Table Of ContentRecognizing and Treating Breathing Disorders
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Recognizing and Treating
Breathing Disorders:
a multidisciplinary approach
Second edition
Leon Chaitow ND DO
Registered Osteopathic Practitioner and Honorary Fellow, School of Life Sciences, University of West-
minster, London, UK
Dinah Bradley DipPhys NZRP MNZSP
Private Consultant, Respiratory Physiotherapist, Breathing Works, Remuera, Auckland, New Zealand
Christopher Gilbert PhD
Psychologist, Chronic Pain Management Program, Kaiser Permanente Medical Center, San Francisco,
California, USA
With contributions by
Jim Bartley John C. Hannon Warrick McNeill
Petr Bitnar Gro K. Haugstad Suzanne Scott
Aileen Chan Tor S. Haugstad Nilkamal Singh
Tania Clifton-Smith Alena Kobesova Shirley Telles
Rosalba Courtney Pavel Kolar Petra Valouchova
Jan van Dixhoorn Laurie McLaughlin Eva Au Zveglic
Foreword by
David Peters MB ChB DRCOG, DM SMed MF Hom FLCOM, Clinical Director, Faculty of Science and
Technology, University of Westminster, London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2014
© 2014 Elsevier Ltd. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
First edition 2002
Second edition 2014
ISBN 978-0-7020-4980-4
e-book ISBN: 978-0-7020-5427-3
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds, or experiments described herein. In using such information or methods
they should be mindful of their own safety and the safety of others, including parties for whom they have a
professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications.
It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability
for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or
from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
The
publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in China
Contributors
Jim Bartley, FRACS, FFPMANZCA Alena Kobesova, MD, PhD
Associate Professor, Department of Surgery, Assistant Academic Director, Lecturer, Clinic of Rehabilitation
University of Auckland, Auckland, New Zealand and Sports Medicine, 2nd Faculty of Medicine, Charles
University, University Hospital Motol, Prague, Czech Republic
Petr Bitnar, DPT
Lecturer, Clinic of Rehabilitation and Sports Medicine, 2nd Pavel Kolar, PaedDr., PhD
Faculty of Medicine, Charles University, University Hospital Director, Clinic of Rehabilitation and Sports Medicine, 2nd
Motol, Prague, Czech Republic Faculty of Medicine, Charles University, University Hospital
Motol, Prague, Czech Republic
Aileen Chan, RN, RM, BSc, PGDip(HIM),
MHA, PhD Laurie McLaughlin, PT, DSc, FCAMPT, CMAG
Assistant Professor, The Nethersole School of Nursing, The Owner and Director, ProActive Education, Oakville, ON,
Chinese University of Hong Kong, Shatin, Hong Kong Canada
Tania Clifton-Smith, NZ Dip Phys MNZSP NZMTA Warrick McNeill, MCSP
ITEC (Lon) Chartered Physiotherapist, Physioworks Chartered
Director, Breathing Works, Auckland, New Zealand Physiotherapists and Pilates Clinic, London, UK
Rosalba Courtney, ND, DO, PhD Suzanne Scott, MA (Cantab), BSc
Osteopath, Breath and Body Clinic, Breathing Therapy and Suzanne Scott Pilates and Movement Practice,
Integrative Medicine, Avalon, NSW, Australia The Scott Studio, Castle Cary, Somerset, UK
Jan van Dixhoorn, MD, PhD Nilkamal Singh, MD, PhD
Center for Breathing Therapy, Amersfoort, Netherlands Patanjali Research Foundation, India
John C. Hannon, DC Shirley Telles, MBBS, PhD
Certified Feldenkrais® Practitioner, Private Practice, Patanjali Research Foundation, Patanjali Yogpeeth, Haridwar,
San Luis Obispo, CA, USA Uttarakhand 249405, India
Gro K. Haugstad, MHS, PhD Petra Valouchova, DPT, PhD
Oslo and Akershus University College, Institute of Lecturer, Clinic of Rehabilitation and Sports Medicine, 2nd
Physiotherapy, Faculty of Health Science, Norway Faculty of Medicine, Charles University, University Hospital
Motol, Prague, Czech Republic
Tor S. Haugstad, MD, PhD
Sunnaas National Rehabilitation Hospital, Dept of Eva Au Zveglic, BApplSci (Phty), MSc,
Neurorehabilitation, Oslo, Norway MBBA, MCSP
Lead Cardiothoracic Physiotherapist,
BUPA Cromwell Hospital, London, UK
vii
Foreword
As you have opened this book, you are probably a practitioner. Perhaps you
have already come to rely on the previous version and are keen to get up to date.
Welcome – you will not be disappointed. Or maybe something has made you curious
about breathing and its power to support wellbeing, or on the other hand to send
health into a tailspin. In which case prepare to have your clinical world expanded,
for this is far more than a book about breathing pattern disorders. At its heart is a
profoundly holistic approach to illness and disease as processes of adaptation, com-
pensation and their failure. It is a book about making sense of that journey and
getting it back on course.
21st Century medicine faces a pandemic of chronic, environmental-, stress- and
lifestyle- mediated diseases. There is some urgency then for it to learn at least as
much about building resilience as it has about ‘fighting’ disease. The editors and
their expert authors shine some light on what that could mean in practical terms to
clinicians, whatever their orientation. Indeed it is the breadth of this book that
astonishes; inviting readers to make their own synthesis, it brings together views
from diverse fields. Which of course it must, because breathing pattern disorders are
whole person problems. And especially so in long-term conditions, where dysfunc-
tional breathing can destabilise mind and muscles, mood and metabolism.
So it is a great loss to medicine that most doctors have yet to take this in.
But sadder still is the bewilderment of so many patients; especially patients
with complex long term conditions, co-morbidities, or perhaps most of all who
have ‘MUS’. Medically unexplained symptoms often become that much more expli-
cable once the vicious mind-body cycle of over-breathing is understood. Leon
Chaitow, and his co-editors, Dinah Bradley and Chris Gilbert, have done a great deal
to address this widespread ignorance. Nor is it confined to doctors: in my experience
too few physical therapists, psychotherapists and complementary practitioners have
a good enough grasp on the part breathing pattern disorders can play for instance
in chronic fatigue, persistent pain, fibromyalgia, and some aspects of anxiety or
depression.
Yet breathing is par excellence the bridge between mind and body. Perhaps that is
why it remains below the horizon of practitioners who feel their expertise must
lie on one or other side of this divide. Thankfully, having overcome that false
demarcation and learned to spot the problem, practitioners’ ability to diagnose BPD
can profoundly re-enable them and their patients. For once given the map BPD
provides – and though ongoing support is often needed – they may at last get some
traction on these downward spirals, and even reverse them.
ix
Foreword
The journeys are seldom easy, and rare is the practitioner who has all the knowl-
edge and skills required to lead them. But, for the intrepid clinician-explorer this
essentially multi-disciplinary book will provide much needed maps and signposts
to the mind-body habits, beliefs, metabolic and structural distortions that keep the
over-breathing tendency going. I recommend you read this book, use it and also
share it with a few good colleagues, so that together you may help some of your
most lost and puzzling patients find their way back.
Professor David Peters
Director, Westminster Centre for Resilience
University of Westminster
London
x
Preface
The second edition of this book has required a comprehensive revision of the origi-
nal text – representing as it does changes in our understanding of the subject over
the 12 years since it was first published.
What has changed in that decade?
The essentials of breathing function have remained the same, but our understand-
ing of the processes involved, and what can go wrong, has advanced, and the revised
text reflects that newly examined information.
As in the first edition, our emphasis is on function, dysfunction, and rehabilitation
strategies – and not on pathology.
Just as poor posture is not a disease, so a poor breathing pattern is not a disease.
However, an unbalanced breathing pattern (or breathing pattern disorder – BPD),
which is frequently habitual, can contribute to the emergence and maintenance of
multiple symptoms, just as poor posture can lead to pain and restriction.
One example of what is new in our understanding of what may aggravate or influ-
ence BPD emerged via research in 2009 by Lin & Peper. This showed what happened
when students familiar with cell/mobile phone texting, were monitored during the
sending and receiving of messages. Surface electromyography (SEMG) and skin con-
ductance (SC) were used to measure changes on the palm of the non-texting hand,
as well as the thorax and abdomen. The results indicated that all those tested showed
significant increases in respiration rate, heart rate and skin-conductance (suggesting
sympathetic arousal), as compared to baseline measures. 83% reported hand and
neck pain during texting, and held their breath, as well as experiencing sympathetic
arousal when receiving text messages. Most of those tested were unaware of these
physiological changes.
The wider implications of these findings, in relation to breathing function/ dys-
function, can be speculated upon – but they do act as a reminder that while the
essentials of respiration remain the same, potential influences on this function are
to be found in many common environmental settings.
This is one reason for the decision to not only update the text, but to widely expand
the therapeutic horizons in this second edition – as well as to marginally modify
the title.
The new edition contains revised and expanded chapters that offer a general over-
view of BPD (Chapters 1 and 3), as well as chapters on the structure and function of
breathing (Chapter 2.2), biochemistry (Chapter 4) and psychology/emotion (Chapter
5), in assessment and management settings, from osteopathic (Chapters 6.2, 7.2),
physiotherapy (Chapters 6.3, 7.3) and psychological (Chapters 6.4, 7.4) perspectives.
xi
Preface
We have also added chapters (many contributed by leading experts) that offer a
variety of additional and pertinent views and options.
For example, in chapters 2.1 developmental kinesiology is evaluated – the way
structural and functional development occurs in the early stages of life, and how this
knowledge can be used in application of dynamic neuromuscular stabilization in
both assessment (Ch 6.1) and management (Ch 7.1b) of breathing dysfunction.
A valuable addition is to be found in Chapter 2.3 which evaluates a topic largely
absent from the first edition – nasal influences on breathing.
Chapter 6.5 introduces details of the use of key questionnaires (and other assess-
ment methods) in management of BPD.
Chapter 6.6 provides an overview of the use of capnography in assessment settings,
while Chapter 7.7 describes capnography in treatment contexts.
Chapter 7.1a provides valuable insights into indirect methods of regulating BPD.
Chapter 7.5 introduces details of the relationship between breathing and vocal
dysfunction as it affects speech and singing – offering potential solutions to these
widespread issues.
Breathing patterns, as these affect athletes, are analyzed from biomechanical, phys-
iological and psychological perspectives, along with management protocols, in
Chapter 7.6.
Breathing and chronic pain is discussed in Chapter 8.1 from a somatocognitive
point of view.
A critical evaluation of the Buteyko system of breathing rehabilitation is offered
in Chapter 8.2, while in Chapter 8.3 the Feldenkrais approach is detailed.
Breathing patterns in relation to Pilates are explained in Chapter 8.4, while Tai
Chi/Qigong (chapter 8.5) and Yoga (Chapter 8.6) complete the selection of different
potential therapeutic models that may impact respiration.
Chapter 9 provides a selection of self-help methods, exercises and suggestions, in
addition to further questionnaires.
What we have set out to do, with the help of experts from a variety of backgrounds,
is to offer as clear a picture as possible of how to understand, assess and manage
breathing pattern disorders, based on current evidence and clinical practice.
Note that the methods outlined, particularly in the chapters on modalities (section
8), are not necessarily recommended for everyone with BPD characteristics. Also,
many of the methods and techniques depend on the context of a particular discipline
and/or specialized training. The descriptions are not meant to give complete direc-
tions, but should be useful for stimulating thinking about diverse approaches to
breathing disorders, including facilitating referral to suitably trained practitioners.
The information provided is designed to offer options and insights – to be employed
or disregarded, based on individual needs and indications.
Leon Chaitow
Dinah Bradley
Chris Gilbert
REFERENCE
Lin, I.M., Peper, E., 2009. Psychophysiological patterns during cell phone text messaging: a preliminary
study. Appl Psychophysiol Biofeedback 34 (1), 53–57.
xii
Acknowledgments
The compilation of this second edition was a truly international, inter-disciplinary,
exercise – with authors scattered between New Zealand, Australia, Canada, Greece,
Hong Kong, India, Czech Republic, Holland, Norway, USA and UK….with our won-
derful editors and publisher, respectively in Scotland and England.
As editors – equally stretched between Greece, New Zealand and California - we
owe a debt of gratitude to the many chapter contributors who have enhanced the
book by bringing together a breathtaking (pun intended) range of disciplines, featur-
ing their specialized knowledge, in order to focus attention on breathing dysfunction
and its potential remedies. Our thanks to Professor David Peters for his insightful
Foreword – emphasising as it does restoration of resilience as a primary objective.
Our profound thanks to everyone involved – and to each other!
Leon Chaitow
Dinah Bradley
Chris Gilbert
xiii
