Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch10 p.6 TK INSTRUCTOR MANUAL: CHAPTER 10 The Thorax and Respiration Chapter manuals include: Objectives Lecture Notes Suggested Classroom and Student Development Activities For other chapter-by-chapter resources, see: Key Term Quizzes Muscle Origin and Insertion Worksheets Muscle OIAs List by Chapter MyTest Test Bank For additional resources see “Teaching Tips and Tools”: 7 research-based learning principles for kinesiology courses in massage 5-step self-directed learning cycle for body mechanics courses Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories OBJECTIVES Identify the three main functions of the thorax and the primary function of respiration. List the bones and bony landmarks of the thorax, and demonstrate how to palpate them. Identify the four major joints of the thorax and describe their locations. Define and describe a rib separation and a rib dislocation. Identify and describe two types of rib motion. Identify the two primary muscles of respiration and the motion that they generate. Define intra-abdominal pressure (IAP) and describe its role in respiration. Identify the origins, insertions, and actions of the primary respiratory muscles. Demonstrate the active movement and palpation of each primary respiratory muscle. Identify the trigger points and pain referral patterns of the primary respiratory muscles. Describe and demonstrate the postural patterns of inhalation and exhalation fixations, paradoxical/upper-chest breathing, and belly breathing. Define chronic obstructive pulmonary disease and name three types. Define hyperventilation. Describe its symptoms and what to do when it occurs. LECTURE NOTES BONES OF THORAX AND RESPIRATION A bony ribcage with three functions: House and protect heart and lungs Provide attachment sites for muscles Provide mechanical bellows for breathing Respiration allows intake of O2 and elimination of CO2 Bones of thorax Sternum: manubrium, body of sternum, xiphoid process 12 ribs Ribs 17: True ribs Ribs 810: False ribs Ribs 1112: Floating ribs 12 thoracic vertebrae JOINTS AND LIGAMENTS OF THORAX Anterior costal joints: Connect ribs to sternum and costal cartilage Sternocostal joints Costalchondral: Connects ribs to costal cartilage Chondrosternal: Connects costal cartilage and sternum Manubriosternal joint Intercostal spaces between rib pairs Allow expansion and deflation of ribcage Allow a full range of spinal movement Posterior costal joints: Connect ribs to vertebral vertebrae Costovertebral joints Costotransverse joints (demifacets) Rib motion During inhalation, space between rib pairs opens Ribcage expands in all three directions Each rib rotates on its own axis Lower/middle ribs turn like bucket handles Upper ribs lift anteriorly like a pump handle MUSCLES OF RESPIRATION Primary Active during relaxed and normal breathing Diaphragm and intercostals Secondary Assist relaxed and normal breathing Scalenes, serratus posterior muscles Muscles of forced or deep inhalation Scalenes Sternocleidomastoid Pectoralis minor Serratus anterior Muscles of forced or deep exhalation Transversus thoracis Internal intercostals Serratus posterior inferior Transversus abdominis Obliques Rectus abdominis Diaphragm Large, dome-shaped muscle Floor of thoracic cavity, roof of abdominal cavity O: Costal attachment – Inner surface of lower six ribs Sternal attachment – Inner surface of xiphoid process Lumbar attachment – Anterior vertebral bodies of L-2 and L-3 I: Central tendon A: On inhalation, pulls central tendon down, increases thoracic cavity volume Openings in diaphragm for vena cava, aorta, esophagus Movement of diaphragm Prime mover in respiration Generates 7080% of respiratory movement Contracts and flattens during inhalation Moves down like piston Lower ribs widen Pulls open airspaces in lungs; air rushes in Relaxes up into dome shape during exhalation Intra-abdominal pressure (IAP) and breathing Organs are situated under diaphragm Downward movement during contraction displaces organs Results in abdominal expansion, increase in IAP Abdominal muscle tone maintains IAP Muscle tone prevents excessive abdominal distention Reduces compressive load on spine Causes expansion to sequence into ribcage Prevents downward drag on thorax and neck Intercostals: Short muscles connecting each pair of ribs Three layers of intercostals External intercostals: Superficial muscle Internal intercostals: Middle layer Subcostalis: Deepest layer O: Inferior border of upper rib I: Superior border of lower rib A: Elevates and separates ribs on inhalation, depresses ribs on exhalation, stabilizes upper ribs Can become inhibited or glue rib pairs together Scalenes Scalene, Anterior O: Anterior tubercles of transverse processes from C-3 to C-6 I: Inner border of 1st rib, anterior to subclavian artery A: Elevates ribs on inhalation, flexes neck laterally, assists neck rotation Scalene, Middle O: Posterior tubercles of transverse processes from C-2 to C-7 I: Below cranial surface of 1st rib, posterior to subclavian artery A: Elevates ribs on inhalation, flexes neck laterally, assists neck rotation Scalene, Posterior O: Above posterior tubercles of transverse processes from C-6 and C-7 I: Lateral surface of 2nd rib A: Elevates ribs on inhalation, flexes neck laterally, assists neck rotation Dysfunction in scalenes Put downward drag on cervical spine Entrap brachial plexus Cause TrP pain and dysfunction Serratus posterior muscles Serratus posterior superior O: Spinous processes of C-6 to T-2 I: 2nd to 5th ribs medial of the scapula A: Assists inhalation during respiration Serratus posterior inferior O: Spinous processes of T-11 to L-2 I: 9th through 12th ribs A: Assists exhalation during respiration Both serratus cross perpendicular to erector spinae Both are difficult to palpate Can develop painful TrPs, especially serratus posterior superior RESPIRATORY MOTION AND RESTRICTIVE PATTERNS Respiratory motion is oscillating movement sequence 1 breath cycle = inhalation ? slight pause ? exhalation ? longer pause Holding patterns on each end of cycle Inhalation fixation: Causes rigid, inflated, lifted posture Exhalation fixation: Causes deflated, collapsed posture Paradoxical breathing A reversed breathing pattern On inhalation: chest moves in, constricts rib cage On exhalation: chest moves out, expands rib cage Found in people with severe respiratory distress, paralysis Upper chest breathing Caused by anxiety or emotional distress On inhalation, person strongly contracts abdominals, then lifts and expands upper thorax Weak abdominals and belly breathing Belly breathing distend abdominals, creates weakness Belly breathing places downward drag on upper body Belly breathing interferes with expansion of ribcage Corrected with transversus abdominis (TA) tone Maintains intra-abdominal pressure Provides counterpressure to downward motion of diaphragm Corrected with diaphragmatic breathing: Lateral expansion of lower ribs Chronic obstructive pulmonary diseases (COPD) Three types: asthma, bronchitis, emphysema COPD symptoms cause restrictions to respiration Chronic and acute inflammation Excess mucous production Narrowing of respiratory passageways Less flexibility/elasticity in lungs Hyperventilation Imbalance in gas exchange from rapid breathing Amount of O2 coming in exceeds CO2 going out Symptoms of hyperventilation Dizziness, lightheadedness, tingling Fainting Tetany (paralyzing muscle spasms) Remedies for hyperventilation Slower breathing and rest Breathe into paper bag to restore CO2. SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES PROVIDE AN OVERVIEW OF THE CLASS Before class, write a short, schematic overview of the class on the board, then go over it at the beginning of class. For example: Today's class covers: Bones of the thorax Joints and ligaments of the thorax Muscles of respiration Respiratory motion and restrictive patterns Activities: Review, lecture and assessments, palpation exercises, recap PALPATION EXERCISES Bones of the thorax (p. 233) Costal joints (p. 237) The diaphragm (p. 244) Intercostals (p. 248) Scalenes (p. 253) Serratus posterior superior and serratus posterior inferior (p. 257) EXPLORING TECHNIQUE EXERCISE Following rib motion (p. 239) SELF-CARE EXERCISES Breath support for shoulder girdle and thoracic spine (p. 240) Locating, tracking, and stretching the diaphragm (p. 242) Coordinating diaphragmatic breathing with IAP (p. 246) Breathing to release tension (p. 258) Exploring muscle patterns in upper chest breathing (p. 259) © 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology