy is excellent.

Breathing evaluation and retraining in manual therapy

23. Functional Impact of Pelvic Floor Physical Therapy on Adolescents with Biopsy Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series

CSM 2014 Sports Physical Therapy Section Poster Presentations (Abstracts SPO1228–SPO1309, SPO6761)

Acute effects of rearfoot manipulation on dynamic standing balance in healthy individuals

Background:Associative learning is the theory that two stimuli can be paired to produce similar behavioral responses. In this model, a previously innocuous stimulus can become paired with a noxious stimulus to a point that this previously innocuous stimulus can result in the perception of pain.Objectives:This review discusses concepts related to neural activation and structural alterations in the presence of both chronic pain and post-traumatic stress disorder (PTSD). The role of associative learning and protective memory-based behavioral responses in the perception of pain is explored to provide a framework to inform clinical management of individuals with chronic pain and will be linked to the presence of actual or perceived threat or fear.Major Findings:Current research demonstrates that in individuals with chronic pain, cortical and subcortical processing of information shifts from normal nocioceptive processing areas to the medial prefrontal, anterior cingulate, and insular cortices, as well as the hippocampus (Hip) regions, all of which also show dysregulation, signs of gray matter atrophy, and changes in epigenetic coding. Because these regions are involved in memory, emotional processing, learning, and conditioning, it is reasonable to suggest that associative learning may be involved in the processing of both pain and PTSD.Conclusions:Clinically, rehabilitation paradigms that incorporate early intervention, positive expectation, therapeutic neuroscience education, visual imagery, movement retraining, and manual therapy all have the potential to change not only pain behavior but also the neural circuitry, epigenetic coding, and cortical morphology underlying chronic pain.

HISTORY: 19 year old male with a long history of shortness of breath on exertion. States that since childhood he has had inspiratory wheezing and tightness in chest with exertion, but he was told he would outgrow it. More recently, he has noted that it has worsened with maximal exertion during military training. He states that he is unable to run all out once around the track without experiencing inspiratory difficulty with gasping. It takes about 10 minutes for him to recover. If he resumes exercise it will recur. Asthma inhalers have not helped. Episodes are associated with pain and dysphagia. PHYSICAL EXAMINATION: Laryngeal examination shows that there is reduced abduction of the vocal folds, with a maximum glottic space of about 6 mm. During high ventilatory output tasks there is evidence of paradoxical movement of the vocal folds, most prominently on inspiration, resulting in shortness of breath, and loud stridor on inspiration. Cardiac: RRR, without murmur Lungs: Clear to Auscultation bilaterally"at rest", Loud inspiratory stridor during “high ventilation”.MSK: Significant muscle tension dyspnea, an inefficient breathing pattern with an upper torso / clavicular breathing, and hyperfunction of strap muscles. DIFFERENTIAL DIAGNOSIS:- Hypertrophic Obstructive Cardiomyopathy (HOCM)- Asthma- Exercise-Induced Bronchoconstricion (EIB)- Exercise-Induced Laryngeal Obstruction (EILO)- Exercise-Induced Anaphylaxis (EIA) TEST AND RESULTS: Cardiopulmonary Exercist Test (CPET): negative. Spirometry with methacholine challenge: negative. Laryngeal function Study: videoendoscopy with stroboscopy revealed reduced abduction of the vocal folds. During high ventilatory provocative challenge, there was evidence of paradoxical movement of the vocal folds, most prominently on inspiration, resulting in shortness of breath, and loud stridor on inspiration. FINAL/WORKING DIAGNOSIS: Exercise-Induced Laryngeal Obstruction (EILO) Patient has developed poor breathing patterns with reduced bilateral vocal fold abduction. TREATMENT AND OUTCOMES: Breathing Retraining Therapy (4-6 sessions). Patient report significant improvement in symptoms after 2nd session, and complete resolution of symptoms following the 5th session. Remaining symptom free for 4 months.