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Description
Chapter 10 Notes
Transcript
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
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