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SUMMARY are integral to the generation of core the grocery bags as they continue
stability. It is estimated that 10% of the to breathe.
MANY FITNESS AND REHABILITA-
population suffers from dysfunctional Maintaining neutral spine during
TION EXPERTS WOULD AGREE
breathing patterns; these percentages activity is believed to preserve the
THAT DIAPHRAGMATIC BREATH-
jump to 30% among asthma sufferers integrity of the spine and protect vary-
ING IS THE MOST FUNDAMENTAL
and 83% in those suffering from anxi- ing structures from injury (24,25,30,38).
DEMONSTRATION OF CORE
ety (7), creating a need for strength and According to Panjabi (30) 3 subsystems
FUNCTION. AS SUCH, ONCE
conditioning professionals to be able work together to maintain this integ-
PROPER BREATHING PATTERNS
to assess and help improve breathing rity, the central nervous subsystem
ARE ESTABLISHED, CLIENTS WILL
pattern function. This article will (control), the skeletal subsystem (pas-
HAVE A SOLID FOUNDATION TO
investigate the influence that upper- sive), and the muscular subsystem
FURTHER DEVELOP CORE FUNC-
chest and/or quick breathing patterns (active). The Panjabi model suggests
TION. IF WE CONSIDER THE
may have on core stability and will that dysfunction of any one subsystem
NOTION THAT BREATHING IS A
suggest basic breathing assessment will compromise stability and poten-
FUNDAMENTAL COMPETENCY OF
methods and breathing retraining tially cause back pain (30). Addition-
CORE STABILITY, WE MUST BE ally, a dysfunction in any component
ideas.
CERTAIN THAT BREATHING PAT- of any subsystem can lead to compen-
TERNS ARE HEALTHY BEFORE According to Kibler et al. (17), core
sation from other systems, long-term
PROGRESSING OUR CLIENTS TO stability is the ability to control the
adaptation by one or more subsystem
MORE ADVANCED CORE EXER- position and motion of the trunk over
or injury to one or more components of
CISES. THIS ARTICLE WILL REVIEW the pelvis to allow optimum produc-
any subsystem. In effect, stability of the
THE CONCEPT OF CORE STABIL- tion, transfer, and control of force and spine is not only reliant on muscular
ITY AND DISCUSS THE ROLE OF motion to the terminal segment in strength but proper sensory input to
PROPER RESPIRATORY MECHAN- integrated athletic activities. In other the central nervous system. Methods
ICS ON CORE FUNCTION. words, proximal stability sets the stage of training for core stability should
for distal mobility. As stated by Cook therefore consider protection of the
(6), “The best core training programs passive structures of the spine, optimi-
INTRODUCTION require the spine to be held in a natural zation of motor control, and improving
ore stability training has or neutral position while breathing and muscular strength and endurance. This
34 VOLUME 34 | NUMBER 5 | OCTOBER 2012 Copyright Ó National Strength and Conditioning Association
breathing patterns can be disruptive to a negative pressure in the thoracic O’Sullivan and Beale (28) studied sub-
the muscular and control subsystems. cavity that forces air into the lungs jects with LBP attributed to the sacro-
These influences suggest that breathing while increasing pressure in the iliac joints and compared them with
in a more diaphragmatic manner may abdominal cavity. control subjects without pain. By com-
be an ideal pathway to effective trunk paring respiratory rate and diaphragm
stability training. The first part of this and pelvic floor movement using real-
article will explore how the diaphragm DUAL ROLE OF THE DIAPHRAGM: time ultrasound during a task that
contributes to posture and core stabil- RESPIRATION AND POSTURAL
required load transfer through the lum-
STABILIZATION
ity; the second part will discuss how bopelvic region (the active straight leg
Lewit (22) suggests that if healthy
adaptations in breathing patterns and raise test), he noted that participants
breathing patterns are not in place,
posture are thought to challenge the with pain had an increase in respiratory
then no other movement pattern can
stability of the core. rate, descent of their pelvic floor, and
be. He believed that if an individual did
a decrease in diaphragm excursion
not demonstrate proper breathing pat-
PART I: LOCAL MUSCLES OF THE compared with the control subjects
CORE terns, the diaphragm likely lacked the
coordination, endurance, and strength who had normal respiratory rates, less
Bergmark and Richardson referred to pelvic floor descent, and optimal dia-
to function in its role of a postural
the core by describing local and phragm excursion. Roussel et al. (35)
stabilizer. Based on Lewit’s work,
global units (1,33). The local muscles have had similar findings, discovering
breathing may well be considered
are viewed as lying deep or possessing that more than half of patients with
a competency in which further move-
deep components that attach to the chronic nonspecific LBP exhibited
spine. The local muscles are believed ment development is based upon, and
developing efficient breathing patterns altered breathing patterns during per-
to brace vulnerable spinal structures formances in which core stability is
thereby allowing superficial global should be prioritized.
challenged.
muscles to perform acts such as Although early research by Hodges
walking and lifting. The local unit placed special relevance on the TrA According to McGill (23), a core sta-
model suggests the transversus ab- in core stability, more recent research bility exercise can be defined as “any
dominus muscle (TrA) forms the walls by Hodges suggests that the inner unit exercise that channels motor patterns
of a cylinder while the muscles of the is a dynamic system and seems to to ensure a stable spine through repe-
pelvic floor and diaphragm form its rely on the integration of the pelvic tition.” One might think of “repetition”
base and lid (33). This cylinder floor, TrA, diaphragm, and multifidus as arm or leg movement while holding
of compression influences intra- (11,13,37). Kolar et al. (21) have discov- neutral; however, in the beginning
abdominal pressure (IAP) that is ered significant involvement in the dia- phases of core development, we could
thought to contribute to spinal stabil- phragm during limb movements. also interpret “repetition” as the dia-
ity (11–13,21). The diaphragm is actu- Another study by Kolar demonstrated phragmatic excursion during breath-
ally 2 separate muscles, the right and a connection between back pain, core ing. McGill noted a reduction in the
left hemidiaphragms, which together function, and diaphragm function. He support offered to the spine if there is
resemble a dome. The diaphragm’s examined 18 patients with chronic low both a load challenge to the low back
costal attachments are on the inner back pain (LBP) and 29 without LBP. combined with a breathing challenge
surface of the lower 6 ribs and the Measurements during tidal breathing as in the case of an individual shoveling
sternal attachment on the ziphoid and isometric flexion of the upper snow (26), postulating that the “mod-
process. The right hemidiaphragm’s and lower extremities against external ulation of muscle activity needed to
lumbar attachment is on the anterior resistance with tidal breathing were facilitate breathing may compromise
portions of L1-L3, whereas the left performed. He noted that those in the margin of safety of tissues that
hemidiaphragm’s lumbar attachment the LBP group had smaller diaphragm depend on constant muscle activity
is on the anterior portions of L1-L2. excursions and higher diaphragm for support.” In other words, the body
Upon inhalation, the diaphragm con- position (20). The researchers stated, will prioritize breathing over stabiliza-
tracts, the dome flattens and moves “The respiratory movement of the dia- tion. This presents a risk to less fit
downward into the abdominal cavity. phragm is synchronized with its stabi- motor systems resulting in a high
During this contraction, the fibers of lization function. Dysfunction of this degree of variability in stability and
the diaphragm, which attach onto synchronization in people with weak could result in temporary losses in stiff-
the lower ribs, create a horizontal body stabilizing function of the dia- ness. However, those with fit motor
expansion. The plunger-like action of phragm leads to overloading of spinal systems seem to meet the simultaneous
the diaphragm, combined with the segments.” This suggests that insuffi- breathing and spine stability challenge
resistance created by the pelvic floor cient and uncoordinated diaphragm with less variance of stability. Hodges
and an eccentric contraction of the activation can compromise the stability et al. (13) discovered similar findings,
entire abdominal wall, creates of the spine. noting a reduction of postural activity
of the diaphragm when respiration varied causation of dysfunctional sensitization (3,38), the result of which
demand is increased. He hypothesized breathing, most patterns present in can alter motor control and ultimately
that during strenuous exercise when the same fashion. These patterns spinal stability (28,29). Dysfunctional
breathing is labored, spinal control will include increased breathing frequency breathing is also known to adversely
be compromised, which could lead to and chest breathing. It is important to affect postural balance and propriocep-
increased potential for injury to spinal note that these patterns are not exclu- tive function of the lower limbs (16).
structures and reduced postural con- sive of each other, as an individual may Other complications resulting from
trol. Much is still unknown regarding display more than one pattern at quick breathing include changes in
the cause/effect relationship of breath- a given time. These breathing patterns magnesium, calcium, and potassium
ing and postural stability, but it is pos- can be seen by simply observing tho- levels, which can also interfere with
sible that optimal breathing patterns racic and/or abdominal movement, the motor control mechanisms that
can improve the diaphragm’s postural upper-thoracic muscle activity, and govern the core.
stabilizing capacity, allowing individu- duration of inhalation and exhalation.
als to extend activity and intensify Increased and/or over breathing in
training while limiting the loss of core POSTURE AND BREATHING
extreme cases is referred to as hyper- Postural adaptation has been linked to
stability. ventilation and is closely associated breathing dysfunction (5,8,22,38).
PART II: DYSFUNCTIONAL with anxiety and apprehension (18). Breathing influences muscular function
BREATHING PATTERNS Stress tends to exacerbate quick and and posture because the habitual use of
Although breathing is regulated and upper-chest breathing patterns and breathing muscles during respiration
coordinated by the autonomic nervous can indicate a general dysfunction of affects how these muscles are used for
system, proper breathing is not auto- an individual’s ability to alternate nonbreathing movement and postural
matic. Physical, chemical, and emo- between heightened activity levels support (7). The reverse is also true
tional factors can alter the rate and and rest periods, limiting full recovery whereby everyday posture affects the
volume of the breath (4,7) and cause before resumption of activity. Recalling habitual use of the breathing muscles.
breathing pattern problems. Recalling that respiration is prioritized over spine As stated by Sahrmann (36), “repeated
Panjabi’s model, the body will compen- stabilization, stressed clients who are movements and sustained alignments
sate for these factors and create varying prone to poor breathing patterns can associated with everyday activities are
pathways to keep up with respiratory be at risk for losing the protective trunk the inducers of tissue adaptations.”
demands by either involving the upper- stabilization efforts of the diaphragm. Sahrmann posits that when everyday
chest accessory muscles or by quicken- Ironically enough, good breathing activities involve repeated movements
ing the rate of the breath. This is a com- patterns can be an effective tool indi- in a specific direction, the movement in
pletely normal adaptive response if an viduals can use to manage stress, there- that direction occurs more readily and
athlete is running; however, problems fore it should be encouraged during easily because of tissue changes. Fur-
may arise if the athlete cannot recover stressful times (4,7,34). thermore, once a joint develops a ten-
to a slower more diaphragmatic One of the major problems with a rapid dency to move easily and readily in
method of breathing during rest. Like- breathing pattern is the affect it has on a direction, that movement will occur
wise, if the athlete demonstrates a chest the body’s pH. Blood pH is tightly with all activities involving that joint
or quick breathing pattern at rest, it can regulated by a system of buffers that and not just the one that induced the
create further adaptive and dysfunc- continuously maintain it in a normal joint changes. If we apply this logic to
tional patterning when the respiratory range of 7.35–7.45 (slightly alkaline). chest dominant breathers, the sterno-
system is subsequently challenged. If Breathing at an increased rate increases cleidomastoid muscles, upper traps,
this is the case, the faulty breathing the amount of carbon dioxide exhaled, and pectoral muscles shorten creating
pattern may perpetuate on a subcorti- which can lead to alkalosis (elevated an overly kyphotic and forward head
cal level and lead to an ingrained motor pH). During respiratory alkalosis, red posture. This suboptimal posture has
program, even when the initial trigger blood cells bind more tightly to the a destabilizing effect on the trunk
no longer exists (7). In other words, oxygen they are carrying, which (21,22,24,30). It will probably never
breathing patterns, much like any other decreases the amount of blood getting be clear which came first, the breathing
motor pattern, can become a habit to the brain and muscles (the Bohr pattern problem or the posture prob-
whether it is healthy or not. effect). Additionally, less oxygen is lem. Regardless, both need to be ad-
Given the complex nature of breathing released by the blood. Lack of ade- dressed to optimize core stability and
problems, there is no gold standard quate blood supply creates a cascade overall performance (3,4).
definition of dysfunctional breathing, of events such as increased muscle ten- A study by Obayashi et al. (27) illus-
and it is often broadly described as dis- sion, reduced motor control (40) per- trates how posture and respiration
turbances in breathing functionality petuation of trigger points, increased influence one another. Subjects
that impact heath (7). Despite the muscle spasm, and increased pain breathed into a SpiroTiger (Autospiro
Table 1
Local and global muscles
Global muscles—prone to shortness/tightness Local muscles—prone to lengthen/weakness
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