Breathing pattern disorders and Lumbopelvic pain and Dysfunction

Breathing pattern disorders (BPD) – the most extreme of which is hyperventilation – are surprisingly common in the general population, but more so in women. There is also recognition that pain and dysfunction contribute significantly to altered breathing patterns, so helping to create a reciprocally negative series of adaptations in which pain alters respiration, which in turn amplifies pain.

Premenstrual symptoms (PMS) may be caused directly by hyperventilation (HVS). “

It has been known for more than 100 years that women hyperventilate during the second half of the menstrual cycle. Symptoms of chronic HVS are remarkably similar to the symptoms observed in some women with PMS.… In women with PMS the sensitivity of the respiratory center to CO2 is increased more than normal by progesterone, or some other secretory product of the corpus luteum, resulting in pronounced hyperventilation .” (Ott et al 2006)

Human pregnancy is characterized by significant increased tendency to hyperventilation largely associated, with increased circulating female sex hormone concentrations. (Jensen et al 2008)

Baranes et al (2005) lists myalgia, back pain and muscle cramps, as common symptoms associated with over breathing in children – with the age of onset most commonly between ages 13 and 16.

The pelvic floor and the respiratory diaphragm are, structurally and functionally bound together by fascial, and muscular connections. (Lee et al 2008).

There appears to be a clear connection between respiration and pelvic floor function as well as SIJ stability, an observation that applies particularly in women. (Hodges et al 2007)

Haugstad et al (2006) observed that women with chronic pelvic pain “typically displayed upper chest breathing patterns, with almost no movement of the thorax or the abdominal area”. They also confirmed “a characteristic pattern of standing, sitting, and walking, …..lack of coordination and irregular high costal respiration”… and that “the highest density, and the highest degree of elastic stiffness [was] found in the iliopsoas muscles”.

Rehabilitation

·Diaphragmatic breathing, progressive muscle relaxation, exercise, self-visualization, and self-hypnosis have been shown to be effective in reducing both stress and pain perception. (Whitmore 2002)

Holloway & West (2007) report that breathing rehabilitation (Papworth Method), as part of a randomized controlled trial, involving a sequence of integrated breathing and relaxation exercises focused on BPD (including hyperventilation), led to a clinically relevant improvement in quality of life.

Musnick (2008) has outlined a protocol that places the role of breathing rehabilitation into context, when managing musculoskeletal pain:

1. Reduce the synergistic inputs to the pain process (i.e. modify adaptive demands)

2. Deactivate trigger (or tender) points

3. Remove noxious input from scars

4. Enhance spinal and general joint functionality

5. Improve muscle recruitment, strength, flexibility

6. Pay attention to exacerbating factors in diet, lifestyle and habits (sleep, exercise, posture, balance, breathing)

7. Consider emotional/psychological factors