CHAPTER 8
Importance of Breathing
in Manual Therapy
Introduction
Breathing is the single most important function in the human body. It is one of the central aspects of our whole being. On average, we breathe 20,000 times a day (Priban, 1963). In addition, there is a positive correlation between adequate breathing and good health. Our breathing patterns reflect whether all the systems of our body, including the biomechanical, respiratory and nervous systems, are functioning properly or not (CliftonSmith and Rowley, 2011).
In manual therapy, the breathing cycle of the patient is as important as the force or pressure being employed by the practitioner. Because breathing patterns advocate relaxation responses and improve cognitive states, practitioners of manipulative therapies usually coordinate various techniques with the patient’s breathing, and hence they often ask their patients to take a deep breath in and exhale while applying the techniques. However, although practitioners place a great emphasis on patient’s respiration, the importance of breathing while performing a technique is rarely described in the textbooks and literature of manual therapy.
Therefore, this chapter aims to provide an insight into the importance of breathing while performing manipulative techniques. In addition, this chapter also describes the physiology of breathing, particularly what happens when we inhale and exhale, and the physiological effects of breath-holding.
In physiology, breathing is the process of absorbing oxygen (O2) into our bloodstream and excreting carbon dioxide (CO2) to the atmosphere. Because this process involves the exchanging of gases, it is also known as gas exchange. On an average, we take 12–20 breaths per minute (Barrett, Barman and Boitano, 2010). However, although this whole process may appear to be a simple one, it is actually much more complex.
The Mechanism of Breathing
The mechanism of breathing is complex. Although we can temporarily suppress our breathing, we do not have complete control over it. The respiratory centres located in the pons and medulla oblongata mainly control a person’s breathing rate. These centres send signals to the lungs telling them when to initiate a breath. This control is automatic, spontaneous and involuntary (Shier, Butler and Lewis, 2001).
Breathing mainly involves two phases: inhalation and exhalation.
•Inhalation, also called inspiration, is the process of breathing in oxygen into our lungs. During normal inhalation, the diaphragm, a domed sheet of skeletal muscle that separates the chest from the abdomen, contracts and moves downwards. The diaphragm descends towards the abdominal cavity, ultimately increasing the volume of the chest cavity. The external intercostal muscles also contract during inhalation; as a result, the ribs and sternum move upwards and outwards, expanding the rib cage. This expansion further increases chest volume. The air pressure in the lungs therefore lowers compared with the atmosphere. Since air naturally moves from areas of high pressure to low pressure, this decrease in air pressure eventually draws air into the alveoli of the lungs (Shier et al., 2001; Novotny and Kravitz, 2007).
•Exhalation
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