How movement neurology of the ribcage and diaphragm can help!
If you caught our last newsletter, you may have a better idea about how the vestibular system can contribute to increased tone around the spinal musculature and potentially increase the workload of the lower limbs. One of the main reasons behind this, is that the vestibular system is a CONSTANT sensory system. This means that it is always feeding information back to the brain, and so it has more impact on the tone held in the muscles throughout the body, particularly around the spine. But from a bottom-up standpoint, what else delivers a pretty continuous stream of feedback to the brain? Breathing! Breathing/respiration is much more than just a process that helps us oxygenate our tissues, but the feedback through the stretching of the rib cage, diaphragm, and all the muscles that attach to the rib cage is crucial to help our brain localize our midline in space. Remember, our brain is in a little black cave, and so the only way it has access to the outside world is through sensory feedback. We are far too quick to prescribe “core stability” training for individuals with back pain, when we should really think about the quality of the feedback from all these tissues that should move so much throughout the day/night. Are we really moving them enough? Do we leverage breathing in a way to allow these peripheral tissues to give better feedback to the nervous system before we add more load/challenge? Maybe not.
Back pain & tightness is a very common experience for our clients. During our assessment, we may feel/observe high levels of tone in the paraspinal muscles that doesn’t seem to shift despite manual therapy, needling, or stretching. There are of course many potential reasons for this, but one that we may not have integrated clinically is the ability for the rib cage to move freely in many directions and allow all the peripheral tissues that connect to it to experience “load.” Loading those tissues with movement helps deliver that much needed feedback to the nervous system.
So, what happens when we breathe? The diaphragm is a muscle just like any other muscle in our body. We all love to do mobility work and take our joints and muscles through their full range of motion, but what about the diaphragm and rib cage? Where’s the love for these guys?
From applied neuroscience research, the diaphragm has very few mechanoreceptors, which are the neural receptors that tell the brain what’s happening in our peripheral tissues. The intercostal muscles that surround the rib cage, however, are loaded with mechanoreceptors. So, the excursion of the diaphragm is heavily influenced by what the rib cage is doing. In the attached study, we can also see how individuals with low back pain have much less rib cage movement during postural tasks than those without pain. To keep things very simple, as we inhale, our rib cage should elevate while the diaphragm contracts and descends. As we exhale, our rib cage should depress to allow our diaphragm to ascend/relax. Yes, the rib cage needs to move. Only breathing through your belly won’t allow you to experience that lovely load through those rib cage tissues. But, what happens to the spinal muscles throughout this process? As we inhale and the ribs elevate, the paraspinal muscles will shorten, and as we exhale, they can lengthen and experience load. But, do we really train our rib cage to go through this full range of motion to allow for this unloading and loading of tissues along our posterior spine? What if that increased muscle tone is there because we are not exhaling all the way, and therefore not allowing the diaphragm to relax? Very often, we find clients are unable to exhale efficiently. As a result, their diaphragm may have a difficult time relaxing, and once again, what we may see is an increase in paraspinal muscle tone. Your ability to RELAX muscles is A LOT more important that your ability to “activate” them.
This, of course, is just one piece of the puzzle. But remember, you breathe 23,000 + times per day, so if you don’t allow these tissues to experience load through movement, then it may have a bigger influence over the tone throughout your spinal muscles compared to their “core stability,” which research shows is really not all that important. So, we would like to take you through one of MANY ways to see if your client has the ability to take diaphragm/rib cage through a full-ish range of motion. We have to remember, the rib cage is very complex, so we’ve got to keep it simple to help guide our rehabilitation.
With your client in supine (knees extended), have your client take a few gentle breaths in and out. Don’t worry about where they are breathing from initially. Place both of their hands on the lower rib cage in the front on both sides. Our goal with this is to see are they able to EXHALE fully and SLOWLY. This essentially allows us to assess whether the diaphragm can relax fully (ascend). There’s no set time that they should be able to exhale for, but we recommend starting with a 6 second exhale.
Have them take a big breath in, and a long and slow breath out for 6 seconds. Have them use their hands to help pull the rib cage down to encourage the relaxation of the diaphragm during the exhale.
You’re looking for:
1.) Do they have back pain while doing this? If so, you can bend the knees and re-assess.
2.) Do they struggle to exhale slowly and fully for 6 seconds? Indicates poor ability for the rib cage to go through its full excursion and the diaphragm to relax
3.) If they can exhale fully, can they hold for 1-2 seconds at the end range? Gives you a general insight into how comfortable they feel with the diaphragm fully relaxed.
If the client has back pain or tension, and they have a difficult time completing this task, then it is certainly worthwhile to integrate this as part of their rehabilitation. Of course, there are many ways to integrate this and we will share more insights in the coming weeks!