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11 August 2012 1 Comment

Clinical Application of breathing and lumbar stability

Below are clinical applications of last week’s blog where we discussed functional anatomy of the diaphragm in lumbar stability and mobility. Enjoy!

Clinical application

During clinical treatment, emphasis should be on relieving fascial tension in the diaphragm and its surrounding structures. Over time treatment should result in healthy tissue changes within diaphragm, and unlocking of the upper lumbar segments.

When treating I use a 4 step approach:

  1. Treat the diaphragm as both a left and right diaphragm. Treat the diaphragm in an unloaded position first (less influence of gravity and posture).
  2. Always be sure to address lumbar segments L1- L3 during treatment. One or more of these segments may not be moving well.
  3. Be sure the diaphragm is in a correct postural position during treatment. Applying techniques with a patient in a dysfunctional position will decrease the effectiveness of your treatment.
  4. Be sure to coach correct breathing mechanics. This will allow for adequate contraction of the diaphragm, allowing for a more even distribution of tension throughout the muscle.

 

Rehabilitation

To reinforce an adequate amount of stability by the diaphragm on the lumbar spine the therapist should coach a full contraction and relaxation of the muscle. This allows maximal dynamic restraint of the crus tendon, and adequate mobility of the upper lumbar segments. For this to occur correct breathing mechanics should be coached, as it will minimize influence of secondary respiratory muscular.

To enhance function of the diaphragm:

  1. Keep the neck in a neutral position
  2. Breathe in the through the nose and out through the mouth
  3. Keep the ribs down (towards the spine), this will allow for a more forceful breath through the diaphragm
  4. Keep the lumbar spine in a neutral position

Remember if the diaphragm is engaged correctly it will exert a significant force on the lumbar spine. Without the ability of the patient to maintain a neutral spine during breathing they are unable to progress to more advanced stages of exercise.

 

References

•Bogduk N, Percy M, Hadfield G. Anatomy and Biomechanics of Psoas Major. Clinical Biomechanics. 1992; 7:109-119

•Dianbo C, Wei L,  Bolduc JP, Deslauriers J. Correlative Anatomy of the Diaphragm. Thorac Surg Clin. 2011; 21(2);281-87

•DiGiovanna E, Schiowtiz S, Dowling D. An Osteopathic Approach to Diagnosis and Treatment. Lippincott Williams & Wilkins. Philadelphia, PA. 2005

•Downey R. Anatomy of a Normal Diaphragm. Thorac Surg Clin. 2011;21(2):273-79

•Kapanji AI. The Physiology of Joints – The Spinal Column, Pelvic Girdle and Head. Churchill Livingstone. Toronto, ON. 2008

•Myers T. Anatomy Trains. Churchill Livingstone. Toronto, ON. 2009

•Schultz R, Feitis R. The Endless Web – Fascial Anatomy and Physical Reality. North Atlantic Books. Berkley, CA. 1996.

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