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COPD / Emphysema classically produces the "Barrel Chest Deformity" as noted in this diagram from Dr. Frank Netter. These changes develop slowly, over many months and years. As such, the early Barrel Chest may be subtle and difficult to recognize, but it is still of importance.
Note the chest is generally overinflated. This is because the lungs are overinflated, and pushing the chest wall out.
Also note the humped back deformity, called Kyphosis, pushing the upper chest and neck forward. Poor general posture is a significant result, and it impacts unfavorably on your ability to breathe.
When pushed out in this manner the normal outward rib movement of the lower / lateral chest becomes limited. And with limited movement comes stiffness, and further movement limitation. This movement limitation will limit your ability to take in a deep breath.
As a result the chest wall becomes "frozen," and the entire chest now is less capable of expanding and therefore further limiting larger breaths. Also, the "frozen" state now results in the chest now moving as a single unit, so-called "Unit Movement," instead of the two distinct chest movements as noted below.
The result is a shift to inefficient abnormal upper chest breathing, using the so-called "Accessory Muscles" of breathing, and therefore a decrease in the normally dominant outward lower / lateral chest breathing. The diaphragm is attached to the lower ribs, and normally has a coordinated and synergistic movement with these ribs. Without this coordinated movement, diaphragm function is significantly impaired. It is therefore very important to restore proper outward lower chest movement in order to allow better diaphragm function. And likewise to minimize the upper chest movement, which should only be used in emergency breathing situations.
Remember, the diaphragm is the major muscular organ that drives breathing, and therefore restoring that function is critically important.
To give you a better understanding of the two distinct chest movements, consider the anatomy of the ribs, as taken from Grant's Atlas of Anatomy.
Note the upper ribs are short and relatively straight. The muscles that move these ribs are centrally placed, and therefore pull the chest directly upward and outward, with the so-called "Pump Handle" movement. With the "frozen" chest, this is what pulls the chest upward and outward with the so-called "Unit Movement."
The lower chest movement is more complex. Other than for the almost straight "short ribs" 12 and 11, the lower ribs are sharply curved. Between these ribs are the "External Intercostal Muscles" which that slant forward and downward to the ribs below. When these muscles contract, the ribs are pulled in an upward and lateral direction, which expands the lower chest. This is the so-called "Bucket Handle" movement.
This outward and lateral Bucket Handle movement is what stretches the attached diaphragm muscle into a more favorable position of movement, and what restores some of the important synergistic movement between ribs and diaphragm.
This diagram taken from Cherniack and Cherniack's text "Respiration in Health and Disease" brilliantly illustrates the complex rib movements of the "Pump Handle" and Bucket Handle" movements.
Note the different actions between the 3rd and 9th ribs.
As the large majority of lung volume is in the lower chest, and considering this illustration of the Bucket Handle movement, can there be any doubt as to the importance of lower / lateral / outward chest movement in restoring diaphragm function?
We will now move on to the topic of chest mobilization, chest movement training and coordination, and chest strengthening, using Chest Physiotherapy techniques. And then the all important topic of Dynamic Hyperinflation, and using breathing strategies to prevent or correct this problem.
With the knowledge you have from these preliminary modules you will then have better understanding of the underlying basics, and why we are asking you to practice certain techniques. And you will be in a better position to learn about effective breathing pattern training.
In other modules we will elaborate on general posture improvement, including neck positioning, as well as some specific posture tricks that will assist your breathing.
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