Debra Dent – Spine Health & Trunk Stability: Influence of the Thorax & Respiration

Outline

Clinical Observations & ImplicationsClinical Observations & Implications

• Evidence-based practice and clinical observationEvidence-based practice and clinical observation
• Clinical implications for patient populations Clinical implications for patient populations
  • Chronic low back and SI joint painChronic low back and SI joint pain
  • Scoliosis and trunk weakness in the elderlyScoliosis and trunk weakness in the elderly
  • Chronic hip and lateral knee painChronic hip and lateral knee pain
  • Chronic cervical pain and headachesChronic cervical pain and headaches
  • Shoulder impingementShoulder impingement
  • Thoracic outlet syndromeThoracic outlet syndrome
  • FibromyalgiaFibromyalgia
  • Balance and gait deviationsBalance and gait deviations
  • Athletic performanceAthletic performance
• Case histories — Could this be your patient? Case histories — Could this be your patient?
  • Chronic painChronic pain
  • Marathon runner/triathleteMarathon runner/triathlete
  • Chronic low back and neck painChronic low back and neck pain

AnatomyAnatomy

• Respiratory and thoracic anatomy/biomechanics Respiratory and thoracic anatomy/biomechanics
  • Thoracic anatomyThoracic anatomy
  • Rib anatomyRib anatomy
  • Thoracic biomechanicsThoracic biomechanics
  • CT junction biomechanicsCT junction biomechanics
  • TL junction biomechanics TL junction biomechanics
    • Trunk musculature Trunk musculature
      • Core-inner groupCore-inner group
      • Outer groupOuter group
      • Posterior obliquePosterior oblique
      • Deep longitudinalDeep longitudinal
      • AnteriorAnterior
      • LateralLateral
      • Psoas/hamstring integrationPsoas/hamstring integration
      • Scalenes, SCM, C spine musclesScalenes, SCM, C spine muscles
    • Muscles of inspirationMuscles of inspiration
    • Muscles of expirationMuscles of expiration
  • Mechanics of respiration Mechanics of respiration
    • Normal breathing-mechanical effectsNormal breathing-mechanical effects
  • Physiology of respiration Physiology of respiration
    • Lung volumesLung volumes
    • Lung perfusionLung perfusion
    • Hyperventilation/alkalosisHyperventilation/alkalosis
• Fascial integration Fascial integration
  • Thorocolumbar fasciaThorocolumbar fascia
  • Lateral femoral fascia/IT bandLateral femoral fascia/IT band
  • Abdominal fasciaAbdominal fascia
  • Cervical/UE and Pelvis/LE biomechanical relationshipsCervical/UE and Pelvis/LE biomechanical relationships

Neuromuscular ControlNeuromuscular Control

• Central nervous system on muscle tone and movementCentral nervous system on muscle tone and movement
• Sympathetic and parasympathetic responsesSympathetic and parasympathetic responses

Lab DemonstrationLab Demonstration

• Evaluation and treatment techniquesEvaluation and treatment techniques
• Evaluation of posture as it relates to respiratory function, UE, pelvis and lumbar functionEvaluation of posture as it relates to respiratory function, UE, pelvis and lumbar function

• Mechanics of respirationMechanics of respiration
• Diaphragmatic, lateral costal, sternal, apical breathingDiaphragmatic, lateral costal, sternal, apical breathing
• Diaphragm positionDiaphragm position
• Seated arm raiseSeated arm raise
• Seated trunk rotationSeated trunk rotation
• Standing torqueStanding torque
• Muscle function testing Muscle function testing
  • Supine active SLRSupine active SLR
  • Prone active SLR and active arm raise Prone active SLR and active arm raise
    • TA, multifidus, and pelvic floor functionTA, multifidus, and pelvic floor function
    • Posterior oblique systemPosterior oblique system
    • Anterior oblique systemAnterior oblique system
    • Lateral systemLateral system
• Rib position and mobility testing and active mobilizationsRib position and mobility testing and active mobilizations
• Length testing and lengthening techniquesLength testing and lengthening techniques
• Core facilitation entry training programCore facilitation entry training program
• Case histories evaluations, treatments, and outcomesCase histories evaluations, treatments, and outcomes

Theory & Evidence-Based PracticeTheory & Evidence-Based Practice

• Suboptimal breathing patterns Suboptimal breathing patterns
  • Over-inflationOver-inflation
  • Upper chest breathingUpper chest breathing
• Diaphragm and thoracic restrictions effects on the lumbar spine/hips/LE, C spine and UE- trunk rotation, or lack of trunk rotation effects Diaphragm and thoracic restrictions effects on the lumbar spine/hips/LE, C spine and UE- trunk rotation, or lack of trunk rotation effects
  • Posture and flawed load transferencePosture and flawed load transference
  • Trunk stability and the diaphragm/core/incontinenceTrunk stability and the diaphragm/core/incontinence
  • Hypertonicity/over activation of the superficial trunk muscleHypertonicity/over activation of the superficial trunk muscle
  • Chronic low back and SI joint pain with poor controlChronic low back and SI joint pain with poor control
  • Scoliosis and trunk weakness in the elderlyScoliosis and trunk weakness in the elderly
  • Chronic hip and lateral knee painChronic hip and lateral knee pain
  • Chronic cervical pain and headachesChronic cervical pain and headaches
  • Shoulder impingement issuesShoulder impingement issues
  • Thoracic outlet syndromeThoracic outlet syndrome
  • FibromyalgiaFibromyalgia
  • Balance and gait deviationsBalance and gait deviations
  • Athletic performanceAthletic performance
• Respiratory alkalosis/hyperventilation and the consequencesRespiratory alkalosis/hyperventilation and the consequences
• Chronic fatigue, fibromyalgia, chronic painChronic fatigue, fibromyalgia, chronic pain