Osteopathy Journals and Research by Darren Chandler

 

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  1. Contents

    • Three effects of incorrect breathing: pain, digestive problems & anxiety
    • What causes and maintains faulty breathing
    • Breathing exercises
      • Correct day to day breathing technique
      • Breathing exercise to work your muscles

    Three effects of incorrect breathing: pain, digestive problems and anxiety

    If you didn’t walk correctly you’d expect to get pain when you walk. If you didn’t breath correctly, understandably, you’d expect pain or shortness of breathe when you breath. This isn’t necessarily always the case. On average we take up to 23,040 breaths a day. Multiply that over the years! Imagine if each breath required a bit more effort and didn’t quite get as much air in as it should. This is how, over the years, you develop a ‘breathing pattern disorder’.

    Breathing pattern disorders can give three main symptoms: pain, digestive problems and anxiety.

    Pain

    You use 93 muscles all over your body to breath. You use them 93 muscles up to 23,040 times a day 7 days a week. It pays to use them correctly! A recent study on breathing pattern disorders found a strong correlation between incorrect breathing patterns and poor posture, shoulder blade, low back, neck and jaw (TMJ) pain(1).

    Digestive problems

    The main muscle you use to breath is your diaphragm. Your diaphragm separates your chest from your stomach. When you breath in your diaphragm pushes down on your stomach to massage your organs. If you’re breathing correctly and your diaphragm is moving correctly then the organs in your stomach are getting a daily massage! Correct breathing also regulates the nerve that goes to your bowels(2). How you breath can also affect heart-burn(3) as well as bloating associated with Irritable Bowel Syndrome (IBS)(4).

    Anxiety

    Not getting enough breathe in makes our body more acidic (respiratory acidosis)(5) and breathing too heavily (getting too much breathe in) makes our body more alkaline (respiratory alkalosis)(1,6). Unless in extreme cases where you can’t get enough air breathed in (e.g. disease of your airways) or you breath too heavily (e.g. anxiety attack) this acid-alkaline shift is quite subtle. However breathing incorrectly day to day can impact the acid-alkaline balance in our body and affects anxiety or panic disorders (6,7).

    What causes and maintains faulty breathing

    • Psychological causes: depressed or anxious mood states affects our use of breathing(5-7) and sighing(7).
    • Biochemical: Asthma suffers can find their symptoms exacerbating just before or during their period. Asthma can also start around puberty in females and around/during the menopause(8). Hormones during pregnancy (and because when the ‘bump’ develops your diaphragm, chest and stomach doesn’t move as well) compromises your breathing (9).
    • Posture: a faulty posture in standing or sitting affects how you use your breathing muscles
    • Mechanical constraints: anything that impedes the chest and stomach from moving properly can affect your breathing pattern e.g. tight fitting bra’s and jeans.

     

    Breathing exercises: correct breathing technique & breathing exercises to work your muscles

    You should not follow any form of exercise, including the two below, until you’ve been assessed by an appropriate healthcare practitioner. Any exercise that affects your breathing may have side effects if you have, amongst other things, any heart, blood pressure, breathing problems or prone to fainting/dizzy spells. Once you’ve been assessed try these two exercises.

    Read through the instructions first before following them. Some people try to perform the exercise whilst reading the instructions and end up holding their breath as they read!

    Exercise one: Correct breathing technique

    Do not breath heavily when performing this exercise just at your normal rate and depth.

    • Put your left hand on your chest.
    • Put your right hand on your stomach.
    • Take a breath in. Your right hand on your stomach should move and your left hand on your chest should stay still.
    • When you breath out everything should relax so you get a natural breathe out - don’t try to blow or force the air out.

    By making your right hand on your stomach move when you breath in and not the hand on your chest ensures you are using your diaphragm.

    Exercise two: Breathing exercise to work your muscles

    As an exercise to really stretch and work all 93 of the muscles you use for breathing perform this exercise just once or twice sporadically throughout the day.

    • Put your left hand on your chest
    • Put your right hand on your stomach
    • Take a breath in so the right hand on your stomach moves but not the left hand on your chest
    • Before breathing out - breath in a bit more so the left hand on your chest moves to really fill up your lungs
    • Now breath out
    • If you don’t feel dizzy/faint and you want to repeat the exercise once more breath normally for 10 seconds first so you don’t end up hyperventilating

    References

    (1) Breathing pattern disorders and functional movement (2014).  Bradley H, Esformes J

    (2) Modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity (2016). Frøkjaer JB et al

    (3) Influence of breathing pattern on the esophagogastric junction pressure and esophageal transit (1995). R. K. Mittal, et al

    (4) Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. (2015). Barba E et al. 

    (5) Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation (2013). Verbraecken J McNicholas W

    (6) Acid–base dysregulation and chemosensory mechanisms in panic disorder: a translational update (2015). L L VollmerJ R Strawn, and R Sah

    (7)The Integrative Role of the Sigh in Psychology, Physiology, Pathology, and Neurobiology (2014). Jan-Marino Ramirez

    (8) https://www.asthma.org.uk/advice/triggers/hormones/. Accessed 4.8.2016

    (9) Respiratory physiology of pregnancy (2015). Antonella LoMauro, A and Aliverti A

     

     

     

  2. Benefits of breastfeeding for mother and baby

    It is recommended mothers breastfeed for approximately the first six months (26 weeks) (1). After that breast milk alongside other foods will help babies continue to grow and develop healthily.

    The medical reasons for not breastfeeding includes if you have illnesses such as HIV or are taking certain medications that may harm your baby (1). Expectations on new mothers can have negative effects making it difficult to come to terms if they are unable or do not want to breastfeed (2).

    Breastfed babies have (1):

    • Lower likelihood of diarrhoea and vomiting
    • Lower likelihood of chest and ear infections
    • Lower likelihood of constipation
    • Lower likelihood of obesity and later obesity-related illnesses e.g. type 2 diabetes
    • Lower likelihood of eczema

    Breastfeeding doesn’t only benefit the baby but mother too. Breastfeeding is good for mums as it (1):

    • Reduces risk of breast and ovarian cancer (1) 
    • Burns up to 500 calories a day (1)
    • Can help to bond mother and baby (1)
    • Reduces risk of postmenopausal hip fractures (3)
    • Reduces risk of postmenopausal cardiovascular disease (4)

    Exclusively breastfeeding can delay the return of the mother’s periods (1).

    Breastfeeding mothers should look for symptoms such as tiredness, general aches and pains, depression and impaired cognitive function as it could - amongst other causes – possibly, be due to a vitamin D deficiency (5). If experiencing any of these symptoms you should consult with your GP.

    Failing to breastfeed and depression

    There is some link with failing to breastfeed and depression although as a theory it’s not quite conclusive (6). With the pressure some women experience by society and healthcare professionals (2) maybe the depression associated with a failure to breastfeed is hormonal as well as social and self-critical?

    Difficulties to breastfeeding

    Examples of breastfeeding difficulties mothers often report include (1, 13):

    • Mother experiencing pain and/or nipple damage during/after feeding
    • An audible ‘clucking’ sound on feeding
    • Difficulty latching/maintaining an attachment on the breast
    • Baby’s frustration at the breast when trying to feed
    • ‘Gumming/chomping’ on the breast rather than sucking
    • Insufficient weight gain/weight loss of baby
    • Short feeds due to baby tiring
    • Colic/reflux-type symptoms
    • Episodes of sore breasts, blocked ducts or mastitis
    • Thrush around the nipples

    Mechanics of breastfeeding

    In order to breastfeed the baby needs to be able to extend the neck back so when the chin contacts the breast, the baby can search for the nipple (13). In order to allow a deep latch the baby must open their jaw to a wide 120-160 deg angle (7). How the jaw works influences sucking habits (8).

    Impedance of the tongue preventing breastfeeding can be from a tongue-tie. It can make it harder for the baby to attach effectively to the breast. A tongue-tie is when the baby is born with a tight piece of skin between the underside of their tongue and the floor of their mouth. It is easily treated just consult your midwife, health visitor or GP.

    What factors predict breastfeeding patterns?

    Early lactation success is strongly influenced by parity (number of births) but may also be affected by (9):

    (1)  Delivery mode (caesarean (10))

    (2)  Duration of labour

    (3)  Labour medications (such as epidural)

    (4)  Use of non-breast milk fluids and/or pacifiers

    (5)  Maternal obesity

    Obviously the use of any intervention is performed for the medical health of the mother and baby and to prevent complications. Any advice given by your doctor, midwife or health visitor should not be ignored on the grounds of this article.

    Can tension in the neck and jaw prevent breastfeeding? What can be done to help?

    In order for the baby to latch on to the breast the neck has to extend and the jaw has to open to 120-160 deg angle (7). We know the jaw works differently in babies that are breastfed and bottlefed (11). This intern affects sucking habits (8) and bite patterns (12).

    Tension in the jaw and neck are two areas that can be gently released if it is assumed they are inhibiting breastfeeding.

    Some people attribute the mode of delivery as placing strain on the neck (13) which could be a contributing factor. It is generally assumed however the position of the baby prior to birth is more of a reliable predictor of neck strain (14) than the method of birth (15).

    These strains placed upon the baby are possibly the reason why gentle osteopathic manipulative techniques performed by an osteopath, in one paper, helped 70% of mother’s breastfeed(16). It has been suggested in an Australian nursing journal that cranial osteopathy is gaining recognition as a successful treatment for a range of conditions and has shown to be especially useful when dealing with instances of breastfeeding problems resulting from birth trauma(17). It could be in the future the success of breastfeeding may depend on collaboration between the lactation consultant and manual therapist.

    Breastfeeding problems

    http://www.nhs.uk/conditions/pregnancy-and-baby/pages/breastfeeding-problems.aspx#close

    References

    (1)  http://www.nhs.uk/conditions/pregnancy-and-baby/pages/why-breastfeed.aspx#close

    (2) Rachael L Spencer et al (2015). ‘I thought it would keep them all quiet’. Women's experiences of breastfeeding as illusions of compliance: an interpretive phenomenological study

    (3) Bjørnerem A et al (2011). Breastfeeding protects against hip fracture in postmenopausal women: the Tromsø study.

    (4) http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Heart-disease/Is-breastfeeding-beneficial-for-maternal-cardiovascular-health/

    (5) Galesanu C, Mocanu V. (2015). Vitamin D deficiency and the clinical consequencies.

    (6) http://www.nhs.uk/news/2014/08August/Pages/Failing-to-breastfeed-linked-with-postnatal-depression.aspx

    (7) Riordan, J., & Wambach, K. (2010). Breastfeeding and Human Lactation.

    (8) Castelo PM et al (2005). Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition.

    (9) Dewey KG et al (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss.

    (10) Sakalidis VS et al (2013). A comparison of early sucking dynamics during breastfeeding after cesarean section and vaginal birth.

    (11) França EC et al (2014). Electromyographic analysis of masseter muscle in newborns during suction in breast, bottle or cup feeding.

    (12) Xiaoxian Chen (2015). Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition

    (13) Bertin F (2015). The Osteopathic influence on breastfeeding. Osteopathy Today. Sept/Oct 2015

    (14) Ah Young Jung et al (2015). Factors That Affect the Rehabilitation Duration in Patients With Congenital Muscular Torticollis

    (15) Seung Jae Lee et al (2011). Comparison of Clinical Severity of Congenital Muscular Torticollis Based on the Method of Child Birth

    (16) An independent audit showed that 70% of mothers who sought help with infant feeding found osteopathic treatment helpful. These results are feedback from Feeding Questionnaires received between February 2015 and June 2015 from parents of babies who attended the Chiltern breastfeeding partnership and who had tongue-tie assessment, breastfeeding support and osteopathic treatment.

    (17) Wescott N. (2004). The use of cranial osteopathy in the treatment of infants with breast feeding problems or sucking dysfunction. Aust J of holistic nursing